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Laohachewin D, Ruile P, Breitbart P, Minners J, Jander N, Soschynski M, Schlett CL, Neumann FJ, Westermann D, Hein M. Quantification of Aortic Valve Calcification in Contrast-Enhanced Computed Tomography. J Clin Med 2024; 13:2386. [PMID: 38673658 PMCID: PMC11051576 DOI: 10.3390/jcm13082386] [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: 03/12/2024] [Revised: 04/09/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Background: The goal of our study is to evaluate a method to quantify aortic valve calcification (AVC) in contrast-enhanced computed tomography for patients with suspected severe aortic stenosis pre-interventionally. Methods: A total of sixty-five patients with aortic stenosis underwent both a native and a contrast-enhanced computed tomography (CECT) scan of the aortic valve (45 in the training cohort and 20 in the validation cohort) using a standardized protocol. Aortic valve calcification was semi-automatically quantified via the Agatston score method for the native scans and was used as a reference. For contrast-enhanced computed tomography, a calcium threshold of the Hounsfield units of the aorta plus four times the standard deviation was used. Results: For the quantification of aortic valve calcification in contrast-enhanced computed tomography, a conversion formula (691 + 1.83 x AVCCECT) was derived via a linear regression model in the training cohort. The validation in the second cohort showed high agreement for this conversion formula with no significant proportional bias (Bland-Altman, p = 0.055) and with an intraclass correlation coefficient in the validation cohort of 0.915 (confidence interval 95% 0.786-0.966) p < 0.001. Conclusions: Calcium scoring in patients with aortic valve stenosis can be performed using contrast-enhanced computed tomography with high validity. Using a conversion factor led to an excellent agreement, thereby obviating an additional native computed tomography scan. This might contribute to a decrease in radiation exposure.
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Affiliation(s)
- Danai Laohachewin
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, Faculty of Medicine, Suedring 15, 79189 Bad Krozingen, Germany
| | - Philipp Ruile
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, Faculty of Medicine, Suedring 15, 79189 Bad Krozingen, Germany
| | - Philipp Breitbart
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, Faculty of Medicine, Suedring 15, 79189 Bad Krozingen, Germany
| | - Jan Minners
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, Faculty of Medicine, Suedring 15, 79189 Bad Krozingen, Germany
| | - Nikolaus Jander
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, Faculty of Medicine, Suedring 15, 79189 Bad Krozingen, Germany
| | - Martin Soschynski
- Department of Diagnostic and Interventional Radiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Christopher L. Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, Faculty of Medicine, Suedring 15, 79189 Bad Krozingen, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, Faculty of Medicine, Suedring 15, 79189 Bad Krozingen, Germany
| | - Manuel Hein
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, Faculty of Medicine, Suedring 15, 79189 Bad Krozingen, Germany
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Weichsel L, Giesen A, André F, Renker M, Baumann S, Breitbart P, Beer M, Maurovitch-Horvat P, Szilveszter B, Vattay B, Buss SJ, Marwan M, Giannopoulos AA, Kelle S, Frey N, Korosoglou G. Comparison of Two Contemporary Quantitative Atherosclerotic Plaque Assessment Tools for Coronary Computed Tomography Angiography: Single-Center Analysis and Multi-Center Patient Cohort Validation. Diagnostics (Basel) 2024; 14:154. [PMID: 38248031 PMCID: PMC10814854 DOI: 10.3390/diagnostics14020154] [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: 12/10/2023] [Revised: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) provides non-invasive quantitative assessments of plaque burden and composition. The quantitative assessment of plaque components requires the use of analysis software that provides reproducible semi-automated plaque detection and analysis. However, commercially available plaque analysis software can vary widely in the degree of automation, resulting in differences in terms of reproducibility and time spent. AIM To compare the reproducibility and time spent of two CCTA analysis software tools using different algorithms for the quantitative assessment of coronary plaque volumes and composition in two independent patient cohorts. METHODS The study population included 100 patients from two different cohorts: 50 patients from a single-center (Siemens Healthineers, SOMATOM Force (DSCT)) and another 50 patients from a multi-center study (5 different > 64 slice CT scanner types). Quantitative measurements of total calcified and non-calcified plaque volume of the right coronary artery (RCA), left anterior descending (LAD), and left circumflex coronary artery (LCX) were performed on a total of 300 coronaries by two independent readers, using two different CCTA analysis software tools (Tool #1: Siemens Healthineers, syngo.via Frontier CT Coronary Plaque Analysis and Tool #2: Siemens Healthineers, successor CT Coronary Plaque Analysis prototype). In addition, the total time spent for the analysis was recorded with both programs. RESULTS The patients in cohorts 1 and 2 were 62.8 ± 10.2 and 70.9 ± 11.7 years old, respectively, 10 (20.0%) and 35 (70.0%) were female and 34 (68.0%) and 20 (40.0%), respectively, had hyperlipidemia. In Cohort #1, the inter- and intra-observer variabilities for the assessment of plaque volumes per patient for Tool #1 versus Tool #2 were 22.8%, 22.0%, and 26.0% versus 2.3%, 3.9%, and 2.5% and 19.7%, 21.4%, and 22.1% versus 0.2%, 0.1%, and 0.3%, respectively, for total, noncalcified, and calcified lesions (p < 0.001 for all between Tools #1 and 2 both for inter- and intra-observer). The inter- and intra-observer variabilities using Tool #2 remained low at 2.9%, 2.7%, and 3.0% and 3.8%, 3.7%, and 4.0%, respectively, for total, non-calcified, and calcified lesions in Cohort #2. For each dataset, the median processing time was higher for Tool #1 versus Tool #2 (459.5 s IQR = 348.0-627.0 versus 208.5 s; IQR = 198.0-216.0) (p < 0.001). CONCLUSION The plaque analysis Tool #2 (CT-guided PCI) encompassing a higher degree of automated support required less manual editing, was more time-efficient, and showed a higher intra- and inter-observer reproducibility for the quantitative assessment of plaque volumes both in a representative single-center and in a multi-center validation cohort.
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Affiliation(s)
- Loris Weichsel
- GRN Hospital Weinheim, Cardiology, Vascular Medicine & Pneumology, 69469 Weinheim, Germany; (L.W.); (A.G.)
- Cardiac Imaging Center Weinheim, Hector Foundations, 69469 Weinheim, Germany
| | - Alexander Giesen
- GRN Hospital Weinheim, Cardiology, Vascular Medicine & Pneumology, 69469 Weinheim, Germany; (L.W.); (A.G.)
- Cardiac Imaging Center Weinheim, Hector Foundations, 69469 Weinheim, Germany
| | - Florian André
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, 69120 Heidelberg, Germany; (F.A.); (N.F.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Matthias Renker
- Department of Cardiology, Campus Kerckhoff, Justus Liebig University Giessen, 61231 Bad Nauheim, Germany;
- DZHK (German Centre for Cardiovascular Research), Partner Site Rhein Main, 61231 Bad Nauheim, Germany
| | - Stefan Baumann
- Department of Cardiology, District Hospital Bergstraße, 64646 Heppenheim, Germany;
- First Department of Medicine-Cardiology, University Medical Center Mannheim, 68167 Mannheim, Germany
| | - Philipp Breitbart
- Department of Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, 79189 Bad Krozingen, Germany;
| | - Meinrad Beer
- Department for Diagnostic and Interventional Radiology, University Hospital Ulm, 89081 Ulm, Germany;
| | - Pal Maurovitch-Horvat
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (P.M.-H.); (B.S.); (B.V.)
| | - Bálint Szilveszter
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (P.M.-H.); (B.S.); (B.V.)
| | - Borbála Vattay
- Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary; (P.M.-H.); (B.S.); (B.V.)
| | | | - Mohamed Marwan
- Department of Cardiology, University of Erlangen, 91054 Erlangen, Germany;
| | - Andreas A. Giannopoulos
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Sebastian Kelle
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Charité-University Medicine Berlin, 10117 Berlin, Germany;
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, 69120 Heidelberg, Germany; (F.A.); (N.F.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, 69120 Heidelberg, Germany
| | - Grigorios Korosoglou
- GRN Hospital Weinheim, Cardiology, Vascular Medicine & Pneumology, 69469 Weinheim, Germany; (L.W.); (A.G.)
- Cardiac Imaging Center Weinheim, Hector Foundations, 69469 Weinheim, Germany
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Soschynski M, Hein M, Capilli F, Hagar MT, Ruile P, Breitbart P, Westermann D, Taron J, Schuppert C, Schlett CL, Bamberg F, Krauss T. Investigation of factors determining haemodynamic relevance of leaflet thrombosis after transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging 2023; 24:1672-1681. [PMID: 37409579 DOI: 10.1093/ehjci/jead156] [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: 05/18/2023] [Revised: 06/20/2023] [Accepted: 06/25/2023] [Indexed: 07/07/2023] Open
Abstract
AIMS To determine the conditions under which early hypoattenuated leaflet thickening (HALT) after transcatheter aortic valve implantation (TAVI) becomes haemodynamically relevant. METHODS AND RESULTS The study included 100 patients (age: 81.5 ± 5.5 years; female 63%), thereof 50 patients with HALT. After anonymization and randomization, blinded readers measured maximum thrombus thickness per prosthesis (MT_pr) and movement restriction (MR_pr) on electrocardiogram (ECG)-gated whole heart cycle computed tomography angiography. These measurements were compared with echocardiographic mean pressure gradient (mPG), its increase from baseline (ΔmPG), and Doppler velocity index (DVI). Haemodynamic valve deterioration (HVD) was defined as mPG > 20 mmHg. Age, body mass index, valve type, valve size, left ventricular ejection fraction, and atrial fibrillation were considered as influencing factors. Multiple regression analysis revealed that only valve size (P = 0.001) and MT_pr (P = 0.02) had a significant influence on mPG. In an interaction model, valve size moderated the effect of MT_pr on mPG significantly (P = 0.004). Sub-group analysis stratified by valve sizes showed a strong correlation between MT_pr and echocardiographic parameters for 23 mm valves (mPG: r = 0.57, ΔmPG: r = 0.68, DVI: r = 0.55, each with P < 0.001), but neither for 26 nor 29 mm valves (r < 0.2, P > 0.2 for all correlations). Six of seven prostheses with HVD had a 23 mm valve diameter, while one had 29 mm (P = 0.02). CONCLUSION Early HALT rarely causes significant mPG increase. Our study shows that valve size is a key factor influencing the haemodynamic impact of HALT. In small valve sizes, mPG is more likely to increase. Our study is the first to offer in vivo evidence supporting previous in vitro findings on this topic.
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Affiliation(s)
- Martin Soschynski
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Manuel Hein
- Department of Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Fabio Capilli
- Department of Radiology, Neuroradiology and Nuclear Medicine, Medical Center Vest, Ruhr University Bochum, Dorstener Straße 151, 45657 Recklinghausen, Germany
| | - Muhammad Taha Hagar
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Philipp Ruile
- Department of Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Philipp Breitbart
- Department of Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Jana Taron
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
- Cardiac MR PET CT Program, Massachusetts General-Hospital-Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Christopher Schuppert
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Tobias Krauss
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
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Brado J, Breitbart P, Hein M, Pache G, Schmitt R, Hein J, Apweiler M, Soschynski M, Schlett C, Bamberg F, Neumann FJ, Westermann D, Krauss T, Ruile P. Pre-Procedural Assessment of the Femoral Access Route for Transcatheter Aortic Valve Implantation: Comparison of a Non-Contrast Time-of-Flight Magnetic Resonance Angiography Protocol with Contrast-Enhanced Dual-Source Computed Tomography Angiography. J Clin Med 2023; 12:6824. [PMID: 37959289 PMCID: PMC10647847 DOI: 10.3390/jcm12216824] [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: 09/14/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 11/15/2023] Open
Abstract
Background: We aimed to evaluate the feasibility of a non-contrast time-of-flight magnetic resonance angiography (TOF-MRA) protocol for the pre-procedural access route assessment of transcatheter aortic valve implantation (TAVI) in comparison with contrast-enhanced cardiac dual-source computed tomography angiography (CTA). Methods and Results: In total, 51 consecutive patients (mean age: 82.69 ± 5.69 years) who had undergone a pre-TAVI cardiac CTA received TOF-MRA for a pre-procedural access route assessment. The MRA image quality was rated as very good (median of 5 [IQR 4-5] on a five-point Likert scale), with only four examinations rated as non-diagnostic. The TOF-MRA systematically underestimated the minimal effective vessel diameter in comparison with CTA (for the effective vessel diameter in mm, the right common iliac artery (CIA)/external iliac artery (EIA)/common femoral artery (CFA) MRA vs. CTA was 8.04 ± 1.46 vs. 8.37 ± 1.54 (p < 0.0001) and the left CIA/EIA/CFA MRA vs. CTA was 8.07 ± 1.32 vs. 8.28 ± 1.34 (p < 0.0001)). The absolute difference between the MRA and CTA was small (for the Bland-Altman analyses in mm, the right CIA/EIA/CFA was -0.36 ± 0.77 and the left CIA/EIA/CFA was -0.25 ± 0.61). The overall correlation between the MRA and CTA measurements was very good (with a Pearson correlation coefficient of 0.87 (p < 0.0001) for the right CIA/EIA/CFA and a Pearson correlation coefficient of 0.9 (p < 0.0001) for the left CIA/EIA/CFA). The feasibility agreement between the MRA and CTA for transfemoral access was good (the right CIA/EIA/CFA agreement was 97.9% and the left CIA/EIA/CFA agreement was 95.7%, Kohen's kappa: 0.477 (p = 0.001)). Conclusions: The TOF-MRA protocol was feasible for the assessment of the access route in an all-comer pre-TAVI population. This protocol might be a reliable technique for patients at an increased risk of contrast-induced nephropathy.
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Affiliation(s)
- Johannes Brado
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189 Bad Krozingen, Germany
| | - Philipp Breitbart
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189 Bad Krozingen, Germany
| | - Manuel Hein
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189 Bad Krozingen, Germany
| | - Gregor Pache
- Radiology Hegau Bodensee, Practice for Diagnostic Radiology, Kreuzensteinstraße 7, 78224 Singen, Germany
| | - Ramona Schmitt
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189 Bad Krozingen, Germany
| | - Jonas Hein
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189 Bad Krozingen, Germany
| | - Matthias Apweiler
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189 Bad Krozingen, Germany
| | - Martin Soschynski
- Department of Diagnostic and Interventional Radiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Christopher Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189 Bad Krozingen, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189 Bad Krozingen, Germany
| | - Tobias Krauss
- Department of Diagnostic and Interventional Radiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Philipp Ruile
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189 Bad Krozingen, Germany
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Bacmeister L, Breitbart P, Sobolewska K, Kaier K, Rahimi F, Löffelhardt N, Valina C, Neumann FJ, Westermann D, Ferenc M. Planned versus unplanned rotational atherectomy for plaque modification in severely calcified coronary lesions. Clin Res Cardiol 2023; 112:1252-1262. [PMID: 36928928 PMCID: PMC10449691 DOI: 10.1007/s00392-023-02176-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/20/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Evidence on the optimal timing of RA is scarce, although increased periprocedural complications for unplanned procedures have been reported. AIMS To compare planned versus unplanned use of rotational atherectomy (RA) for plaque modification in patients with severely calcified coronary lesions. METHODS Procedural and 1-year follow-up data of planned (n = 562 lesions in 448 vessels of 416 patients) and unplanned (n = 490 lesions in 435 vessels of 403 patients) RA between 2008 and 2020 were analyzed using the propensity score methods. The primary composite endpoint was target lesion failure (TLF), defined as cardiovascular death (CVD), target vessel myocardial infarction (TVMI), or target lesion revascularization (TLR). RESULTS Angiographic success was > 99% in both groups. Fluoroscopy time and contrast volume were significantly lower in planned RA (p < 0.001). Periprocedural complications including slow-flow, coronary dissection, and MI occurred in 4.8% after planned, and in 5.7% after unplanned RA. TLF occurred in 18.5% after planned, and in 14.7% after unplanned RA. Weighted subdistribution hazard ratios for TLFs revealed an unfavorable 1-year outcome for planned RA (sHR 1.62 [1.07-2.45], p = 0.023), which was driven by TLR (sHR 2.01 [1.18-3.46], p = 0.011), but not by CVD, or TVMI. No differences were observed in all-cause mortality. CONCLUSIONS Unplanned RA was associated with favorable outcome when compared to planned RA. Thus, RA can safely be reserved for lesions that prove untreatable by conventional means. Randomized and prospective trials are needed to evaluate a predominant use of rotational atherectomy as a bailout strategy in the future.
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Affiliation(s)
- Lucas Bacmeister
- Department of Cardiology and Angiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Philipp Breitbart
- Department of Cardiology and Angiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany.
| | - Karolina Sobolewska
- Department of Cardiology and Angiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Faridun Rahimi
- Department of Cardiology and Angiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Nikolaus Löffelhardt
- Department of Cardiology and Angiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Christian Valina
- Department of Cardiology and Angiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Dirk Westermann
- Department of Cardiology and Angiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Miroslaw Ferenc
- Department of Cardiology and Angiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
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Meder B, Duncker D, Helms TM, Leistner DM, Goss F, Perings C, Johnson V, Freund A, Reich C, Ledwoch J, Rahm AK, Milles BR, Perings S, Pöss J, Dieterich C, Fleck E, Breitbart P, Dutzmann J, Diller G, Thiele H, Frey N, Katus HA, Radke P. eCardiology: a structured approach to foster the digital transformation of cardiovascular medicine. Kardiologie 2023. [PMCID: PMC9936476 DOI: 10.1007/s12181-022-00592-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Eggebrecht H, Niethammer M, Breitbart P, Liebetrau C. Gerinnungsmanagement nach Transkatheter-Aortenklappenimplantation (TAVI). Aktuelle Kardiologie 2022. [DOI: 10.1055/a-1893-7462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ZusammenfassungIn dieser Übersicht stellen wir die aktuelle Literatur zum Gerinnungsmanagement nach TAVI zusammen. Aus den publizierten Studien ergibt sich für die klinische Praxis, dass direkte orale
Antikoagulanzien den Vitamin-K-Antagonisten nicht unterlegen sind, wenn aus anderen Gründen (z. B. Vorhofflimmern) eine Antikoagulation nach TAVI erforderlich ist. Die zusätzliche Gabe eines
Thrombozytenaggregationshemmers bringt in dieser Konstellation keinen Vorteil. Bei Patienten, die keine Indikation für eine orale Antikoagulation haben, hat sich in vielen Zentren die duale
Thrombozytenaggregationshemmung mit ASS und Clopidogrel für 3–6 Monate als Standard etabliert. Die randomisierte POPular TAVI-Studie hat allerdings gezeigt, dass die alleinige ASS-Gabe nach
TAVI Blutungskomplikationen reduziert, bei gleicher Sicherheit in der Verhinderung thrombotischer Komplikationen.
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Affiliation(s)
- Holger Eggebrecht
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt, Deutschland
- Medizinische Klinik I, Kardiologie, Angiologie, Intensivmedizin, Klinikum Fulda, Fulda, Deutschland
| | - Margit Niethammer
- Medizinische Klinik I, Kardiologie, Angiologie, Intensivmedizin, Klinikum Fulda, Fulda, Deutschland
| | - Philipp Breitbart
- Abteilung für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg Bad Krozingen, Bad Krotzingen, Deutschland
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Hein M, Schoechlin S, Schulz U, Minners J, Breitbart P, Lehane C, Neumann FJ, Ruile P. Long-Term Follow-Up of Hypoattenuated Leaflet Thickening After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2022; 15:1113-1122. [PMID: 35680190 DOI: 10.1016/j.jcin.2022.04.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [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: 11/29/2021] [Revised: 03/01/2022] [Accepted: 04/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Early hypoattenuated leaflet thickening (HALT) occurs in at least 10% of all transcatheter aortic valve replacement (TAVR) patients. The long-term prognostic impact of HALT is uncertain. OBJECTIVES The aim of this study was to assess the long-term risk of early HALT post-TAVR. METHODS We report outcome data from our prospective observational registry with post-TAVR computed tomography angiography performed between May 2012 and December 2017. The outcomes were survival, cardiovascular mortality, ischemic cerebrovascular events, and symptomatic hemodynamic valve deterioration. RESULTS Early HALT was diagnosed in 115 (16.0%) of 804 patients. During a median follow-up of 3.25 years, survival rates did not differ significantly between patients with and without HALT (Kaplan-Meier 3-year estimates for survival 70.1% vs 74.0%, P = 0.597). The 3-year cardiovascular mortality rate was 13.2% versus 11.3% (with vs without HALT, P = 0.733). The 3-year event rate for cerebrovascular events was 2.0% versus 4.4% (with vs without HALT, P = 0.246), and the 3-year event rate of symptomatic hemodynamic valve deterioration was 9.4% versus 1.5% (with vs without HALT, P < 0.001). Multivariable analysis revealed the following predictors of symptomatic hemodynamic valve deterioration: HALT (HR: 6.10; 95% CI: 2.59-14.29; P < 0.001), the mixed valve-type group (HR: 6.51; 95% CI: 2.38-17.81; P < 0.001), and prosthesis diameter (HR valve size per 3 mm [HR: 0.37; 95% CI: 0.17-0.79]; P = 0.011). CONCLUSIONS During a median follow-up of more than 3 years, HALT was not associated with mortality or cerebrovascular events. However, we observed an association of HALT with symptomatic hemodynamic valve deterioration.
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Affiliation(s)
- Manuel Hein
- Department of Cardiology and Angiology, University Heart Center, Freiburg-Bad Krozingen, Germany.
| | - Simon Schoechlin
- Department of Cardiology and Angiology, University Heart Center, Freiburg-Bad Krozingen, Germany
| | - Undine Schulz
- Department of Cardiology and Angiology, University Heart Center, Freiburg-Bad Krozingen, Germany
| | - Jan Minners
- Department of Cardiology and Angiology, University Heart Center, Freiburg-Bad Krozingen, Germany
| | - Philipp Breitbart
- Department of Cardiology and Angiology, University Heart Center, Freiburg-Bad Krozingen, Germany
| | - Cornelius Lehane
- Department of Anesthesiology, University Heart Center Freiburg, Bad Krozingen, Freiburg, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology, University Heart Center, Freiburg-Bad Krozingen, Germany
| | - Philipp Ruile
- Department of Cardiology and Angiology, University Heart Center, Freiburg-Bad Krozingen, Germany
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9
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Eggebrecht H, Breitbart P, Koch A, Nowak B, Walther C, Voigtländer T, Liebetrau C, Metha RH, Schmermund A. Trends in ambulatory cardiology consultations for suspected myocarditis after COVID-19 vaccination. Clin Res Cardiol 2021; 111:237-239. [PMID: 34812930 PMCID: PMC8608850 DOI: 10.1007/s00392-021-01974-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/16/2021] [Indexed: 01/08/2023]
Affiliation(s)
- Holger Eggebrecht
- Cardioangiological Center Bethanien (CCB), Im Prüfling 23, 60389, Frankfurt, Germany.
| | - Philipp Breitbart
- Cardioangiological Center Bethanien (CCB), Im Prüfling 23, 60389, Frankfurt, Germany
| | - Alexander Koch
- Cardioangiological Center Bethanien (CCB), Im Prüfling 23, 60389, Frankfurt, Germany
| | - Bernd Nowak
- Cardioangiological Center Bethanien (CCB), Im Prüfling 23, 60389, Frankfurt, Germany
| | - Claudia Walther
- Cardioangiological Center Bethanien (CCB), Im Prüfling 23, 60389, Frankfurt, Germany
| | - Thomas Voigtländer
- Cardioangiological Center Bethanien (CCB), Im Prüfling 23, 60389, Frankfurt, Germany
| | - Christoph Liebetrau
- Cardioangiological Center Bethanien (CCB), Im Prüfling 23, 60389, Frankfurt, Germany
| | - Rajendra H Metha
- Duke Clinical Research Institute (DCRI) and Duke University Medical Center, Durham, NC, USA
| | - Axel Schmermund
- Cardioangiological Center Bethanien (CCB), Im Prüfling 23, 60389, Frankfurt, Germany
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10
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Breitbart P, Minners J, Hein M, Schroefel H, Neumann FJ, Ruile P. Prosthesis position and its influence on complications after transcatheter aortic valve implantation with self-expanding valves. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0176] [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/Introduction
Prior studies in patients with transcatheter aortic valve implantation (TAVI) demonstrated an influence of transcatheter heart valve (THV) position on the occurrence of new conductions disturbances (CD) and paravalvular leakage (PVL) post TAVI in balloon-expandable valves (BEV).
Purpose
Purpose of this study was to investigate the THV position and its influence on the occurrence of CD and PVL in self-expanding valves (SEV).
Methods
We performed fusion imaging of pre- and post-procedural computed tomography angiography in 104 TAVI-patients (all with Evolut R) to receive a 3-D reconstruction of the THV within the native annulus region. The THV length below the native annulus was measured for assessment of implantation depth. Electrocardiograms pre-discharge were assessed for conduction disturbances (CD), PVL was determined in transthoracic echocardiography.
Results
The mean implantation depth of the THV in the whole cohort was 4.3±3.0 mm. Using the best cut-off of >4 mm in receiver operating characteristic curve analysis (sensitivity 83.3%, specificity 60.0%) patients with lower THV position developed more new CD after TAVI (68.2 vs. 23.7%, P<0.001). A deep THV position was identified as the only predictor for new CD after TAVI (odds ratio [CI]: 1.312 [1.119–1.539], P=0.001). The implantation depth showed no influence on the grade of PVL (r=0.052, P=0.598).
Conclusions
In patients with TAVI using the Evolut R SEV, a lower THV positioning (>4 mm length below annulus) was a predictor for new conduction disturbances. In contrast, prosthesis position was not associated with the extent of PVL.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Breitbart
- University Heart Center Freiburg-Bad Krozingen, Division of Cardiology & Angiology II, Bad Krozingen, Germany
| | - J Minners
- University Heart Center Freiburg-Bad Krozingen, Division of Cardiology & Angiology II, Bad Krozingen, Germany
| | - M Hein
- University Heart Center Freiburg-Bad Krozingen, Division of Cardiology & Angiology II, Bad Krozingen, Germany
| | - H Schroefel
- University Heart Center Freiburg-Bad Krozingen, Division of Cardiovascular Surgery, Bad Krozingen, Germany
| | - F J Neumann
- University Heart Center Freiburg-Bad Krozingen, Division of Cardiology & Angiology II, Bad Krozingen, Germany
| | - P Ruile
- University Heart Center Freiburg-Bad Krozingen, Division of Cardiology & Angiology II, Bad Krozingen, Germany
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11
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Breitbart P, Meister S, Meyer T, Gärtner BC. Incidence and Prevalence of Borrelia burgdorferi Antibodies in Male Professional Football Players. Clin J Sport Med 2021; 31:e200-e206. [PMID: 31241490 DOI: 10.1097/jsm.0000000000000758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 03/19/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Infections with Borrelia burgdorferi can cause Lyme disease with multiorganic involvement such as (myo)carditis or joint manifestations. Musculoskeletal complaints possibly mimicking some of these symptoms are common among elite athletes. This study aimed to determine seroprevalence and incidence of B. burgdorferi antibodies in professional football players. DESIGN Prospective observational study. SETTING Healthy professional football players. PARTICIPANTS Five hundred thirty-five men in the first and second German league. INTERVENTIONS Two screening assays were used to examine immunoglobulin M (IgM) and immunoglobulin G (IgG) against B. burgdorferi: an enzyme immunoassay (EIA) and a chemiluminescence assay (CLIA). In case of a positive or equivocal result, an immunoblot including in vivo antigens was performed. MAIN OUTCOME MEASURES Course of IgM and IgG against B. burgdorferi in overall 1529 blood samples. RESULTS A total of 96.4% of all results were concordant between EIA and CLIA. Considering only samples with identical results in both assays, prevalence was 1.6%. A positive IgM was detected in 2.3%. No player showed any symptoms of Lyme disease. A seroconversion to IgG was not found. Three players developed a positive IgM corresponding to an incidence of 1032/100 000 person-years. Depending on the assay, 49% to 75% of positive or equivocal screening results could not be confirmed by immunoblot. CONCLUSIONS Seroprevalence and incidence of B. burgdorferi among healthy male professional football players are low. Therefore, infections with B. burgdorferi have to be regarded a rare differential diagnosis in professional football in Central Europe. The low confirmation rate of positive screening assays points to an unspecific immune activation.
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Affiliation(s)
- Philipp Breitbart
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Faculty of Medicine, University of Freiburg, Germany
| | - Steffen Meister
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
- Sportmedizin München, Munich, Germany; and
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Barbara C Gärtner
- Department of Medical Microbiology and Hygiene, Saarland University, Faculty of Medicine and Medical Center, Homburg/Saar, Germany
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12
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Kim WK, Pellegrini C, Ludwig S, Möllmann H, Leuschner F, Makkar R, Leick J, Amat-Santos IJ, Dörr O, Breitbart P, Jimenez Diaz VA, Dabrowski M, Rudolph T, Avanzas P, Kaur J, Toggweiler S, Kerber S, Ranosch P, Regazzoli D, Frank D, Landes U, Webb J, Barbanti M, Purita P, Pilgrim T, Liska B, Tabata N, Rheude T, Seiffert M, Eckel C, Allali A, Valvo R, Yoon SH, Werner N, Nef H, Choi YH, Hamm CW, Sinning JM. Feasibility of Coronary Access in Patients With Acute Coronary Syndrome and Previous TAVR. JACC Cardiovasc Interv 2021; 14:1578-1590. [PMID: 34294400 DOI: 10.1016/j.jcin.2021.05.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 03/22/2021] [Revised: 05/04/2021] [Accepted: 05/11/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aim of this study was to characterize the feasibility of coronary angiography (CA) and percutaneous coronary intervention (PCI) in acute settings among patients who have undergone transcatheter aortic valve replacement (TAVR). BACKGROUND Impaired coronary access after TAVR may be challenging and particularly in acute settings could have deleterious consequences. METHODS In this international registry, data from patients with prior TAVR requiring urgent or emergent CA were retrospectively collected. A total of 449 patients from 25 sites with acute coronary syndromes (89.1%) and other acute cardiovascular situations (10.9%) were included. RESULTS Success rates were high for CA of the right coronary artery (98.3%) and left coronary artery (99.3%) and were higher among patients with short stent-frame prostheses (SFPs) than in those with long SFPs for CA of the right coronary artery (99.6% vs 95.9%; P = 0.005) but not for CA of the left coronary artery (99.7% vs 98.7%; P = 0.24). PCI of native coronary arteries was successful in 91.4% of cases and independent of valve type (short SFP 90.4% vs long SFP 93.4%; P = 0.44). Guide engagement failed in 6 patients, of whom 3 underwent emergent coronary artery bypass grafting and another 3 died in the hospital. Among patients requiring revascularization of native vessels, independent predictors of 30-day all-cause mortality were prior diabetes, cardiogenic shock, and failed PCI but not valve type or success of coronary engagement. CONCLUSIONS CA or PCI after TAVR in acute settings is usually successful, but selective coronary engagement may be more challenging in the presence of long SFPs. Among patients requiring PCI, prior diabetes, cardiogenic shock, and failed PCI were predictors of early mortality.
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Affiliation(s)
- Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany; Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany; Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany.
| | - Costanza Pellegrini
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Sebastian Ludwig
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | - Florian Leuschner
- Department of Medicine III, University of Heidelberg, German Centre for Cardiovascular Research (DZHK), Heidelberg, Germany
| | - Raj Makkar
- Cedars-Sinai Medical Center, Smidt Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Jürgen Leick
- Department of Cardiology, Barmherzige Brüder Hospital, Trier, Germany
| | | | - Oliver Dörr
- Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany
| | - Philipp Breitbart
- Division of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Victor A Jimenez Diaz
- Hospital Alvaro Cunqueiro, Interventional Cardiology Unit, Cardiology Department, University Hospital of Vigo, Vigo, Spain
| | - Maciej Dabrowski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland
| | - Tanja Rudolph
- Herz- und Diabeteszentrum NRW, Department of General and Interventional Cardiology and Angiology, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Pablo Avanzas
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain; Department of Medicine, University of Oviedo, Oviedo, Spain
| | - Jatinderjit Kaur
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | | | - Sebastian Kerber
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Bad Neustadt an der Saale, Germany
| | - Patrick Ranosch
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Bad Neustadt an der Saale, Germany
| | | | - Derk Frank
- Department of Internal Medicine III (Cardiology, Angiology and Intensive Care Medicine), UKSH University Clinical Center Schleswig-Holstein, Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Uri Landes
- Centre for Cardiovascular Innovation, Centre for Heart Valve Innovation, St. Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada; Rabin Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - John Webb
- Centre for Cardiovascular Innovation, Centre for Heart Valve Innovation, St. Paul's and Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco," Catania, Italy
| | - Paola Purita
- Interventional Cardiology, Department of Cardiacthoracic and Vascular Science, Ospedale dell'Angelo, Venice, Italy
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital Bern, University Hospital, University of Bern, Bern, Switzerland
| | - Branislav Liska
- National Cardiovascular Institute, Bratislava, Slovak Republic
| | - Noriaki Tabata
- University Hospital Bonn, Heart Center Bonn, Bonn, Germany
| | - Tobias Rheude
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Moritz Seiffert
- Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany
| | - Clemens Eckel
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | - Abdelhakim Allali
- Department of Cardiology, Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Roberto Valvo
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco," Catania, Italy
| | - Sung-Han Yoon
- Cedars-Sinai Medical Center, Smidt Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Nikos Werner
- Department of Cardiology, Barmherzige Brüder Hospital, Trier, Germany
| | - Holger Nef
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany; Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany; Department of Cardiology, Justus-Liebig University of Giessen and Marburg, Giessen, Germany
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13
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Breitbart P, Minners J, Hein M, Schröfel H, Neumann FJ, Ruile P. Implantation depth and its influence on complications after TAVI with self-expanding valves. Int J Cardiovasc Imaging 2021; 37:3081-3092. [PMID: 33988801 PMCID: PMC8494692 DOI: 10.1007/s10554-021-02275-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/03/2021] [Indexed: 11/30/2022]
Abstract
Prior studies in patients with transcatheter aortic valve implantation (TAVI) demonstrated an influence of transcatheter heart valve (THV) position on the occurrence of new conductions disturbances (CD) and paravalvular leakage (PVL) post TAVI in balloon-expandable valves (BEV). Purpose of this study was to investigate the THV implantation depth and its influence on the occurrence of CD and PVL in self-expanding valves (SEV). We performed fusion imaging of pre- and post-procedural computed tomography angiography in 104 TAVI-patients (all with Evolut R) to receive a 3-D reconstruction of the THV within the native annulus region. The THV length below the native annulus was measured for assessment of implantation depth. Electrocardiograms pre-discharge were assessed for conduction disturbances (CD), PVL was determined in transthoracic echocardiography. The mean implantation depth of the THV in the whole cohort was 4.3 ± 3.0 mm. Using the best cut-off of ≥ 4 mm in receiver operating characteristic curve analysis (sensitivity 83.3%, specificity 60.0%) patients with lower THV position developed more new CD after TAVI (68.2 vs. 23.7%, P < 0.001). A deep THV position was identified as the only predictor for new CD after TAVI (odds ratio [CI] 1.312[1.119–1.539], P = 0.001). The implantation depth showed no influence on the grade of PVL (r = 0.052, P = 0.598). In patients with TAVI using the Evolut R SEV, a lower THV positioning (≥ 4 mm length below annulus) was a predictor for new conduction disturbances. In contrast, implantation depth was not associated with the extent of PVL.
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Affiliation(s)
- Philipp Breitbart
- Division of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany.
| | - Jan Minners
- Division of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany
| | - Manuel Hein
- Division of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany
| | - Holger Schröfel
- Division of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Division of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany
| | - Philipp Ruile
- Division of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany
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14
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Schmermund A, Breitbart P, Eckert J, Magedanz A, Schmidt M, Voigtländer T. 2020: Entwicklungen in der kardialen Computertomographie. Kardiologe 2021. [PMCID: PMC7921831 DOI: 10.1007/s12181-021-00454-z] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Die Entwicklung der kardialen Computertomographie (CT) im Jahr 2020 war durch 3 dominante Schwerpunkte im Bereich der koronaren Bildgebung gekennzeichnet: 1) die prognostische Bedeutung der Plaquebildung, 2) die Möglichkeit ihrer volumetrischen Quantifizierung und 3) den Bedeutungsgewinn in den Leitlinien, verstärkt durch die zunehmende Anwendung in der Therapie von strukturellen Herzerkrankungen. Die Veröffentlichung der Ergebnisse von ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) hat den Blick auf die anatomische Charakterisierung der koronaren Herzkrankheit gelenkt, die Visualisierung der koronaren Plaquebildung. Nicht zuletzt als Ergebnis von „machine learning“/künstlicher Intelligenz hat sich die Möglichkeit herauskristallisiert, die koronare Plaquebildung automatisiert und volumetrisch zu erfassen. Diese beiden Entwicklungen haben die Frage nach der prognostischen Dominanz des Ischämienachweises aufgeworfen, der sekundär aus der Plaquebildung resultiert. Auch hat sich das Verständnis der Pathophysiologie der koronaren Herzerkrankung verändert: Die Ausprägung des (nicht verkalkten) Plaquevolumens, seine Lokalisierung und Dynamik scheinen als Merkmale der Vulnerabilität im Vergleich zur Fokussierung auf ein großes Atherom oder expansives Remodeling einzelner Plaques bedeutsamer zu sein. In den Leitlinien ist die koronare CT-Angiographie (CTA) sowohl bei den akuten Koronarsyndromen ohne ST-Hebung als auch den chronischen Koronarsyndromen an die erste Stelle gerückt – gleichberechtigt mit den klassischen bildgebenden Ischämietests. Unabhängig davon gewinnt die kardiale CT zunehmend an Bedeutung für die Therapieplanung von Vitien (insbesondere der Aorten- und Trikuspidalklappe), aber auch anderer struktureller Herzerkrankungen (z. B. Verschluss des linken Vorhofohrs, LAA).
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Affiliation(s)
- Axel Schmermund
- Cardioangiologisches Centrum Bethanien, CCB, Im Prüfling 23, 60389 Frankfurt am Main, Deutschland
| | - Philipp Breitbart
- Cardioangiologisches Centrum Bethanien, CCB, Im Prüfling 23, 60389 Frankfurt am Main, Deutschland
| | - Joachim Eckert
- Cardioangiologisches Centrum Bethanien, CCB, Im Prüfling 23, 60389 Frankfurt am Main, Deutschland
| | - Annett Magedanz
- Cardioangiologisches Centrum Bethanien, CCB, Im Prüfling 23, 60389 Frankfurt am Main, Deutschland
| | - Marco Schmidt
- Cardioangiologisches Centrum Bethanien, CCB, Im Prüfling 23, 60389 Frankfurt am Main, Deutschland
| | - Thomas Voigtländer
- Cardioangiologisches Centrum Bethanien, CCB, Im Prüfling 23, 60389 Frankfurt am Main, Deutschland
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15
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Breitbart P, Pache G, Minners J, Hein M, Schroefel H, Neumann FJ, Ruile P. Influence of prosthesis related factors on the occurrence of early leaflet thrombosis after transcatheter aortic valve implantation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2585] [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
Early leaflet thrombosis (LT) is a well described phenomenon after transcatheter aortic valve implantation (TAVI) with an incidence between 10 and 16%. So far, data about predictors of LT are scarce.
Purpose
The purpose of the study was to investigate the influence of prosthesis related factors on the occurrence of LT.
Methods
Fusion imaging of pre- and post-procedural CTA was performed in 140 TAVI-patients (55 with LT, 85 without LT) to obtain a 3D-reconstruction of the transcatheter heart valve (THV) within the native annulus region. All patients received a balloon-expandable Sapien 3 THV. The length of the THV above and below the native annulus was measured within the fused images to assess the implantation depth. The deployed THV area was quantified on three heights (left ventricular outflow tract end, center of the stent, aortic end) to determine the average expansion of the prosthesis as percent of the nominal area. We also calculated the extent of prosthesis waist in percent of maximum area. The stent tilt was determined in relation to the annulus plane.
Results
After multivariate adjustment the extent of THV expansion (odds ratio per 10 percent [CI]: 0.660 [0.555–0.786], P<0.001) and waist (odds ratio per 10 percent [CI]: 0.725 [0.615–0.854], P<0.001) had significant, independent influence on the occurrence of LT. Neither the implantation depth nor the stent tilt showed any influence on LT manifestation (P=0.393 and 0.578).
Conclusion
Our study suggests that less than fully expanded Sapien 3 THVs are more prone to LT, whereas some degree of waist was protective. These deployment characteristics may help identify patients who qualify for intensified surveillance.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- P Breitbart
- University Heart Center Freiburg-Bad Krozingen, Division of Cardiology & Angiology II, Bad Krozingen, Germany
| | - G Pache
- Radiology Hegau.Bodensee, Singen, Germany
| | - J Minners
- University Heart Center Freiburg-Bad Krozingen, Division of Cardiology & Angiology II, Bad Krozingen, Germany
| | - M Hein
- University Heart Center Freiburg-Bad Krozingen, Division of Cardiology & Angiology II, Bad Krozingen, Germany
| | - H Schroefel
- University Heart Center Freiburg-Bad Krozingen, Division of Cardiovascular Surgery, Bad Krozingen, Germany
| | - F.-J Neumann
- University Heart Center Freiburg-Bad Krozingen, Division of Cardiology & Angiology II, Bad Krozingen, Germany
| | - P Ruile
- University Heart Center Freiburg-Bad Krozingen, Division of Cardiology & Angiology II, Bad Krozingen, Germany
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Ruile P, Pache G, Minners J, Hein M, Neumann FJ, Breitbart P. Fusion imaging of pre- and post-procedural computed tomography angiography in transcatheter aortic valve implantation patients: evaluation of prosthesis position and its influence on new conduction disturbances. Eur Heart J Cardiovasc Imaging 2020; 20:781-788. [PMID: 30544215 DOI: 10.1093/ehjci/jey195] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 06/22/2018] [Revised: 08/23/2018] [Accepted: 11/15/2018] [Indexed: 02/03/2023] Open
Abstract
AIMS The purpose of this study was to evaluate prosthesis position by fusion of pre- and post-transcatheter aortic valve implantation (TAVI) computed tomography angiography (CTA) images and to investigate its influence on the occurrence of new conduction disturbances (CD). METHODS AND RESULTS We performed CTA fusion imaging in 120 TAVI patients (Edwards Sapien 3) on a standard image post-processing workstation to obtain a 3D reconstruction of the transcatheter heart valve (THV) position within the native annulus region. Optimal implantation depth of the THV was defined according to the manufacturers recommendations as 70-80% of the prosthesis above (aortic) and 20-30% below (ventricular) the native annulus plane. Pre- and post-interventional electrocardiograms (ECGs) were assessed for the development of new CD. THV position was found to be within, above, or below the prespecified margins in 32 patients (27%), 71 patients (59%), and 17 patients (14%), respectively. Interobserver reliability was high for fusion measurements [e.g. median THV position 0.983, 95% confidence interval (CI): 0.935-0.996]. Patients with low stent position were significantly more likely to develop new CD compared with patients with optimal or high stent position (P = 0.039). Independent predictors of CD in multivariate analysis were low THV position [odds ratio (CI): 1.362 (1.093-1.698), P = 0.006] and calcification of the device landing zone [odds ratio (CI): 1.149 (1.024-1.289), P = 0.018]. CONCLUSION Fusion imaging of pre- and post-TAVI-CTA allows for the exact evaluation of THV position in relation to the native annulus plane. A low THV position as assessed by fusion imaging is associated with the development of new CD post-TAVI.
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Affiliation(s)
- Philipp Ruile
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Gregor Pache
- Section of Cardiovascular Radiology, Department of Radiology, University of Freiburg, Hugstetterstr. 55, Freiburg, Germany
| | - Jan Minners
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Manuel Hein
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Philipp Breitbart
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, Bad Krozingen, Germany
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Breitbart P, Pache G, Minners J, Hein M, Schröfel H, Neumann FJ, Ruile P. Influence of prosthesis-related factors on the occurrence of early leaflet thrombosis after transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging 2020; 21:1082-1089. [DOI: 10.1093/ehjci/jeaa139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 01/02/2020] [Revised: 03/20/2020] [Accepted: 05/25/2020] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aims
Early leaflet thrombosis (LT) is a well-described phenomenon after transcatheter aortic valve implantation (TAVI) with an incidence around 15%. Data about predictors of LT are scarce. The purpose of the study was to investigate the influence of prosthesis-related factors on the occurrence of LT.
Materials and results
Fusion imaging of pre- and post-procedural computed tomography angiography was performed in 55 TAVI patients with LT and 140 selected patients as control groups (85 patients in an unmatched and 55 in a matched control) to obtain a 3D reconstruction of the transcatheter heart valve (THV) within the native annulus region. All patients received a balloon-expandable Sapien 3 THV. The THV length above and below the native annulus was measured within the fused images to assess the implantation depth. The deployed THV area was quantified on three heights (left ventricular outflow tract end, stent centre, and aortic end) to determine the average expansion of the prosthesis as percent of the nominal area. We also calculated the extent of prosthesis waist in percent of maximum area. After multivariate adjustment, the extent of THV waist [odds ratio (OR) per 10% (confidence interval, CI) 0.636 (0.526–0.769), P < 0.001] as prosthesis-related factor and previous oral anticoagulation [OR (CI) 0.070 (0.020–0.251), P < 0.001] had significant, independent influence on the occurrence of LT. The implantation depth showed no influence on LT manifestation (P = 0.704).
Conclusion
Besides the absence of previous oral anticoagulation, a less pronounced waist of the implanted THV was a prosthesis-position-related independent predictor of LT after TAVI using the Sapien 3.
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Affiliation(s)
- Philipp Breitbart
- Division of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | - Gregor Pache
- Radiology Hegau.Bodensee, Practice for Diagnostic Radiology, Kreuzensteinstraße 7, 78224 Singen, Germany
| | - Jan Minners
- Division of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | - Manuel Hein
- Division of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | - Holger Schröfel
- Division of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Division of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
| | - Philipp Ruile
- Division of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189 Bad Krozingen, Germany
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Breitbart P, Minners J, Pache G, Hansson NC, Nørgaard BL, De Backer O, Søndergaard L, Alsanjari O, Hildick-Smith D, Abdel-Wahab M, Löbig S, Neumann FJ, Ruile P. Long-term follow-up of patients with contained annulus ruptures after TAVI: the EuropeaN COntained RupturE (ENCORE) registry. EUROINTERVENTION 2020; 16:83-88. [PMID: 32011285 DOI: 10.4244/eij-d-19-00740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/23/2022]
Abstract
AIMS The purpose of this registry was to determine the long-term outcomes in patients with asymptomatic contained annulus rupture (CR) as a rare complication of transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS The ENCORE registry is a multicentre registry (six centres across Europe) of patients with CR diagnosed on post-TAVI computed tomography angiography (CTA) or transoesophageal echocardiography (TEE). A total of 21 patients (mean age 81.9±4.1 years, 81% balloon-expandable TAVI prostheses) were diagnosed with CR (mean size of lesions was 15.3±6.9 × 8.5±3.3 × 8.5±2.3 mm). Seventeen were diagnosed among a total of 1,602 consecutive routine post-TAVI CTA (incidence 1.1%), two in TEE and two in post-TAVI CTA (each conducted due to suspicion of peri-interventional complications). During a mean follow-up of 2.3±1.7 years (cumulative 48.6 patient-years), nine patients (43%) died from non-cardiac causes. None of the patients exhibited symptoms or underwent interventional treatment related to the CR; no sudden cardiac death occurred. A follow-up CTA, performed in eleven patients 240±176 days post TAVI, revealed stable CR findings in seven, regression in one, and remission in three patients. CONCLUSIONS The results of our international multicentre registry demonstrate favourable long-term outcomes of CR after TAVI supporting a watch-and-wait strategy in these patients.
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Affiliation(s)
- Philipp Breitbart
- Division of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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Breitbart P, Pache G, Minners J, Hein M, Schröfel H, Neumann FJ, Ruile P. Predictors for low TAVI-prosthesis position assessed by fusion imaging of pre- and post-procedural CT angiography. Clin Res Cardiol 2020; 110:93-101. [PMID: 32399896 PMCID: PMC7806565 DOI: 10.1007/s00392-020-01654-5] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/20/2020] [Indexed: 12/19/2022]
Abstract
Background Low prosthesis position after transcatheter aortic valve implantation (TAVI) is associated with higher rates of new onset conduction disturbances and permanent pacemaker implantations. Purpose of this study was to investigate possible predictors of a low prosthesis position of the SAPIEN 3 (Edwards Lifesciences, Irvine, California, USA) valve type using fusion imaging of pre- and post-procedural computed tomography angiography (CTA). Methods CTA fusion imaging was performed in 120 TAVI-patients with 3D-reconstruction of the transcatheter heart valve (THV) position within the device landing zone. A low implantation position was defined according to the manufacturer’s recommendations as > 30% of the prosthesis below the native annulus plane. Results A low THV position was found in 17 patients (14%). Patients with low THV position had less calcification of the annulus region and a smaller annulus size compared to patients with a normal or high THV position (P = 0.003 and 0.041, respectively). The only independent predictor of a low THV position in multivariate logistic regression analysis was the extent of calcification of the cusp region (odds ratio [CI] 0.842 [0.727–0.976], P = 0.022). Conclusions Fusion imaging of pre-and post-procedural CTA identified reduced calcification of the cusp region as an independent predictor of a low THV position of the SAPIEN 3. This should be considered when planning the TAVI procedure. Graphic abstract Correlation of cusp region calcification and prosthesis position after TAVI ![]()
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Affiliation(s)
- Philipp Breitbart
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany.
| | - Gregor Pache
- Radiology Hegau Bodensee, Practice for Diagnostic Radiology, Singen, Germany
| | - Jan Minners
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany
| | - Manuel Hein
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany
| | - Holger Schröfel
- Division of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany
| | - Philipp Ruile
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany
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Ruile P, Minners J, Breitbart P, Schoechlin S, Gick M, Pache G, Neumann FJ, Hein M. Medium-Term Follow-Up of Early Leaflet Thrombosis After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2019; 11:1164-1171. [PMID: 29929639 DOI: 10.1016/j.jcin.2018.04.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [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: 12/22/2017] [Revised: 02/26/2018] [Accepted: 04/03/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to investigate medium-term outcomes in patients with leaflet thrombosis (LT). BACKGROUND The clinical significance of early LT after transcatheter aortic valve replacement, diagnosed by computed tomography angiography in approximately 10% of patients, is uncertain. METHODS In this observational study, computed tomographic angiography was performed a median of 5 days after transcatheter aortic valve replacement and assessed for evidence of LT. Follow-up consisted of clinical visits, telephone contact, or questionnaire. RESULTS LT was diagnosed in 120 of 754 patients (15.9%). Patients with LT were less likely male (36.7% vs. 47.0%, p = 0.045), with a lower rate of atrial fibrillation (28.3% vs. 41.5%, p = 0.008). Peri- and post-procedural characteristics were comparable between groups (e.g., valve implantation technique; p = 0.116). During a median follow-up period of 406 days, there were no significant differences in the primary endpoint of all-cause mortality and the secondary combined endpoint of stroke and transient ischemic attack between patients with LT and those without LT (18-month Kaplan-Meier estimate for mortality 86.6% vs. 85.4%, p = 0.912; for stroke- or transient ischemic attack-free survival 98.5% vs. 96.8%, p = 0.331). In univariate and multivariate analyses, LT was not predictive of either endpoint, whereas male sex (p = 0.03), atrial fibrillation (p = 0.002), and more than mild paravalvular leak (p = 0.015) were associated with all-cause mortality. CONCLUSIONS In this prospective observational cohort undergoing post-transcatheter aortic valve replacement computed tomographic angiography, LT was not associated with increased mortality or rates of stroke over a follow-up period of 406 days.
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Affiliation(s)
- Philipp Ruile
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany.
| | - Jan Minners
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Philipp Breitbart
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Simon Schoechlin
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Michael Gick
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Gregor Pache
- Department of Radiology, Section of Cardiovascular Radiology, University of Freiburg, Freiburg, Germany
| | - Franz-Josef Neumann
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Manuel Hein
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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21
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Breitbart P, Minners J, Pache G, Hansson NC, Norgaard BL, De Backer O, Sondergaard L, Alsanjari O, Hildick-Smith D, Reinoehl J, Abdel-Wahab M, Loebig S, Neumann FJ, Ruile P. 94Course of contained annulus ruptures after TAVI: the ENCORE (European contained rupture)-registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0023] [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
An asymptomatic contained rupture (CR) of the aortic annulus is a rare complication of transcatheter aortic valve implantation (TAVI). Their clinical implication is unclear so far.
Purpose
To determine the long-term outcomes in patients with CR.
Methods
The ENCORE-registry is a multicenter registry (6 centers across Europe) of patients with CR diagnosed on post-TAVI computed tomography angiography (CTA) or transesophageal echocardiography (TEE).
Results
A total of 21 patients (mean age 81.9±4.1 years, 81% balloon-expandable TAVI-prostheses) were diagnosed with CR (62% located adjacent to the left coronary cusp, mean size of lesions was 15.3±6.9 x 8.5±3.3 x 8.5±2.3 mm). Seventeen were diagnosed among a total of 1602 consecutive routine post-TAVI CTA (incidence 1.1%), two in TEE and two in post-TAVI CTA (each conducted due to suspicion of periinterventional complications). During a mean follow-up of 2.3±1.7 years nine patients (43%) died from non-cardiac causes. None of the patients exhibited symptoms or underwent interventional treatment related to the CR, no sudden cardiac death occurred. A follow-up CTA, performed in eleven patients 240±176 days post-TAVI, revealed stable CR findings in seven, regression in one, and remission in three patients.
Conclusion
The results of our ENCORE-registry demonstrate a benign course of initially asymptomatic contained ruptures of the aortic annulus after TAVI supporting a watch-and-wait approach in these patients. Thus, no specific treatment seems to be necessary.
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Affiliation(s)
- P Breitbart
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology & Angiology II, Bad Krozingen, Germany
| | - J Minners
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology & Angiology II, Bad Krozingen, Germany
| | - G Pache
- University of Freiburg, Department of Radiology, Section of Cardiovascular Radiology, Freiburg, Germany
| | - N C Hansson
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - B L Norgaard
- Aarhus University Hospital, Department of Cardiology, Aarhus, Denmark
| | - O De Backer
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - L Sondergaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - O Alsanjari
- Sussex Cardiac Centre, Brighton, United Kingdom
| | | | - J Reinoehl
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology & Angiology I, Freiburg, Germany
| | - M Abdel-Wahab
- Heart Center of Leipzig, Department of Cardiology, Leipzig, Germany
| | - S Loebig
- Robert Bosch Hospital, Division of Cardiology, Stuttgart, Germany
| | - F.-J Neumann
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology & Angiology II, Bad Krozingen, Germany
| | - P Ruile
- University Heart Center Freiburg-Bad Krozingen, Department of Cardiology & Angiology II, Bad Krozingen, Germany
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Breitbart P, Minners J, Pache G, Blanke P, Reinöhl J, Hansson NC, Nørgaard BL, Neumann FJ, Ruile P. Outcomes in patients with contained ruptures of the aortic annulus after transcatheter aortic valve implantation with balloon-expandable devices. EUROINTERVENTION 2019; 13:1300-1302. [PMID: 28781240 DOI: 10.4244/eij-d-17-00347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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)
- Philipp Breitbart
- Department of Cardiology & Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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Hein M, Minners J, Breitbart P, Stratz C, Pache G, Neumann FJ, Ruile P. P1677Anticoagulation is associated with improved hemodynamic prosthetic valve performance in patients with early leaflet thrombosis after transcatheter aortic valve implantation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1677] [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: 11/13/2022] Open
Affiliation(s)
- M Hein
- University of Freiburg, University Heart Center Freiburg – Bad Krozingen, Department of Cardiology and Angiology II, Freiburg, Germany
| | - J Minners
- University of Freiburg, University Heart Center Freiburg – Bad Krozingen, Department of Cardiology and Angiology II, Freiburg, Germany
| | - P Breitbart
- University of Freiburg, University Heart Center Freiburg – Bad Krozingen, Department of Cardiology and Angiology II, Freiburg, Germany
| | - C Stratz
- University of Freiburg, University Heart Center Freiburg – Bad Krozingen, Department of Cardiology and Angiology II, Freiburg, Germany
| | - G Pache
- University of Freiburg, University Heart Center Freiburg – Bad Krozingen, Department of Cardiology and Angiology II, Freiburg, Germany
| | - F J Neumann
- University of Freiburg, University Heart Center Freiburg – Bad Krozingen, Department of Cardiology and Angiology II, Freiburg, Germany
| | - P Ruile
- University of Freiburg, University Heart Center Freiburg – Bad Krozingen, Department of Cardiology and Angiology II, Freiburg, Germany
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