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Al-Kassou B, Theuerkauf N, Nickenig G, Zimmer S. Hemodynamic effects of the combined support with VAV-ECMO, Impella CP, and Impella RP. Clin Res Cardiol 2024; 113:647-650. [PMID: 37728774 PMCID: PMC10954856 DOI: 10.1007/s00392-023-02304-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Affiliation(s)
- Baravan Al-Kassou
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Nils Theuerkauf
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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Al-Kassou B, Weber M, Nickenig G, Zimmer S. Thrombotic ST-segment elevation myocardial infarction caused by a caseous mitral annular calcification. Clin Res Cardiol 2024; 113:644-646. [PMID: 36809351 PMCID: PMC10954851 DOI: 10.1007/s00392-023-02167-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/02/2023] [Indexed: 02/23/2023]
Affiliation(s)
- Baravan Al-Kassou
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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Salam B, Al-Kassou B, Weinhold L, Sprinkart AM, Nowak S, Theis M, Schmid M, Al Zaidi M, Weber M, Pieper CC, Kuetting D, Shamekhi J, Nickenig G, Attenberger U, Zimmer S, Luetkens JA. CT-derived Epicardial Adipose Tissue Inflammation Predicts Outcome in Patients Undergoing Transcatheter Aortic Valve Replacement. J Thorac Imaging 2024:00005382-990000000-00124. [PMID: 38389116 DOI: 10.1097/rti.0000000000000776] [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: 02/24/2024]
Abstract
PURPOSE Inflammatory changes in epicardial (EAT) and pericardial adipose tissue (PAT) are associated with increased overall cardiovascular risk. Using routine, preinterventional cardiac CT data, we examined the predictive value of quantity and quality of EAT and PAT for outcome after transcatheter aortic valve replacement (TAVR). MATERIALS AND METHODS Cardiac CT data of 1197 patients who underwent TAVR at the in-house heart center between 2011 and 2020 were retrospectively analyzed. The amount and density of EAT and PAT were quantified from single-slice CT images at the level of the aortic valve. Using established risk scores and known independent risk factors, a clinical benchmark model (BMI, Chronic kidney disease stage, EuroSCORE 2, STS Prom, year of intervention) for outcome prediction (2-year mortality) after TAVR was established. Subsequently, we tested whether the additional inclusion of area and density values of EAT and PAT in the clinical benchmark model improved prediction. For this purpose, the cohort was divided into a training (n=798) and a test cohort (n=399). RESULTS Within the 2-year follow-up, 264 patients died. In the training cohort, particularly the addition of EAT density to the clinical benchmark model showed a significant association with outcome (hazard ratio 1.04, 95% CI: 1.01-1.07; P =0.013). In the test cohort, the outcome prediction of the clinical benchmark model was also significantly improved with the inclusion of EAT density (c-statistic: 0.589 vs. 0.628; P =0.026). CONCLUSIONS EAT density as a surrogate marker of EAT inflammation was associated with 2-year mortality after TAVR and may improve outcome prediction independent of established risk parameters.
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Affiliation(s)
- Babak Salam
- Departments of Diagnostic and Interventional Radiology
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | | | - Leonie Weinhold
- Medical Biometry, Informatics, and Epidemiology, University Hospital Bonn
| | - Alois M Sprinkart
- Departments of Diagnostic and Interventional Radiology
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Sebastian Nowak
- Departments of Diagnostic and Interventional Radiology
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Maike Theis
- Departments of Diagnostic and Interventional Radiology
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | - Matthias Schmid
- Medical Biometry, Informatics, and Epidemiology, University Hospital Bonn
| | | | | | | | - Daniel Kuetting
- Departments of Diagnostic and Interventional Radiology
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
| | | | | | | | | | - Julian A Luetkens
- Departments of Diagnostic and Interventional Radiology
- Quantitative Imaging Lab Bonn (QILaB), Bonn, Germany
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Sudo M, Shamekhi J, Aksoy A, Al-Kassou B, Tanaka T, Silaschi M, Weber M, Nickenig G, Zimmer S. A simply calculated nutritional index provides clinical implications in patients undergoing transcatheter aortic valve replacement. Clin Res Cardiol 2024; 113:58-67. [PMID: 37178161 PMCID: PMC10808226 DOI: 10.1007/s00392-023-02220-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Malnutrition is associated with adverse outcomes in patients with aortic stenosis. The Triglycerides × Total Cholesterol × Body Weight Index (TCBI) is a simple scoring model to evaluate the status of nutrition. However, the prognostic relevance of this index in patients undergoing transcatheter aortic valve replacement (TAVR) is unknown. This study aimed to evaluate the association of the TCBI with clinical outcomes in patients undergoing TAVR. METHODS A total of 1377 patients undergoing TAVR were evaluated in this study. The TCBI was calculated by the formula; triglyceride (mg/dL) × total cholesterol (mg/dL) × body weight (kg)/1000. The primary outcome was all-cause mortality within 3 years. RESULTS Patients with a low TCBI, based on a cut-off value of 985.3, were more likely to have elevated right atrial pressure (p = 0.04), elevated right ventricular pressure (p < 0.01), right ventricular systolic dysfunction (p < 0.01), tricuspid regurgitation ≥ moderate (p < 0.01). Patients with a low TCBI had a higher cumulative 3-year all-cause (42.3% vs. 31.6%, p < 0.01; adjusted HR 1.36, 95% CI 1.05-1.77, p = 0.02) and non-cardiovascular mortality (15.5% vs. 9.1%, p < 0.01; adjusted HR 1.95, 95% CI 1.22-3.13, p < 0.01) compared to those with a high TCBI. Adding a low TCBI to EuroSCORE II improved the predictive value for 3-year all-cause mortality (net reclassification improvement, 0.179, p < 0.01; integrated discrimination improvement, 0.005, p = 0.01). CONCLUSION Patients with a low TCBI were more likely to have right-sided heart overload and exhibited an increased risk of 3-year mortality. The TCBI may provide additional information for risk stratification in patients undergoing TAVR.
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Affiliation(s)
- Mitsumasa Sudo
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
| | - Jasmin Shamekhi
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Adem Aksoy
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Baravan Al-Kassou
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tetsu Tanaka
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Miriam Silaschi
- Heart Center Bonn, Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Wilde NG, Mauri V, Piayda K, Al-Kassou B, Shamekhi J, Maier O, Tiyerili V, Sugiura A, Weber M, Zimmer S, Zeus T, Kelm M, Adam M, Baldus S, Nickenig G, Veulemans V, Sedaghat A. Left ventricular reverse remodeling after transcatheter aortic valve implantation in patients with low-flow low-gradient aortic stenosis. Hellenic J Cardiol 2023; 74:1-7. [PMID: 37119968 DOI: 10.1016/j.hjc.2023.04.009] [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: 01/12/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/01/2023] Open
Abstract
OBJECTIVES Left ventricular reverse remodeling (LVRR) is associated with improved outcome in patients with heart failure. Factors associated with and predictive of LVRR in patients with low-flow low-gradient aortic stenosis (LFLG AS) after transcatheter aortic valve implantation (TAVI) and its impact on outcome were assessed. METHODS Pre- and postprocedural left ventricular (LV) function and volume were investigated in 219 patients with LFLG. LVRR was defined as an absolute increase of ≥10% in LV ejection fraction (LVEF) and reduction of ≥15% in LV end-systolic volume (LVESV). The primary endpoint was the combination of all-cause mortality and rehospitalization for heart failure. RESULTS The mean LVEF was 35.0 ± 10.0%, with a stroke volume index (SVI) of 25.9 ± 6.0 mL/m2 and LVESV of 94.04 ± 46.0 mL. At a median of 5.2 months (interquartile range, 2.7-8.1 months), 77.2% (n = 169) of the patients showed echocardiographic evidence of LVRR. A multivariate model revealed three independent factors for LVRR after TAVI: SVI of <25 mL/m2 (hazard ratio [HR], 2.31; 95% confidence interval [CI], 1.08-3.58; p < 0.01), LVEF of <30% (HR, 2.76; 95% CI, 1.53-2.91; p < 0.01), and valvulo-arterial impedance (Zva) of <5 mmHg/mL/m2 (HR, 5.36; 95% CI, 1.80-15.98; p < 0.01). Patients without evidence of LVRR showed a significantly higher incidence of the 1-year combined endpoint (32 [64.0%] vs. 75 [44.4%], p < 0.01). CONCLUSIONS The majority of patients with LFLG AS show LVRR after TAVI, which is associated with favorable outcomes. An SVI of <25 mL/m2, LVEF of <30%, and Zva < 5mmHg/mL/m2 represent predictors of LVRR.
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Affiliation(s)
- Nihal G Wilde
- Heart Centre Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Victor Mauri
- Heart Centre Cologne, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Kerstin Piayda
- Department of Cardiology, Pulmonology, and Angiology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Baravan Al-Kassou
- Heart Centre Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Jasmin Shamekhi
- Heart Centre Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Oliver Maier
- Department of Cardiology, Pulmonology, and Angiology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Vedat Tiyerili
- Department of Internal Medicine, St.-Johannes-Hospital Dortmund, Dortmund, Germany
| | - Atsushi Sugiura
- Heart Centre Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Heart Centre Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Heart Centre Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Tobias Zeus
- Department of Cardiology, Pulmonology, and Angiology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology, and Angiology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Matti Adam
- Heart Centre Cologne, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Stephan Baldus
- Heart Centre Cologne, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Georg Nickenig
- Heart Centre Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Verena Veulemans
- Department of Cardiology, Pulmonology, and Angiology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Alexander Sedaghat
- Heart Centre Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany; RheinAhrCardio - Praxis für Kardiologie, Bad Neuenahr-Ahrweiler, Germany.
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Düsing P, Heinrich NN, Al-Kassou B, Gutbrod K, Dörmann P, Nickenig G, Jansen F, Zietzer A. Analysis of circulating ceramides and hexosylceramides in patients with coronary artery disease and type II diabetes mellitus. BMC Cardiovasc Disord 2023; 23:454. [PMID: 37700226 PMCID: PMC10498560 DOI: 10.1186/s12872-023-03454-x] [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] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/16/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) remains the leading cause of death worldwide. The main driving force behind this association is coronary artery disease (CAD), the manifestation of atherosclerosis in the coronary circulation. Cornerstones in the development of CAD are pathologies in lipid metabolism. In recent years, ongoing research has identified ceramides, a subclass of sphingolipids to be mediators of CVD. The aim of this study is to investigate the influence of type II diabetes mellitus (DM) on circulating ceramides and hexosylceramides (HexCers) in CAD patients. METHODS 24 patients aged 40-90 years with CAD confirmed by angiography were included into a pilot study. Patients with DM were identified by analysis of discharge letters or other medical documents available at the study center. During coronary angiography, arterial blood samples were collected and quantification of sphingolipids in patient serum was performed by mass spectrometry. RESULTS Statistical analysis showed nine significantly different HexCers in CAD patients with DM compared to patients without DM. Among the nine significantly regulated HexCers, we identified seven d18:1 HexCers. This group contributes to the fourth most abundant subgroup of total ceramides and HexCers in this dataset. HexCer-d18:1-23:1(2-OH) showed the strongest downregulation in the patient group with DM. CONCLUSION This study suggests that levels of circulating HexCers are downregulated in patients with CAD and concomitant DM compared to patients without DM. Further research is needed to investigate the underlying mechanisms and the suitability of HexCers as possible mediators and/or prognostic markers in CAD.
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Affiliation(s)
- Philip Düsing
- Heart Center, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Nadine N Heinrich
- Heart Center, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Baravan Al-Kassou
- Heart Center, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Katharina Gutbrod
- Institute of Molecular Physiology and Biotechnology of Plants, University of Bonn, Bonn, Germany
| | - Peter Dörmann
- Institute of Molecular Physiology and Biotechnology of Plants, University of Bonn, Bonn, Germany
| | - Georg Nickenig
- Heart Center, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Felix Jansen
- Heart Center, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Andreas Zietzer
- Heart Center, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany.
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7
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Wolpers AC, Welchowski T, Sedaghat A, Wintergerst MWM, Al-Kassou B, Finger RP, Terheyden JH. Modifications in ocular microperfusion after transcatheter aortic valve implantation. Sci Rep 2023; 13:14181. [PMID: 37648792 PMCID: PMC10468531 DOI: 10.1038/s41598-023-41054-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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 08/21/2023] [Indexed: 09/01/2023] Open
Abstract
Cerebral embolization is a known complication of transcatheter aortic valve implantation (TAVI) but the effect of the procedure on the ocular perfusion is currently unclear. Thus, we investigated post-procedural morphologic and perfusion changes of the retina and choroid, using optical coherence tomography angiography (OCTA) and color fundus photography (CFP) in a prospective cohort study. Ophthalmic examinations were conducted pre- and post-TAVI. OCTA images were analyzed quantitatively based on vessel density and skeleton density of the superficial and deep retinal plexus as well as the signal intensity and flow deficits in the choriocapillaris. CFP images were assessed for presence of acute retinal ischemia, optic nerve swelling, vessel emboli, hemorrhages and cotton wool spots. Data was analyzed using linear mixed models. Twenty patients (9 women; 11 men) at a mean age of 81 ± 6 years were included. Pre- and post-interventional ocular imaging data were available for 32 eyes. The analysis revealed a significant impairment of the choriocapillaris perfusion after TAVI with an increased proportion of flow deficits (p = 0.044). When controlling for blood pressure, the average size of choriocapillaris flow voids was significantly increased (systolic and diastolic, p = 0.039 and 0.029). Qualitatively, focal areas of retinal ischemia were detected on OCTA in 33% of participants. Silent emboli or cotton wool spots were identified on CFP in 21%. Our findings indicate a reduced choroidal perfusion as well as areas of retinal ischemia and embolization in a considerable proportion of patients following TAVI. Pending confirmation in a larger sample, these complications merit monitoring as well as inclusion in consent procedures for TAVI.
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Affiliation(s)
- Anne Caroline Wolpers
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
- Department of Cardiology and Internal Intensive Care, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Thomas Welchowski
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - Alexander Sedaghat
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany.
- RheinAhrCardio Practice for Cardiology, Wilhelmstr. 14, 53474, Bad Neuenahr-Ahrweiler, Germany.
| | | | - Baravan Al-Kassou
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Department of Ophthalmology, University Hospital Mannheim & Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jan Henrik Terheyden
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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Al-Kassou B, Al-Shaikh H, Aksoy A, Shamekhi J, Zietzer A, Sugiura A, Veulemans V, Adam M, Grube E, Bakhtiary F, Zimmer S, Kelm M, Baldus S, Nickenig G, Sedaghat A. Impact of transradial versus transfemoral access for preprocedural coronary angiography on TAVR-associated complications. Int J Cardiol Heart Vasc 2023; 46:101205. [PMID: 37122629 PMCID: PMC10130599 DOI: 10.1016/j.ijcha.2023.101205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/28/2023] [Accepted: 04/04/2023] [Indexed: 05/02/2023]
Abstract
Background Vascular injury and bleeding complications remain frequent after transcatheter aortic valve replacement (TAVR). Whether the access-site of preprocedural coronary angiography (CAG) affects TAVR-related complications is not known. The aim of this study was to evaluate the impact of transradial (TRA) versus transfemoral access (TFA) for preprocedural CAG on outcomes in patients undergoing subsequent TAVR. Methods The study cohort included 1002 patients undergoing transfemoral TAVR, of whom 39.4% (395/1002) had undergone radial and 60.6% (607/1002) femoral access for pre-TAVR CAG. The primary endpoint was a composite of 30-day mortality and major vascular complications after TAVR. Key secondary endpoints included VARC-3-defined complications. Results The primary endpoint occurred less frequently in patients with prior TRA (3.3%) as compared to patients with prior TFA (6.3%, p = 0.04), which was mainly driven by significantly lower rates of major vascular complications (0.8% vs 2.5%, p = 0.05). Moreover, incidences of periprocedural access-related vascular injury and unplanned endovascular interventions were lower in TRA patients (13.2% vs 18.0%, p = 0.05). The rate of major bleeding tended to be lower in the TRA (1.5%) as compared to the TFA group (3.5%) but was not significantly different (p = 0.07). Moreover, the rate of life-threatening bleeding was comparable between both groups (0.5% vs 0.8%, p = 0.71). Conclusion Transradial access for preprocedural CAG was associated with significantly lower rates of vascular complications following subsequent TAVR as compared to transfemoral access. However, despite the tendency to lower major bleedings with transradial access, no significant association was detectable between the access-site of coronary angiography and TAVR-related bleeding complications.
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Affiliation(s)
- Baravan Al-Kassou
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Hasanin Al-Shaikh
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Adem Aksoy
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Jasmin Shamekhi
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Andreas Zietzer
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Atsushi Sugiura
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Verena Veulemans
- Division of Cardiology, University Hospital of Duesseldorf, Germany
- CARID, Cardiovascular Research Institute Duesseldorf, Germany
| | - Matti Adam
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Eberhard Grube
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Farhad Bakhtiary
- Heart Center, Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Malte Kelm
- CARID, Cardiovascular Research Institute Duesseldorf, Germany
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Georg Nickenig
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Alexander Sedaghat
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
- RheinAhrCardio, Praxis für Kardiologie, Bad Neuenahr-Ahrweiler, Germany
- Corresponding author.
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9
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Gehlen J, Stundl A, Debiec R, Fontana F, Krane M, Sharipova D, Nelson CP, Al-Kassou B, Giel AS, Sinning JM, Bruenger CMH, Zelck CF, Koebbe LL, Braund PS, Webb TR, Hetherington S, Ensminger S, Fujita B, Mohamed SA, Shrestha M, Krueger H, Siepe M, Kari FA, Nordbeck P, Buravezky L, Kelm M, Veulemans V, Adam M, Baldus S, Laugwitz KL, Haas Y, Karck M, Mehlhorn U, Conzelmann LO, Breitenbach I, Lebherz C, Urbanski P, Kim WK, Kandels J, Ellinghaus D, Nowak-Goettl U, Hoffmann P, Wirth F, Doppler S, Lahm H, Dreßen M, von Scheidt M, Knoll K, Kessler T, Hengstenberg C, Schunkert H, Nickenig G, Nöthen MM, Bolger AP, Abdelilah-Seyfried S, Samani NJ, Erdmann J, Trenkwalder T, Schumacher J. Elucidation of the genetic causes of bicuspid aortic valve disease. Cardiovasc Res 2023; 119:857-866. [PMID: 35727948 PMCID: PMC10153415 DOI: 10.1093/cvr/cvac099] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 05/21/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS The present study aims to characterize the genetic risk architecture of bicuspid aortic valve (BAV) disease, the most common congenital heart defect. METHODS AND RESULTS We carried out a genome-wide association study (GWAS) including 2236 BAV patients and 11 604 controls. This led to the identification of a new risk locus for BAV on chromosome 3q29. The single nucleotide polymorphism rs2550262 was genome-wide significant BAV associated (P = 3.49 × 10-08) and was replicated in an independent case-control sample. The risk locus encodes a deleterious missense variant in MUC4 (p.Ala4821Ser), a gene that is involved in epithelial-to-mesenchymal transformation. Mechanistical studies in zebrafish revealed that loss of Muc4 led to a delay in cardiac valvular development suggesting that loss of MUC4 may also play a role in aortic valve malformation. The GWAS also confirmed previously reported BAV risk loci at PALMD (P = 3.97 × 10-16), GATA4 (P = 1.61 × 10-09), and TEX41 (P = 7.68 × 10-04). In addition, the genetic BAV architecture was examined beyond the single-marker level revealing that a substantial fraction of BAV heritability is polygenic and ∼20% of the observed heritability can be explained by our GWAS data. Furthermore, we used the largest human single-cell atlas for foetal gene expression and show that the transcriptome profile in endothelial cells is a major source contributing to BAV pathology. CONCLUSION Our study provides a deeper understanding of the genetic risk architecture of BAV formation on the single marker and polygenic level.
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Affiliation(s)
- Jan Gehlen
- Institute of Human Genetics, University of Bonn and University Hospital Bonn, Bonn, Germany
- Institute of Human Genetics, Philipps University of Marburg, Marburg, Germany
| | - Anja Stundl
- Department of Medicine II, Heart Center Bonn, University of Bonn and University Hospital Bonn, Bonn, Germany
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Radoslaw Debiec
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
- East Midlands Congenital Heart Centre, Glenfield Hospital, Leicester, UK
| | - Federica Fontana
- Institute of Biochemistry and Biology, Potsdam University, Potsdam, Germany
| | - Markus Krane
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Division of Experimental Surgery, Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
- Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Dinara Sharipova
- Institute of Biochemistry and Biology, Potsdam University, Potsdam, Germany
| | - Christopher P Nelson
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Baravan Al-Kassou
- Department of Medicine II, Heart Center Bonn, University of Bonn and University Hospital Bonn, Bonn, Germany
| | - Ann-Sophie Giel
- Institute of Human Genetics, Philipps University of Marburg, Marburg, Germany
| | - Jan-Malte Sinning
- Department of Medicine II, Heart Center Bonn, University of Bonn and University Hospital Bonn, Bonn, Germany
| | | | - Carolin F Zelck
- Institute of Human Genetics, Philipps University of Marburg, Marburg, Germany
| | - Laura L Koebbe
- Institute of Human Genetics, Philipps University of Marburg, Marburg, Germany
| | - Peter S Braund
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Thomas R Webb
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | | | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, University Hospital of Schleswig-Holstein, Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Buntaro Fujita
- Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, University Hospital of Schleswig-Holstein, Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Salah A Mohamed
- Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, University Hospital of Schleswig-Holstein, Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Malakh Shrestha
- Department of Adult and Pediatric Cardiothoracic Surgery, Vascular Surgery, Heart and Lung Transplantation, Hannover Medical School, Hannover, Germany
| | - Heike Krueger
- Department of Adult and Pediatric Cardiothoracic Surgery, Vascular Surgery, Heart and Lung Transplantation, Hannover Medical School, Hannover, Germany
| | - Matthias Siepe
- Heart Center Freiburg/Bad Krozingen, University Freiburg/Bad Krozingen, Freiburg, Germany
| | - Fabian Alexander Kari
- Heart Center Freiburg/Bad Krozingen, University Freiburg/Bad Krozingen, Freiburg, Germany
| | - Peter Nordbeck
- Medizinische Klinik und Poliklinik I, University Hospital Würzburg, Würzburg, Germany
| | - Larissa Buravezky
- Medizinische Klinik und Poliklinik I, University Hospital Würzburg, Würzburg, Germany
| | - Malte Kelm
- Department of Cardiology, Pneumology and Angiology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Verena Veulemans
- Department of Cardiology, Pneumology and Angiology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Matti Adam
- Department of Medicine III, Heart Center Cologne, University Hospital Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Medicine III, Heart Center Cologne, University Hospital Cologne, Cologne, Germany
| | - Karl-Ludwig Laugwitz
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Yannick Haas
- Klinik und Poliklinik für Innere Medizin I, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Matthias Karck
- Department of Cardiothoracic Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Uwe Mehlhorn
- Department of Cardiothoracic Surgery, Helios Klinik Karlsruhe, Karlsruhe, Germany
| | | | - Ingo Breitenbach
- Department of Cardiothoracic Surgery and Vascular Surgery, Clinic of Braunschweig, Braunschweig, Germany
| | - Corinna Lebherz
- Department of Medicine I, Cardiology/Angiology/Intensive Care, University Hospital Aachen, Aachen, Germany
| | - Paul Urbanski
- Department of Cardiovascular Surgery, Cardiovascular Clinic, Rhön-Klinikum Campus Bad Neustadt, Neustadt, Germany
| | - Won-Keun Kim
- Department of Cardiology, Heart Center, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Joscha Kandels
- Department of Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - David Ellinghaus
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
- Novo Nordisk Foundation Center for Protein Research, Disease Systems Biology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ulrike Nowak-Goettl
- Department of Clinical Chemistry, Thrombosis and Hemostasis Unit, University Hospital of Kiel and Lübeck, Kiel, Germany
| | - Per Hoffmann
- Institute of Human Genetics, University of Bonn and University Hospital Bonn, Bonn, Germany
| | - Felix Wirth
- Division of Experimental Surgery, Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefanie Doppler
- Division of Experimental Surgery, Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Harald Lahm
- Division of Experimental Surgery, Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Martina Dreßen
- Division of Experimental Surgery, Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Moritz von Scheidt
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Katharina Knoll
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Thorsten Kessler
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Heribert Schunkert
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Georg Nickenig
- Department of Medicine II, Heart Center Bonn, University of Bonn and University Hospital Bonn, Bonn, Germany
| | - Markus M Nöthen
- Institute of Human Genetics, University of Bonn and University Hospital Bonn, Bonn, Germany
| | - Aidan P Bolger
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
- East Midlands Congenital Heart Centre, Glenfield Hospital, Leicester, UK
- Institute of Biochemistry and Biology, Potsdam University, Potsdam, Germany
| | - Salim Abdelilah-Seyfried
- Institute of Biochemistry and Biology, Potsdam University, Potsdam, Germany
- Institute of Molecular Biology, Hannover Medical School, Hannover, Germany
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Jeanette Erdmann
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
- Institute for Cardiogenetics, University Heart Centre Lübeck, University of Lübeck, Lübeck, Germany
| | - Teresa Trenkwalder
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Department of Cardiology, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Johannes Schumacher
- Institute of Human Genetics, University of Bonn and University Hospital Bonn, Bonn, Germany
- Institute of Human Genetics, Philipps University of Marburg, Marburg, Germany
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10
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Sugiura A, Zachoval C, Al-Kassou B, Shamekhi J, Vogelhuber J, Sudo M, Tanaka T, Weber M, Nickenig G, Zimmer S. Impact of New eGFR Equations on Risk Assessment In Patients Undergoing Transcatheter Aortic Valve Implantation. Cardiovasc Revasc Med 2023; 49:42-46. [PMID: 36609100 DOI: 10.1016/j.carrev.2022.12.011] [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: 10/20/2022] [Revised: 12/19/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Recently, the Chronic Kidney Disease-Epidemiology Collaboration working group has published new formulas for race-independent estimation of glomerular filtration rate (GFR). We investigated the old and new eGFR equations in patients transcatheter aortic valve implantation (TAVI). METHODS We conducted a retrospective analysis based on the data from a prospective registry of patients who underwent TAVI from January 2008 to May 2019. The primary endpoint was 30-day mortality after TAVI, and the secondary endpoints included one- and three-year mortality. RESULTS In total, 1792 patients undergoing TAVI were included in the present analysis. The thirty-day mortality was 4.6 % (95 % CI 3.8-5.7 %), and the one- and three-year mortality were 17.5 % (95 % CI 15.7-19.4 %) and 34.4 % (95 % CI 32.0-37.0 %). After the application of the new eGFR formula, 12.0 % of patients were reclassified within the GFR category in CKD, while 13.2 % of patients were reclassified within the GFR categories of the EuroSCORE II. Hazard ratios for 30-day, one-year, and three-year mortality increased after introduction of the new creatine-based eq. (1.51, 1.52, 1.49 vs. 1.87, 1.79, 1.74, respectively). Compared to the old equation, the new eGFR <60 ml/min/1.73 m2 had a better discrimination ability for the 30-day mortality (Harell's C: 0.563 (95 % CI 0.518-0.608) vs, 0.583 (95 % CI 0.546-0.636); delta Harell's C, 0.031 ± 0.022, p < 0.001). Similar findings were consistently observed in the cystatin creatinine-based equations. CONCLUSIONS The application of the new race-independent estimators of GFR results in the reassessment of renal function in a significant proportion of TAVI patients and may influence the risk stratification of this population.
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Affiliation(s)
- Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany
| | - Christian Zachoval
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany
| | - Baravan Al-Kassou
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany
| | - Jasmin Shamekhi
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany
| | - Johanna Vogelhuber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany
| | - Mitsumasa Sudo
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany
| | - Tetsu Tanaka
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany.
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11
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Veulemans V, Wilde N, Wienemann H, Adrichem R, Hokken TW, Al-Kassou B, Shamekhi J, Mauri V, Maier O, Jung C, Horn P, Adam M, Nickenig G, Baldus S, Van Mieghem NM, Kelm M, Sedaghat A, Zeus T. Impact of different guidewires on the implantation depth using the largest self-expandable TAVI device. Front Cardiovasc Med 2023; 9:1064916. [PMID: 36684595 PMCID: PMC9849574 DOI: 10.3389/fcvm.2022.1064916] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/05/2022] [Indexed: 01/07/2023] Open
Abstract
Background The deployment process of the largest self-expandable device (STHV-34) during transcatheter aortic valve implantation (TAVI) might be challenging due to stabilization issues. Whether the use of different TAVI-guidewires impact the procedural success and outcome is not well-known. Therefore, we sought to evaluate the impact of non-Lunderquist (NLu) vs. the Lunderquist (Lu) guidewires during TAVI using the STHV-34 on the procedural and 30-day outcomes. Methods The primary study endpoint was defined as the final implantation depth (ID) depending on the selected guidewire strategy. Key secondary endpoints included VARC-3-defined complications. Results The study cohort included 398 patients of four tertiary care institutions, of whom 79.6% (317/398) had undergone TAVI using NLu and 20.4% (81/398) using Lu guidewires. Baseline characteristics did not substantially differ between NLu and Lu patients. The average ID was higher in the Lu cohort (NLu vs. Lu: -5.2 [-7.0-(-3.5)] vs. -4.5 [-6.0-(-3.0)]; p = 0.022*). The optimal ID was reached in 45.0% of patients according to former and only in 20.1% according to nowadays best practice recommendations. There was no impact of the guidewire use on the 30-day outcomes, including conduction disturbances and pacemaker need (NLu vs. Lu: 15.1 vs. 18.5%; p = 0.706). Conclusion The use of the LunderquistTM guidewire was associated with a higher ID during TAVI with the STHV-34 without measurable benefits in the 30-day course concerning conduction disturbances and associated pacemaker need. Whether using different guidewires might impact the outcome in challenging anatomies should be further investigated in randomized studies under standardized conditions.
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Affiliation(s)
- Verena Veulemans
- Department of Cardiology, Pulmonology, and Vascular Diseases, University Hospital Düsseldorf, Düsseldorf, Germany,Cardiovascular Research Institute, Düsseldorf, Germany,*Correspondence: Verena Veulemans
| | - Nihal Wilde
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Hendrik Wienemann
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Rik Adrichem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Thijmen W. Hokken
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Baravan Al-Kassou
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Jasmin Shamekhi
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Victor Mauri
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Oliver Maier
- Department of Cardiology, Pulmonology, and Vascular Diseases, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christian Jung
- Department of Cardiology, Pulmonology, and Vascular Diseases, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Patrick Horn
- Department of Cardiology, Pulmonology, and Vascular Diseases, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Matti Adam
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Georg Nickenig
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | | | - Malte Kelm
- Department of Cardiology, Pulmonology, and Vascular Diseases, University Hospital Düsseldorf, Düsseldorf, Germany,Cardiovascular Research Institute, Düsseldorf, Germany
| | - Alexander Sedaghat
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Tobias Zeus
- Department of Cardiology, Pulmonology, and Vascular Diseases, University Hospital Düsseldorf, Düsseldorf, Germany
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12
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Wienemann H, Hof A, Ludwig S, Veulemans V, Sedaghat A, Iliadis C, Meertens M, Macherey S, Hohmann C, Kuhn E, Al-Kassou B, Wilde N, Schofer N, Bleiziffer S, Maier O, Kelm M, Baldus S, Rudolph TK, Adam M, Mauri V. Transcatheter aortic valve implantation with different self-expanding devices-a propensity score-matched multicenter comparison. Hellenic J Cardiol 2022; 70:1-9. [PMID: 36538975 DOI: 10.1016/j.hjc.2022.12.006] [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: 09/22/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Several supra-annular self-expanding transcatheter systems are commercially available for transcatheter aortic valve implantation (TAVI). Comparative data in large-scale multicenter studies are scant. METHODS This study included a total of 5175 patients with severe aortic stenosis undergoing TAVI with the ACURATE neo (n = 1095), Evolut R (n = 3365), or Evolut PRO (n = 715) by a transfemoral approach at five high-volume centers. Propensity score matching resulted in 654 triplets. Outcomes are reported according to the Valve Academic Research Consortium-3 (VARC-3) consensus. RESULTS Moderate or severe paravalvular regurgitation (PVR) occurred significantly more often in the ACURATE neo group (5.2%) than in the Evolut R (1.8%) and Evolut PRO (3.3%) groups (p = 0.003). The rates of major vascular-/access-related complications (4.6%, 3.8%, and 5.0%; p = 0.56), type 3 or 4 bleeding (3.2%, 2.1%, and 4.1%; p = 0.12), and 30-day mortality (2.4%, 2.6%, and 3.7%; p = 0.40) were comparable. The rate of new permanent pacemaker implantation (PPI) was significantly lower in the ACURATE neo group (9.5%, 17.6%, and 16.8%; p < 0.001). Independent predictors for 2-year survival were a Society of Thoracic Surgeons (STS) risk score ≥5%, diabetes mellitus, a glomerular filtration rate <30 ml/min, baseline mean transvalvular gradient ≤ 30 mm Hg, treating center, and relevant PVR. CONCLUSION In this multicenter study, TAVI with the ACURATE neo, Evolut R, or Evolut PRO was feasible and safe. The rate of relevant PVR was more frequent after the ACURATE neo implantation, with, however, lower rates of PPI. Two-year survival was mainly driven by baseline comorbidities.
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Affiliation(s)
- Hendrik Wienemann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Alexander Hof
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Sebastian Ludwig
- University Hamburg, University Heart and Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - Verena Veulemans
- Heinrich-Heine University, University Hospital Düsseldorf, Department of Cardiology, Pneumology, and Vascular Medicine, Düsseldorf, Germany
| | - Alexander Sedaghat
- University of Bonn, University Hospital Bonn, Clinic II for Internal Medicine, Bonn, Germany
| | - Christos Iliadis
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Max Meertens
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Sascha Macherey
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Christopher Hohmann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Elmar Kuhn
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Baravan Al-Kassou
- University of Bonn, University Hospital Bonn, Clinic II for Internal Medicine, Bonn, Germany
| | - Nihal Wilde
- University of Bonn, University Hospital Bonn, Clinic II for Internal Medicine, Bonn, Germany
| | - Niklas Schofer
- University Hamburg, University Heart and Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - Sabine Bleiziffer
- Ruhr University Bochum, Heart and Diabetes Centre North Rhine Westphalia, Clinic for Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Germany
| | - Oliver Maier
- Heinrich-Heine University, University Hospital Düsseldorf, Department of Cardiology, Pneumology, and Vascular Medicine, Düsseldorf, Germany
| | - Malte Kelm
- Heinrich-Heine University, University Hospital Düsseldorf, Department of Cardiology, Pneumology, and Vascular Medicine, Düsseldorf, Germany
| | - Stephan Baldus
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Tanja Katharina Rudolph
- Ruhr University Bochum, Heart and Diabetes Center North Rhine Westphalia, Clinic for General and Interventional Cardiology, Bad Oeynhausen, Germany
| | - Matti Adam
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Victor Mauri
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany.
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13
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Al-Kassou B, Al-Kassou L, Mahn TH, Luetjohann D, Shamekhi J, Willemsen N, Niepmann ST, Baldus S, Kelm M, Nickenig G, Zimmer S. Novel assay for quantifying the cholesterol crystal dissolution capacity of serum predicts outcomes in patients with severe aortic stenosis undergoing TAVR. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1623] [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
Aortic stenosis (AS) is the most common valvular heart disease (VHD) in developed countries. The pathophysiology of calcific AS has several clinical and pathobiological findings in common with atherosclerosis including chronic inflammation and lipoprotein deposition. Histopathological examination has revealed atherosclerosis-like lesions, that mainly contain cholesterol crystals (CC) in resected calcific aortic valve cusps. Previous studies have demonstrated that CCs can activate the NLRP3 inflammasome, resulting in an IL-1 driven systemic inflammation, that leads to the development of atherosclerotic plaques.
Purpose
In this study, we sought to validate a novel assay for measuring the serum capacity to dissolve cholesterol crystals (CCDC) in patients with AS and to examine whether this biomarker may be associated with clinical outcomes.
Methods
Our study cohort included 348 patients with AS undergoing transcatheter aortic valve replacement. The CCDC was measured using flow cytometry to enumerate CC, that were added to a 50% serum solution, at baseline and after two hours of incubation. The dissolution capacity was indicated as percentage change in CC count at baseline and after incubation. The study cohort was stratified according to the median CCDC into high and low CC dissolvers.
Results
The study population was 47.7% female and had a mean age of 80.9±6.2 years. The primary end point, a composite of one-year all-cause mortality and major vascular complication occurred less frequently in the high CCDC group (7.0%) as compared with the low CCDC group (15.3%, p=0.01). This was mainly driven by lower rates of one-year mortality in patients with a high CCDC (7.0% vs 13.6%, p=0.05), as presented in Figure 1. Furthermore, unplanned endovascular interventions were significantly less frequent in high CC dissolvers in contrast to low CC dissolvers (12.2% vs 20.5%, p=0.04). Although LDL cholesterol (101.8±37.3 mg/dL vs 97.9±37.6 mg/dL, p=0.35) and total cholesterol levels (158.1±43.8 mg/dL vs 154.1±40.2, p=0.41) were comparable in the high and low CCDC group, only patients with a low CCDC showed a benefit from statin treatment (Figure 2). In multivariate analysis, only low CCDC (OR: 2.51 [95% CI: 1.02–6.15], p=0.05) and Albumin (OR: 0.88 [95% CI: 0.79–0.98], p=0.03) were independently associated with one-year all-cause mortality
Conclusion
The CCDC is a novel biomarker associated with clinical outcome in patients with AS undergoing TAVR. It may provide new insights into patient's preventative anti-inflammatory capacity and additional prognostic information to identify vulnerable patients beyond classic risk assessment.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation).
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Affiliation(s)
| | - L Al-Kassou
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - T H Mahn
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - D Luetjohann
- University Hospital Bonn, Institute of Clinical Chemistry und Clinical Pharmacology , Bonn , Germany
| | - J Shamekhi
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - N Willemsen
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - S T Niepmann
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - S Baldus
- University hospital Koln, Department of Cardiology, Heart Center , Cologne , Germany
| | - M Kelm
- University Hospital Duesseldorf, Division of Cardiology , Duesseldorf , Germany
| | - G Nickenig
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - S Zimmer
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
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14
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Al-Kassou B, Veulemans V, Shamekhi J, Maier O, Aksoy A, Zietzer A, Meertens M, Weber M, Sinning JM, Adam M, Zimmer S, Baldus S, Kelm M, Nickenig G, Sedaghat A. Optimal protamine-to-heparin dosing ratio for the prevention of bleeding complications in patients undergoing TAVR – a multicentre experience. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1583] [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
Despite major advances, transcatheter aortic valve replacement (TAVR) is associated with procedure-related vascular and bleeding complications, that have a significant impact on mortality. A recently published study has shown that heparin antagonization using protamine resulted in significantly lower rates of serious bleeding events in patients undergoing TAVR as compared to those without heparin reversal. However, the optimal protamine-to-heparin dosing ratio to prevent bleeding complications without increasing ischemic complications in patients undergoing TAVR is unknown. Accordingly, daily clinical practice varies between selective to routine administration of protamine in different dosing ratios.
Purpose
The aim of this observational multicentre study was to compare the safety and efficacy of two different protamine-to-heparin dosing ratios for the prevention of bleeding complications after TAVR.
Methods
The study included 1446 patients undergoing TAVR, of whom 623 (43.1%) received partial and 823 (56.9%) full heparin antagonization (0.4–0.6 mg versus 0.9–1.0 mg protamine/100 units of heparin). The indication for partial or full heparin antagonization was left to the discretion of the operator, who made the decision according to the patient's individual thrombotic and bleeding risk. The primary endpoint was a composite of 30-day mortality, life-threatening and major bleeding. Safety endpoints included stroke and myocardial infarction at 30 days.
Results
The overall study population had a mean age of 81.1±6.0 years; 47.9% were of female gender.
The baseline characteristics were well balanced between the two groups. Full antagonization of heparin resulted in significantly lower rates of the primary endpoint as compared to partial heparin reversal (5.6 vs. 10.4%, p<0.01), mainly driven by lower rates of life-threatening (0.5 vs 1.6%, p=0.05) and major bleeding (3.2 vs 7.5%, p<0.01). The incidence of major vascular complications was significantly lower in patients with full heparin reversal (3.5 vs 7.5%, p<0.01), as presented in Figure 1. Accordingly, the post-interventional drop in hemoglobin level and the need for red-blood-cell transfusion was lower in patients receiving full as compared to partial heparin reversal (1.5±1.2 vs 1.7±1.2 g/dl, p<0.01; 10.4 vs 15.9%, p<0.01, respectively). Regarding safety endpoints, no differences were observed in the incidence of stroke and myocardial infarction between the groups (2.2 vs 2.6%, p=0.73 and 0.2 vs 0.4%, p=0.64, respectively). Multivariate regression analyses revealed that full antagonization of heparin (OR: 0.43 [95% CI: 0.24–0.81], p<0.01) was independently associated with the primary end point
Conclusion
Full heparin antagonization resulted in significantly lower rates of life-threatening and major bleeding after TAVR as compared to partial heparin reversal. The occurrence of stroke and myocardial infarction was low and comparable between both groups.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation).
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Affiliation(s)
- B Al-Kassou
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - V Veulemans
- University Hospital Duesseldorf, Division of Cardiology , Duesseldorf , Germany
| | - J Shamekhi
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - O Maier
- University Hospital Duesseldorf, Division of Cardiology , Duesseldorf , Germany
| | - A Aksoy
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - A Zietzer
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - M Meertens
- University hospital Koln, Department of Cardiology, Heart Center , Cologne , Germany
| | - M Weber
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - J M Sinning
- St Vinzenz-Hospital, Department of Cardiology , Cologne , Germany
| | - M Adam
- University hospital Koln, Department of Cardiology, Heart Center , Cologne , Germany
| | - S Zimmer
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - S Baldus
- University hospital Koln, Department of Cardiology, Heart Center , Cologne , Germany
| | - M Kelm
- University Hospital Duesseldorf, Division of Cardiology , Duesseldorf , Germany
| | - G Nickenig
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
| | - A Sedaghat
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology , Bonn , Germany
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Shamekhi J, Hasse C, Veulemans V, Al-Kassou B, Piayda K, Maier O, Zeus T, Weber M, Sedaghat A, Zimmer S, Kelm M, Nickenig G, Sinning JM. A simplified cardiac damage staging predicts the outcome of patients undergoing TAVR-A multicenter analysis. Catheter Cardiovasc Interv 2022; 100:850-859. [PMID: 35989489 DOI: 10.1002/ccd.30368] [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: 05/23/2022] [Revised: 07/24/2022] [Accepted: 08/10/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND A significant number of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) suffer from extra-aortic cardiac damage. Few studies have investigated strategies to quantify cardiac damage and stratify patients accordingly in different risk groups. The aim of this retrospective multicenter study was to provide a user-friendly simplified staging system based on the proposed classification system of Généreux et al. as a tool to evaluate the prognosis of patients undergoing TAVR more easily. Moreover, we analyzed changes in cardiac damage after TAVR. METHODS We assessed cardiac damage in patients, who underwent TAVR at the Heart Center Bonn or Düsseldorf, using pre- and postprocedural transthoracic echocardiography. Patients were assigned to the staging system proposed by Généreux et al. according to the severity of their baseline cardiac damage. Based on the established system, we created a simplified staging system to facilitate improved applicability. Finally, we compared clinical outcomes between the groups and evaluated changes in cardiac damage after TAVR. RESULTS A total of 933 TAVR patients were included in the study. We found a significant association between cardiac damage and 1-year all-cause mortality (stage 0: 0% vs. stage 1: 3% vs. stage 2: 6.6%; p < 0.009). In multivariate analysis, cardiac damage was an independent predictor of 1-year all-cause mortality (hazard ratio: 2.0, 95% confidence interval: 1.1-3.8; p = 0.03). CONCLUSIONS In patients undergoing TAVR, cardiac damage is associated with enhanced mortality. A simplified staging system can help identify patients at high risk for an adverse outcome.
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Affiliation(s)
- Jasmin Shamekhi
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Caroline Hasse
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Verena Veulemans
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Baravan Al-Kassou
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Kerstin Piayda
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Oliver Maier
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Tobias Zeus
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Marcel Weber
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Alexander Sedaghat
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Malte Kelm
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Georg Nickenig
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Jan-Malte Sinning
- Department of Cardiology, St. Vinzenz-Hospital Cologne, Cologne, Germany
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16
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Zietzer A, Breitrück N, Düsing P, Böhle S, Klussmann JP, Al-Kassou B, Goody PR, Hosen MR, Nickenig G, Nachtsheim L, Shabli S, Jansen F, Jansen S. The lncRNA MRPL20-AS1 is associated with severe OSAS and downregulated upon hypoxic injury of endothelial cells. Int J Cardiol 2022; 369:65-68. [PMID: 35988669 DOI: 10.1016/j.ijcard.2022.08.035] [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] [Received: 05/20/2022] [Revised: 07/15/2022] [Accepted: 08/16/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Obstructive sleep apnea syndrome (OSAS) is the most common sleep disorder in humans. Although OSAS is clearly related to arterial hypertension, coronary artery disease, and heart failure, it remains unknown through which pathomechanisms OSAS influences cardiovascular health. Recent research has pinpointed long non-coding RNAs (lncRNA) as important molecular mediators of various cardiovascular pathologies. In this study, we have identified the lncRNA MRPL20-AS1 to be affected by OSAS in patients as well as by hypoxia in vitro. METHODS AND RESULTS A transcriptomic analysis was performed on peripheral blood from four patients with severe OSAS taken after one night of polygraphic assessment. We found that three lncRNAs were significantly dysregulated, of which MRPL20-AS1 was the most significant. In a larger cohort of 22 OSAS patients, MRPL20-AS1 was inversely correlated with the apnea-hypopnea index (AHI). This indicates that OSAS patients with higher AHI levels and therefore more severe OSAS had lower levels of MRPL20-AS1 in the blood. The results were recapitulated in vitro by subjecting endothelial cells to hypoxia. In these experiments, hypoxia led to a significant downregulation of MRPL20-AS1 in endothelial cells. CONCLUSION MRPL20-AS1 may serve as a useful tool to identify patients suffering from severe OSAS and further research should be done to evaluate the therapeutic potential of MRPL20-AS1 as a target to counteract the cardiovascular effects of OSAS.
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Affiliation(s)
- Andreas Zietzer
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Bonn, Germany.
| | - Nils Breitrück
- Head and Neck Surgery, Department of Otorhinolaryngology, Medical Faculty, University of Cologne, Germany
| | - Philip Düsing
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Sabrina Böhle
- Head and Neck Surgery, Department of Otorhinolaryngology, Medical Faculty, University of Cologne, Germany
| | - Jens Peter Klussmann
- Head and Neck Surgery, Department of Otorhinolaryngology, Medical Faculty, University of Cologne, Germany
| | - Baravan Al-Kassou
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Philip Roger Goody
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Mohammed Rabiul Hosen
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Lisa Nachtsheim
- Head and Neck Surgery, Department of Otorhinolaryngology, Medical Faculty, University of Cologne, Germany
| | - Sami Shabli
- Head and Neck Surgery, Department of Otorhinolaryngology, Medical Faculty, University of Cologne, Germany
| | - Felix Jansen
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Stefanie Jansen
- Head and Neck Surgery, Department of Otorhinolaryngology, Medical Faculty, University of Cologne, Germany
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Landes U, Richter I, Danenberg H, Kornowski R, Sathananthan J, De Backer O, Søndergaard L, Abdel-Wahab M, Yoon SH, Makkar RR, Thiele H, Kim WK, Hamm C, Buzzatti N, Montorfano M, Ludwig S, Schofer N, Voigtlaender L, Guerrero M, El Sabbagh A, Rodés-Cabau J, Mesnier J, Okuno T, Pilgrim T, Fiorina C, Colombo A, Mangieri A, Eltchaninoff H, Nombela-Franco L, Van Wiechen MP, Van Mieghem NM, Tchétché D, Schoels WH, Kullmer M, Barbanti M, Tamburino C, Sinning JM, Al-Kassou B, Perlman GY, Ielasi A, Fraccaro C, Tarantini G, De Marco F, Witberg G, Redwood SR, Lisko JC, Babaliaros VC, Laine M, Nerla R, Finkelstein A, Eitan A, Jaffe R, Ruile P, Neumann FJ, Piazza N, Sievert H, Sievert K, Russo M, Andreas M, Bunc M, Latib A, Bruoha S, Godfrey R, Hildick-Smith D, Barbash I, Segev A, Maurovich-Horvat P, Szilveszter B, Spargias K, Aravadinos D, Nazif TM, Leon MB, Webb JG. Outcomes of Redo Transcatheter Aortic Valve Replacement According to the Initial and Subsequent Valve Type. JACC Cardiovasc Interv 2022; 15:1543-1554. [DOI: 10.1016/j.jcin.2022.05.016] [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: 02/24/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 10/17/2022]
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18
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Sudo M, Shamekhi J, Sedaghat A, Aksoy A, Zietzer A, Tanaka T, Wilde N, Weber M, Sinning JM, Grube E, Veulemans V, Adam M, Kelm M, Baldus S, Nickenig G, Zimmer S, Tiyerili V, Al-Kassou B. Predictive value of the Fibrosis-4 index in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Clin Res Cardiol 2022; 111:1367-1376. [DOI: 10.1007/s00392-022-02055-6] [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: 01/22/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022]
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19
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Hoffmann J, Tabata N, Mas-Peiro S, Spyridopoulos I, Sinning JM, Berkowitsch A, Martin-Ruiz C, Al-Kassou B, Herrmann E, Dimmeler S, Zeiher AM, Vasa-Nicotera M. Longer leukocyte telomere length is associated with myeloid inflammation and increased mortality after transcatheter aortic valve replacement. European Heart Journal Open 2022; 2:oeac045. [PMID: 35983406 PMCID: PMC9380992 DOI: 10.1093/ehjopen/oeac045] [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] [Received: 02/16/2022] [Revised: 05/09/2022] [Indexed: 12/04/2022]
Abstract
Aims Inflammatory activation of leukocytes may limit prognosis of patients (pts) with severe aortic valve stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Leukocyte telomere length (LTL) is a marker of proliferative capacity and inflammatory responsiveness but the impact of LTL on the prognosis in AS remains elusive. The aim of this study was to analyse the association of LTL with inflammatory markers and prognosis of pts undergoing TAVR. Methods and results LTL was analysed using quantitative real-time PCR in 285 consecutive pts (median age 82 years) undergoing TAVR and correlated with 18-month all-cause mortality. C-reactive protein was significantly elevated in pts with the longest LTL (P = 0.017), paralleled by increased procalcitonin (PCT) serum levels (P = 0.0006). This inflammatory reaction was accompanied by increased myeloid cells in the highest LTL tertile, mainly a rise in circulating neutrophils (P = 0.0025) and monocytes (P = 0.01). Multivariate analysis revealed LTL (HR 2.6, 95%CI 1.4–5.1, P= 0.004) and PCT levels (HR 4.3, 95%CI 1.7–11.0, P = 0.003) as independent predictors of mortality. Conclusions Longer LTL is associated with increased mortality after TAVR. This might be explained by enhanced proliferative capacity of cells resulting in myeloid and systemic inflammation. Our findings suggest that targeting the specific inflammation pathways could present a novel strategy to augment survival in selected patients with degenerative aortic stenosis.
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Affiliation(s)
- Jedrzej Hoffmann
- Department of Medicine, Cardiology, Goethe University Hospital , Frankfurt , Germany
- German Center for Cardiovascular Research DZHK, Partner Site Rhine-Main , Berlin , Germany
| | - Noriaki Tabata
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn , Bonn , Germany
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
| | - Silvia Mas-Peiro
- Department of Medicine, Cardiology, Goethe University Hospital , Frankfurt , Germany
- German Center for Cardiovascular Research DZHK, Partner Site Rhine-Main , Berlin , Germany
- Cardiopulmonary Institute, Goethe University Frankfurt , Frankfurt , Germany
| | - Ioakim Spyridopoulos
- Translational and Clinical Research Institute, Newcastle University , Newcastle upon Tyne, UK
| | - Jan-Malte Sinning
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn , Bonn , Germany
| | - Alexander Berkowitsch
- Department of Medicine, Cardiology, Goethe University Hospital , Frankfurt , Germany
| | - Carmen Martin-Ruiz
- Newcastle University Bioscience Institute, Newcastle University , Newcastle upon Tyne , UK
- BioScreening Core facility, Campus for Ageing and Vitality, Newcastle University , Newcastle upon Tyne , UK
| | - Baravan Al-Kassou
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn , Bonn , Germany
| | - Eva Herrmann
- German Center for Cardiovascular Research DZHK, Partner Site Rhine-Main , Berlin , Germany
- Institute of Biostatistics and Mathematical Modelling, Goethe University , Frankfurt , Germany
| | - Stefanie Dimmeler
- Institute of Cardiovascular Regeneration, Center of Molecular Medicine, Goethe University Frankfurt , Germany
- German Center for Cardiovascular Research DZHK, Partner Site Rhine-Main , Berlin , Germany
- Cardiopulmonary Institute, Goethe University Frankfurt , Frankfurt , Germany
| | - Andreas M Zeiher
- Department of Medicine, Cardiology, Goethe University Hospital , Frankfurt , Germany
- German Center for Cardiovascular Research DZHK, Partner Site Rhine-Main , Berlin , Germany
- Cardiopulmonary Institute, Goethe University Frankfurt , Frankfurt , Germany
| | - Mariuca Vasa-Nicotera
- Department of Medicine, Cardiology, Goethe University Hospital , Frankfurt , Germany
- German Center for Cardiovascular Research DZHK, Partner Site Rhine-Main , Berlin , Germany
- Cardiopulmonary Institute, Goethe University Frankfurt , Frankfurt , Germany
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Al-Kassou B, Aksoy A, Shamekhi J, Zietzer A, Sinning JM, Grube E, Bakhtiary F, Zimmer S, Nickenig G, Sedaghat A. Impact of Transradial Versus Transfemoral Artery Approach for Pre-Procedural Coronary Angiography on Outcomes in Patients Undergoing Subsequent TAVR. Cardiovascular Revascularization Medicine 2022. [DOI: 10.1016/j.carrev.2022.06.212] [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: 11/03/2022]
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21
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Sugiura A, Sudo M, Al-Kassou B, Shamekhi J, Silaschi M, Wilde N, Sedaghat A, Becher UM, Weber M, Sinning JM, Grube E, Nickenig G, Charitos EI, Zimmer S. Percutaneous trans-axilla transcatheter aortic valve replacement. Heart Vessels 2022; 37:1801-1807. [PMID: 35505257 PMCID: PMC9399016 DOI: 10.1007/s00380-022-02082-3] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/15/2022] [Indexed: 11/26/2022]
Abstract
The left axillary artery is an attractive alternative access route for transcatheter aortic valve replacement (TAVR) and may provide better outcomes compared to other alternatives. Nevertheless, there remain concerns about vascular complications, lack of compressibility, and thorax-related complications. Between March 2019 and March 2021, 13 patients underwent transaxillary TAVR for severe aortic stenosis at the University Hospital Bonn. The puncture was performed with a puncture at the distal segment of the axillary artery through the axilla, with additional femoral access for applying a safety wire inside the axillary artery. Device success was defined according to the VARC 2 criteria. The study participants were advanced in age (77 ± 9 years old), and 54% were female, with an intermediate risk for surgery (STS risk score 4.7 ± 2.0%). The average diameter of the distal segment of the axillary artery was 5.8 ± 1.0 mm (i.e., the puncture site) and 7.6 ± 0.9 mm for the proximal axillary artery. Device success was achieved in all patients. 30-day major adverse cardiac and cerebrovascular events were 0%. With complete percutaneous management, stent-graft implantation was performed at the puncture site in 38.5% of patients. Minor bleeding was successfully managed with manual compression. Moreover, no thorax-related complications, hematomas, or nerve injuries were observed. Percutaneous trans-axilla TAVR was found to be feasible and safe. This modified approach may mitigate the risk of bleeding and serious complications in the thorax and be less invasive than surgical alternatives.
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Affiliation(s)
- Atsushi Sugiura
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Mitsumasa Sudo
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Baravan Al-Kassou
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Jasmin Shamekhi
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Miriam Silaschi
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Nihal Wilde
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Alexander Sedaghat
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Ulrich Marc Becher
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Jan-Malte Sinning
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Eberhard Grube
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Efstratios I Charitos
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.
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22
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Seoudy H, Shamekhi J, Voigtländer L, Ludwig S, Frank J, Kujat T, Bramlage P, Al-Kassou B, Sugiura A, Rangrez AY, Schofer N, Puehler T, Lutter G, Seiffert M, Nickenig G, Conradi L, Frey N, Westermann D, Sinning JM, Frank D. C-Reactive Protein to Albumin Ratio in Patients Undergoing Transcatheter Aortic Valve Replacement. Mayo Clin Proc 2022; 97:931-940. [PMID: 35410750 DOI: 10.1016/j.mayocp.2021.11.022] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 10/11/2021] [Accepted: 11/03/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate whether the serum C-reactive protein to albumin ratio (CAR) could be used for risk stratification of patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS). PATIENTS AND METHODS Frailty is a predictor of poor outcomes in patients undergoing AS interventions. The CAR reflects key components of frailty (systemic inflammation and nutrition) and could potentially be implemented into assessment and management strategies for patients with AS. From March 1, 2010, through February 29, 2020, 1836 patients were prospectively enrolled in an observational TAVR database. Patients (prospective development cohort, n=763) were grouped into CAR quartiles to compare the upper quartile (CAR Q4) with the lower quartiles (CAR Q1-3). Primary end point was all-cause mortality. Results were verified in an independent retrospective cohort (n=1403). RESULTS The CAR Q4 had a higher prevalence of impaired left ventricular function, atrial fibrillation, diabetes, and cerebrovascular disease and a higher median logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) vs CAR Q1-3. After median follow-up of 15.0 months, all-cause mortality was significantly higher in CAR Q4 vs CAR Q1-3 (P<.001). In multivariable analyses, risk factors for all-cause mortality were CAR Q4 (>0.1632; hazard ratio, 1.45; 95% confidence interval, 1.05 to 2.00; P=.03), N-terminal pro-B-type natriuretic peptide Q4 (>3230 pg/mL [to convert to ng/L, multiply by 1), high-sensitivity troponin T Q4 (>0.0395 ng/mL [to convert to μg/L, multiply by 1]), above-median logistic EuroSCORE (16.1%), myocardial infarction, Acute Kidney Injury Network stage 3, and life-threatening bleeding. CONCLUSION Elevated CAR was associated with increased risk of all-cause mortality in patients undergoing transfemoral TAVR. The CAR, a simple, objective tool to assess frailty, could be incorporated into assessing patients with AS being considered for TAVR.
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Affiliation(s)
- Hatim Seoudy
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Jasmin Shamekhi
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Lisa Voigtländer
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Sebastian Ludwig
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Johanne Frank
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Tim Kujat
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Baravan Al-Kassou
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Atsushi Sugiura
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Ashraf Yusuf Rangrez
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Niklas Schofer
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Thomas Puehler
- Department of Cardiac and Vascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Georg Lutter
- Department of Cardiac and Vascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Moritz Seiffert
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Georg Nickenig
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Norbert Frey
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Dirk Westermann
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Jan-Malte Sinning
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Derk Frank
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany.
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Shamekhi J, Nguyen TQA, Sigel H, Maier O, Piayda K, Zeus T, Al-Kassou B, Weber M, Zimmer S, Sugiura A, Wilde N, Kelm M, Nickenig G, Veulemans V, Sedaghat A. Left atrial function index (LAFI) and outcome in patients undergoing transcatheter aortic valve replacement. Clin Res Cardiol 2022; 111:944-954. [PMID: 35320406 PMCID: PMC9334426 DOI: 10.1007/s00392-022-02010-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/08/2022] [Indexed: 11/18/2022]
Abstract
Background Clinical data regarding the association between the left atrial function index (LAFI) and outcome in patients undergoing transcatheter aortic valve replacement (TAVR) are limited. Objectives We aimed to investigate the association between the left atrial function index (LAFI) and outcome in patients undergoing TAVR. Methods In this retrospective multicenter study, we assessed baseline LAFI in 733 patients undergoing TAVR for severe aortic stenosis in two German high-volume centers between 2008 and 2019. Based on receiver operating characteristic curves, patients were stratified according to their baseline LAFI into two groups (LAFI ≤ 13.5 vs. LAFI > 13.5) and assessed for post-procedural outcome. The primary endpoint of our study was the 1-year all-cause mortality. Results Patients with a LAFI ≤ 13.5 had significantly more often atrial fibrillation (p < 0.001), lower LVEF (p < 0.001) and higher levels of NT-proBNP (p < 0.001). After TAVR, a significant improvement in the LAFI as compared to baseline was observed at 12 months after the procedure (28.4 vs. 32.9; p = 0.001). Compared to patients with a LAFI > 13.5, those with a LAFI ≤ 13.5 showed significantly higher rate of 1-year mortality (7.9% vs. 4.0%; p = 0.03). A lower LAFI has been identified as independent predictor of mortality in multivariate analysis (HR (95% CI) 2.0 (1.1–3.9); p = 0.03). Conclusion A reduced LAFI is associated with adverse outcome and an independent predictor of mortality in TAVR patients. TAVR improves LAFI within 12 months after the procedure. Graphical abstract Left Atrial Function Index (LAFI) in Patients undergoing Transcatheter Aortic Valve Implantation. A Kaplan–Meier survival analysis of 1-year all-cause mortality in patients with LAFI ≤ 13.5 compared with patients with LAFI > 13.5. Comparing rates of 1-year all-cause mortality between the different LAFI groups, we found a significant association between left atrial function and mortality. LAFI Left atrial function index. B Comparison of the mean LAFI before and after TAVR. After long-term follow-up the LAFI improved significantly. LAFI Left atrial function index; FU follow-up. C Assessment of the left atrial function index using the pre-procedural transthoracic echocardiography. A Measurement of the minimal left atrial volume (LAEDV). B Assessment of the maximal left atrial volume (LAESV). ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-022-02010-5.
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Affiliation(s)
- Jasmin Shamekhi
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Thi Quynh Anh Nguyen
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Helen Sigel
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Oliver Maier
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Kerstin Piayda
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Tobias Zeus
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Baravan Al-Kassou
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Nihal Wilde
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Malte Kelm
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Verena Veulemans
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Alexander Sedaghat
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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Morais P, Nelles D, Vij V, Al-Kassou B, Weber M, Nickenig G, Schrickel JW, Vilaca J, Sedaghat A. Assessment of LAA strain and thrombus mobility and its impact on thrombus resolution - value of a novel echocardiographic thrombus tracking method. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.294] [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
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): FCT – Fundação para a Ciência e Tecnologia Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER)
Background
The left atrial appendage (LAA) is the major nidus for thrombus in patients with non-valvular atrial fibrillation. LAA thrombus mobility and changes hereof under anticoagulation may serve as a marker of both risk of embolism and efficacy of treatment. In this study, we hypothesized that LAA dynamics and thrombus mobility could serve as a baseline marker of thrombus dissolvability.
Methods
Transesophageal echocardiographic (TEE) images of in whom LAA thrombi were previously diagnosed were evaluated. Each image was tracked using a state-of-the-art tracking toolbox and functional information from the LAA and thrombi extracted. Global LAA motion was quantified through the longitudinal strain, while thrombus mobility was measured through a novel tracking scheme by directly capturing and measuring the thrombus motion isolated from the global cardiac motion. Baseline characteristics and echocardiographic parameters were compared between responders (thrombus resolution, i.e. no thrombus found at follow-up TEE) and non-responders (thrombus persistence or growth, i.e. thrombus found at follow up TEE) groups.
Results
35 patients (54.3% male and 45.7% female) with a mean age of 72.9 ± 14.1 years were included. Atrial fibrillation was present in all patients, showing a high risk for thromboembolism (CHA2DS2-VASc-Score 4.1 ± 1.5). Moderately reduced LVEF (41.7 ± 14.4%) and signs of diastolic dysfunction (E/E’ = 19.7 ± 8.5) was found in the cohort. While anticoagulation was initiated in all patients, resolution was achieved in 51.4% of patients. Significantly higher thrombus mobility (0.33 ± 0.13mm vs. 0.18 ± 0.08mm, p < 0.01 – Figure 1A) and LAA peak strain (-3.0 ± 1.3 vs -1.6 ± 1.5%, p < 0.01 – Figure 1B) were observed in responders against the non-responders group.
Conclusions
The quantification of the thrombus mobility through a tracking scheme is feasible. In our study population, higher thrombus mobility appeared to be associated with thrombus resolution. Further studies are required to evaluate the additional prognostic of the proposed technique.
Figure 1 – Quantification of the thrombus mobility (A) and peak LAA longitudinal strain (B) in both responder (blue) and non-responder group (green). *p < 0.05, unpaired t-test between non-responder and responder groups. Abstract Figure 1
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Affiliation(s)
- P Morais
- 2Ai – School of Technology, IPCA, Barcelos, Portugal
| | - D Nelles
- Med. Klinik Und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - V Vij
- Med. Klinik Und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - B Al-Kassou
- Med. Klinik Und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - M Weber
- Med. Klinik Und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - G Nickenig
- Med. Klinik Und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - JW Schrickel
- Med. Klinik Und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - J Vilaca
- 2Ai – School of Technology, IPCA, Barcelos, Portugal
| | - A Sedaghat
- Med. Klinik Und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
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25
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Wilde N, Rogmann M, Mauri V, Piayda K, Schmitz MT, Al-Kassou B, Shamekhi J, Maier O, Sugiura A, Weber M, Zimmer S, Zeus T, Kelm M, Adam M, Baldus S, Nickenig G, Veulemans V, Sedaghat A. Haemodynamic differences between two generations of a balloon-expandable transcatheter heart valve. Heart 2022; 108:1479-1485. [PMID: 35039329 DOI: 10.1136/heartjnl-2021-320084] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/07/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study aimed to investigate early haemodynamic and clinical performance of the SAPIEN 3 Ultra (S3 Ultra) transcatheter heart valve (THV) system in comparison to its precursor, the SAPIEN 3 (S3). Previous studies have indicated potential haemodynamic differences between the S3 Ultra and S3. Such differences may impact clinical outcome after transcatheter aortic valve implantation (TAVI). METHODS Postprocedural haemodynamic performance and 30-day clinical outcome were compared in patients who underwent TAVI receiving either the S3 or the new S3 Ultra prostheses. Multivariable analysis and propensity score matching (PSM) were used to identify factors associated with higher mean transvalvular gradients. RESULTS We included 697 patients (S3 Ultra: n=314, S3: n=383) from the multicentre RhineHeart TAVI Registry. Patients receiving the S3 Ultra prosthesis showed significantly higher postprocedural mean transvalvular gradients (14.2±4.8 vs 10.2±4.4 mm Hg; p<0.01). Multivariable logistic regression analyses and additional PSM revealed the use of the S3 Ultra to be associated with higher postprocedural mean transvalvular gradients (p<0.01). 30-day clinical outcomes, such as mortality, myocardial infarction, permanent pacemaker implantation and vascular complications were comparable between the groups. CONCLUSIONS The new S3 Ultra THV was associated with a higher postprocedural mean transvalvular gradient compared with the S3 system, while there was no difference in mortality or adverse clinical outcomes at 30 days. These echocardiographic differences will require long-term studies to assess the clinical relevance of this finding.
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Affiliation(s)
- Nihal Wilde
- Heart Centre Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marc Rogmann
- Heart Centre Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Victor Mauri
- Heart Centre Cologne, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Kerstin Piayda
- Department of Cardiology, Pulmonology, and Angiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Marie-Therese Schmitz
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Baravan Al-Kassou
- Heart Centre Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Jasmin Shamekhi
- Heart Centre Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Oliver Maier
- Department of Cardiology, Pulmonology, and Angiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Atsushi Sugiura
- Heart Centre Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Heart Centre Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Heart Centre Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Tobias Zeus
- Department of Cardiology, Pulmonology, and Angiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology, and Angiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Matti Adam
- Heart Centre Cologne, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Stephan Baldus
- Heart Centre Cologne, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Georg Nickenig
- Heart Centre Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Verena Veulemans
- Department of Cardiology, Pulmonology, and Angiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Alexander Sedaghat
- Heart Centre Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
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26
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Zietzer A, Steffen E, Niepmann S, Düsing P, Hosen MR, Liu W, Jamme P, Al-Kassou B, Goody PR, Zimmer S, Reiners KS, Pfeifer A, Böhm M, Werner N, Nickenig G, Jansen F. MicroRNA-mediated vascular intercellular communication is altered in chronic kidney disease. Cardiovasc Res 2022; 118:316-333. [PMID: 33135066 DOI: 10.1093/cvr/cvaa322] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 10/23/2020] [Indexed: 02/27/2024] Open
Abstract
AIMS Chronic kidney disease (CKD) is an independent risk factor for the development of coronary artery disease (CAD). For both, CKD and CAD, the intercellular transfer of microRNAs (miRs) through extracellular vesicles (EVs) is an important factor of disease development. Whether the combination of CAD and CKD affects endothelial function through cellular crosstalk of EV-incorporated miRs is still unknown. METHODS AND RESULTS Out of 172 screened CAD patients, 31 patients with CAD + CKD were identified and matched with 31 CAD patients without CKD. Additionally, 13 controls without CAD and CKD were included. Large EVs from CAD + CKD patients contained significantly lower levels of the vasculo-protective miR-130a-3p and miR-126-3p compared to CAD patients and controls. Flow cytometric analysis of plasma-derived EVs revealed significantly higher numbers of endothelial cell-derived EVs in CAD and CAD + CKD patients compared to controls. EVs from CAD + CKD patients impaired target human coronary artery endothelial cell (HCAEC) proliferation upon incubation in vitro. Consistent with the clinical data, treatment with the uraemia toxin indoxyl sulfate (IS)-reduced miR-130a-3p levels in HCAEC-derived EVs. EVs from IS-treated donor HCAECs-reduced proliferation and re-endothelialization in EV-recipient cells and induced an anti-angiogenic gene expression profile. In a mouse-experiment, intravenous treatment with EVs from IS-treated endothelial cells significantly impaired endothelial regeneration. On the molecular level, we found that IS leads to an up-regulation of the heterogenous nuclear ribonucleoprotein U (hnRNPU), which retains miR-130a-3p in the cell leading to reduced vesicular miR-130a-3p export and impaired EV-recipient cell proliferation. CONCLUSION Our findings suggest that EV-miR-mediated vascular intercellular communication is altered in patients with CAD and CKD, promoting CKD-induced endothelial dysfunction.
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Affiliation(s)
- Andreas Zietzer
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Eva Steffen
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Sven Niepmann
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Philip Düsing
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Mohammed Rabiul Hosen
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Weiyi Liu
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Paul Jamme
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Baravan Al-Kassou
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Philipp Roger Goody
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Sebastian Zimmer
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Katrin S Reiners
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alexander Pfeifer
- Institute of Pharmacology and Toxicology, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Michael Böhm
- Medical Department III, Faculty of Medicine, Saarland University Medical Center, Saarland University, Kirrberger Straße 100, 66421 Homburg, Germany
| | - Nikos Werner
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Medical Department II, Krankenhaus der Barmherzigen Brüder Trier, Nordallee 1, 54292 Trier, Germany
| | - Georg Nickenig
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Felix Jansen
- Department of Internal Medicine II, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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Morais P, Nelles D, Vij V, Al-Kassou B, Weber M, Nickenig G, Schrickel JW, Vilaça JL, Sedaghat A. Assessment of LAA Strain and Thrombus Mobility and Its Impact on Thrombus Resolution-Added-Value of a Novel Echocardiographic Thrombus Tracking Method. Cardiovasc Eng Technol 2022; 13:950-960. [PMID: 35562637 PMCID: PMC9750899 DOI: 10.1007/s13239-022-00629-z] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/27/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE The mobility of left atrial appendage (LAA) thrombi and changes hereof under anticoagulation may serve as a marker of both risk of embolism and efficacy of treatment. In this study, we sought to evaluate thrombus mobility and hypothesized that LAA dynamics and thrombus mobility could serve as a baseline marker of thrombus dissolvability. METHODS Patients with two-dimensional transesophageal echocardiographic images of the LAA, and with evidence of LAA thrombus were included in this study. Using a speckle tracking algorithm, functional information from the LAA and thrombi of different patients was computed. While the LAA motion was quantified through the longitudinal strain, thrombus mobility was evaluated using a novel method by directly tracking the thrombus, isolated from the global cardiac motion. Baseline characteristics and echocardiographic parameters were compared between responders (thrombus resolution) and non-responders (thrombus persistence) to anticoagulation. RESULTS We included 35 patients with atrial fibrillation with evidence of LAA thrombi. Patients had a mean age of 72.9 ± 14.1 years, exhibited a high risk for thromboembolism (CHA2DS2-VASc-Score 4.1 ± 1.5) and had moderately reduced LVEF (41.7 ± 14.4%) and signs of diastolic dysfunction (E/E' = 19.7 ± 8.5). While anticoagulation was initiated in all patients, resolution was achieved in 51.4% of patients. Significantly higher LAA peak strain (- 3.0 ± 1.3 vs. - 1.6 ± 1.5%, p < 0.01) and thrombus mobility (0.33 ± 0.13 mm vs. 0.18 ± 0.08 mm, p < 0.01) were observed in patients in whom thrombi resolved (i.e. responders against non-responders). Receiver operating characteristic (ROC) analysis revealed a high discriminatory ability for thrombus mobility with regards to thrombus resolution (AUC 0.89). CONCLUSION Isolated tracking of thrombus mobility from echocardiographic images is feasible. In patients with LAA thrombus, higher thrombus mobility appeared to be associated with thrombus resolution. Future studies should be conducted to evaluate the role of the described technique to predict LAA thrombus resolution or persistence.
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Affiliation(s)
- Pedro Morais
- 2Ai – School of Technology, IPCA, Barcelos, Portugal
| | - Dominik Nelles
- Med. Klinik und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - Vivian Vij
- Med. Klinik und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - Baravan Al-Kassou
- Med. Klinik und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - Marcel Weber
- Med. Klinik und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - Georg Nickenig
- Med. Klinik und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | - Jan Wilko Schrickel
- Med. Klinik und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
| | | | - Alexander Sedaghat
- Med. Klinik und Poliklinik II, Herzzentrum Bonn, Universitätsklinikum Bonn, Bonn, Germany
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Nelles D, Vij V, Al-Kassou B, Weber M, Vogelhuber J, Beiert T, Nickenig G, Schrickel JW, Sedaghat A. Incidence, persistence, and clinical relevance of iatrogenic atrial septal defects after percutaneous left atrial appendage occlusion. Echocardiography 2021; 39:65-73. [PMID: 34921426 DOI: 10.1111/echo.15271] [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: 07/05/2021] [Revised: 10/29/2021] [Accepted: 11/21/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate the rate and clinical impact of a persisting iatrogenic atrial septal defect (iASD) after percutaneous left atrial appendage occlusion (LAAO). BACKGROUND Percutaneous LAAO is an alternative to oral anticoagulation (OAC) for the prevention of ischemic stroke and systemic embolism in patients with atrial fibrillation (AF). Data regarding incidence and persistence of iASD after LAAO procedures and its clinical relevance is scarce. METHODS We retrospectively analyzed 144 patients that underwent LAAO at our center between 2009 and 2020 who had at least one follow-up including transesophageal echocardiography (TEE). Baseline clinical, procedural data and echocardiographic characteristics in patients with and without evidence of an iASD were compared. We furthermore determined the rate of iASD persistence over time and evaluated outcomes of patients with and without spontaneous iASD closure. RESULTS After a median of 92 days (IQR 75-108 days) after LAAO, 50 patients (50/144, 34.7%) showed evidence of an iASD. Patients with iASD had higher CHADS-VASc-scores (4.9±1.5 vs 4.2±1.2, p = 0.03), larger left atrial volumes (80.5±30.5 ml vs 67.1±19.7 ml, p = 0.01) and were more likely to have relevant mitral regurgitation (≥° II) (46.0% vs 12.3%, p = 0.001). LAAO procedures took longer (50.1±24.3 vs 41.1±17.8 min, p = 0.06) in patients with a persisting iASD. Furthermore, larger device sizes were implanted (24.3±3.4 mm vs 22.1±2.8 mm, p = 0.03). The presence of an iASD had no impact on RV dysfunction, thromboembolism or mortality. Spontaneous closure of an iASD was documented in 52.0% (26/50). Hereby, similar risk factors were identified for the persistence of an iASD in follow-up.
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Affiliation(s)
- Dominik Nelles
- Med. Klinik und Poliklinik II - Herzzentrum Bonn, Bonn, Germany
| | - Vivian Vij
- Med. Klinik und Poliklinik II - Herzzentrum Bonn, Bonn, Germany
| | | | - Marcel Weber
- Med. Klinik und Poliklinik II - Herzzentrum Bonn, Bonn, Germany
| | | | - Thomas Beiert
- Med. Klinik und Poliklinik II - Herzzentrum Bonn, Bonn, Germany
| | - Georg Nickenig
- Med. Klinik und Poliklinik II - Herzzentrum Bonn, Bonn, Germany
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29
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Sudo M, Sugiura A, Treiling L, Al-Kassou B, Shamekhi J, Kütting D, Wilde N, Weber M, Zimmer S, Nickenig G, Sedaghat A. Baseline PA/BSA ratio in patients undergoing transcatheter aortic valve replacement - A novel CT-based marker for the prediction of pulmonary hypertension and outcome. Int J Cardiol 2021; 348:26-32. [PMID: 34923001 DOI: 10.1016/j.ijcard.2021.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/16/2021] [Accepted: 12/13/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Pulmonary hypertension (pH) has a prognostic impact on patients undergoing transcatheter aortic valve replacement (TAVR). Pulmonary artery (PA) dilatation assessed by multidetector computed tomography (MDCT) has the potential to predict PH. The aim of the study was to evaluate the clinical parameters associated with PA dilatation and to investigate its prognostic relevance in patients undergoing TAVR. METHODS In 770 patients undergoing TAVR between February 2016 and July 2019, PA diameter was measured by MDCT before TAVR. Additionally, PA diameter divided by ascending aorta diameter or body surface area (BSA) was calculated. RESULTS Of all the CT-derived parameters compared with a receiver operating characteristic curve, the value for PA/BSA with a median of 1.68 (IQR 1.47, 1.91) cm/m2 showed the greatest area-under-the-curve (0.75) for predicting PH at baseline. Based on this median, patients were assigned to a small PA/BSA (n = 386) or a large PA/BSA (n = 384) group. Hereby, a large PA/BSA was independently associated with PH at baseline (OR:8.39 [5.36-13.14], p < 0.001) and after TAVR (OR:1.73 [1.18-2.53], p = 0.005). A large PA/BSA was associated with a significantly higher cumulative two-year all-cause mortality compared to small PA/BSA (30.0% vs. 13.7%, p < 0.001), which was supported in the multivariable model (HR:1.87; 95%CI, 1.12-3.04; p = 0.017). CONCLUSION Patients with a large PA/BSA on MDCT are more likely to have PH at baseline and after TAVR. Large PA/BSA is associated with an increased risk of mortality and could provide additional information for risk stratification in patients undergoing TAVR.
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Affiliation(s)
- Mitsumasa Sudo
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany; Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Louisa Treiling
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Baravan Al-Kassou
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Jasmin Shamekhi
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Daniel Kütting
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Nihal Wilde
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Alexander Sedaghat
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany.
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30
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Sugiura A, Treiling L, Al-Kassou B, Shamekhi J, Wilde N, Sinning JM, Zimmer S, Kuetting D, Oldenburg J, Poetzsch B, Nickenig G, Sedaghat A. Spleen Size and Thrombocytopenia After Transcatheter Aortic Valve Implantation. Am J Cardiol 2021; 157:85-92. [PMID: 34404506 DOI: 10.1016/j.amjcard.2021.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 11/17/2022]
Abstract
The pathophysiology of thrombocytopenia after transcatheter aortic valve implantation (TAVI) thrombocytopenia is still poorly understood. We assessed the association of spleen size with acquired thrombocytopenia in patients undergoing TAVI. We included 732 patients who underwent TAVI with new generation transcatheter heart valves (THVs) at our center from February 2016 to July 2019. We measured splenic volume index in consecutive patients derived from multidetector row computed tomographic datasets. Patients were stratified according to post-TAVI thrombocytopenia, which was defined as a decline in platelet count (DPC) ≥50% at nadir, and evaluated regarding baseline characteristics and outcome parameters. After the procedure, platelet counts declined from 212.9 ± 67.4 × 109/L at baseline to 138.8 ± 49.8 × 109/L at nadir after a median of 2 days (interquartile range [IQR] 2 to 3). Of all patients, 10.1% showed a DPC ≥50%. Compared with patients with DPC <50%, patients with DPC ≥50% had significantly lower splenic volume index (95.5 ml/m2 [IQR 78.0 to 123.7] vs 85.8 ml/m2 [IQR 71.4 to 102.6], p = 0.008). A multivariable analysis revealed that the splenic volume index was negatively associated with a DPC ≥50% (OR 0.89, 95% CI 0.82 to 0.97, p = 0.005), independent of the type of THV (balloon-expandable THV: OR 2.06, 95% CI 1.13 to 3.76, p = 0.02), major bleeding (OR 13.40, 95% CI 3.58 to 50.40, p <0.001), blood transfusion (OR 3.63, 95% CI 1.54 to 8.56, p = 0.003), or postprocedural paravalvular leakage ≥moderate (OR 5.48, 95% CI 1.23 to 24.40, p = 0.03). Furthermore, DPC ≥50% was independently associated with 1-year mortality (HR 3.36, 95% CI 1.66 to 6.81, p <0.001). In conclusion, acquired thrombocytopenia remains prevalent in modern TAVI patients. Spleen size appears to be associated with the occurrence of thrombocytopenia after TAVI, which is independently correlated with 1-year mortality.
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Affiliation(s)
- Atsushi Sugiura
- Med. Klinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Louisa Treiling
- Med. Klinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Baravan Al-Kassou
- Med. Klinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Jasmin Shamekhi
- Med. Klinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Nihal Wilde
- Med. Klinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Jan-Malte Sinning
- Med. Klinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Med. Klinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
| | - Daniel Kuetting
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Bonn, Bonn, Germany
| | - Johannes Oldenburg
- Institut für Experimentelle Hämatologie und Transfusionsmedizin, Universitätsklinikum Bonn, Bonn, Germany
| | - Bernd Poetzsch
- Institut für Experimentelle Hämatologie und Transfusionsmedizin, Universitätsklinikum Bonn, Bonn, Germany
| | - Georg Nickenig
- Med. Klinik II, Herzzentrum, Universitätsklinikum Bonn, Bonn, Germany
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31
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Al-Kassou B, Shamekhi J, Weber M, Germeroth J, Gillrath J, Feldmann K, Sedaghat A, Werner N, Treede H, Becher MU, Tiyerili V, Grube E, Zimmer S, Nickenig G, Sinning JM. Frailty, malnutrition, and the endocrine system impact outcome in patients undergoing aortic valve replacement. Catheter Cardiovasc Interv 2021; 99:145-157. [PMID: 34143555 DOI: 10.1002/ccd.29821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/01/2021] [Accepted: 06/05/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Frailty is a multidimensional syndrome that affects mortality after aortic valve replacement (AVR). Malnutrition is often associated with the development of frailty. However, data regarding the association of frailty with nutritional status and underlying endocrinological dysregulation in patients with severe aortic valve stenosis are limited. OBJECTIVES We aimed to systematically screen for frailty and malnutrition, to evaluate for underlying endocrinological disorders and inflammation, and to assess the ability of these parameters to predict outcomes after AVR. METHODS Our study included 373 patients undergoing transcatheter and surgical AVR. Frailty was assessed using the Fried Frailty Phenotype (FFP), Essential Frailty Toolset, Lawton-Brody, and Katz Index. Malnutrition was measured using the Mini Nutritional Assessment (MNA-LF) and Controlling Nutritional Status. Outcomes of interest were 30-day and one-year mortality. RESULTS The prevalence of frailty ranged from 6.4% to 65.7% and malnutrition from 5.9% to 10.5%, depending on the evaluation tool. Both parameters were associated with higher levels of cortisol and parathormone as well as lower levels of IGF-1, testosterone, DHEAS, and c-reactive protein. Malnutrition was associated with increased 30-day mortality, and both frailty and malnutrition with increased one-year mortality. In a multivariate analysis, malnutrition measured by the MNA-LF (OR: 2.32 [95%CI: 1.19-4.53], p = 0.01) and frailty as assessed by the FFP (OR: 1.42 [95%CI: 1.02-1.96], p = 0.03) were independent predictors of one-year mortality. CONCLUSION The prevalence of frailty and malnutrition varies significantly depending on the assessment tool. Both syndromes share common endocrinological alterations. Frailty and malnutrition are independent risk factors for mortality after AVR.
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Affiliation(s)
- Baravan Al-Kassou
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Jasmin Shamekhi
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Jana Germeroth
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Jana Gillrath
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Katharina Feldmann
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Alexander Sedaghat
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Nikos Werner
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Hendrik Treede
- Heart Center, Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Marc Ulrich Becher
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Vedat Tiyerili
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Eberhard Grube
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Jan-Malte Sinning
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
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32
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Seoudy H, Al-Kassou B, Shamekhi J, Sugiura A, Frank J, Saad M, Bramlage P, Seoudy AK, Puehler T, Lutter G, Schulte DM, Laudes M, Nickenig G, Frey N, Sinning JM, Frank D. Frailty in patients undergoing transcatheter aortic valve replacement: prognostic value of the Geriatric Nutritional Risk Index. J Cachexia Sarcopenia Muscle 2021; 12:577-585. [PMID: 33764695 PMCID: PMC8200421 DOI: 10.1002/jcsm.12689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/19/2021] [Accepted: 01/26/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Malnutrition is a hallmark of frailty, is common among elderly patients, and is a predictor of poor outcomes in patients with severe symptomatic aortic stenosis (AS). The Geriatric Nutritional Risk Index (GNRI) is a simple and well-established screening tool to predict the risk of morbidity and mortality in elderly patients. In this study, we evaluated whether GNRI may be used in the risk stratification and management of patients undergoing transcatheter aortic valve replacement (TAVR). METHODS Patients with symptomatic severe AS (n = 953) who underwent transfemoral TAVR at the University Hospital Schleswig-Holstein Kiel, Germany, between 2010 and 2019 (development cohort) were divided into two groups: normal GNRI ≥ 98 (no nutrition-related risk; n = 618) versus low GNRI < 98 (at nutrition-related risk; n = 335). The results were validated in an independent (validation) cohort from another high-volume TAVR centre (n = 977). RESULTS The low-GNRI group had a higher proportion of female patients (59.1% vs. 52.1%), higher median age (82.9 vs. 81.8 years), prevalence of atrial fibrillation (50.4% vs. 40.0%), median logistic EuroSCORE (17.5% vs. 15.0%) and impaired left ventricular function (<35%: 10.7% vs. 6.8%), lower median estimated glomerular filtration rate (50 vs. 57 mL/min/1.73 m2 ) and median albumin level (3.5 vs. 4.0 g/dL) compared with the normal-GNRI group. Among peri-procedural complications, Acute Kidney Injury Network (AKIN) Stage 3 was more common in the low-GNRI group (3.6% vs. 0.6%, p = 0.002). After a mean follow-up of 21.1 months, all-cause mortality was significantly increased in the low-GNRI group compared with the normal-GNRI group (p < 0.001). This was confirmed in the validation cohort (p < 0.001). Low GNRI < 98 was identified as an independent risk factor for all-cause mortality (hazard ratio 1.44, 95% CI 1.01-2.04, p = 0.043). Other independent risk factors included albumin level < median of 4.0 g/dL, high-sensitive troponin T in the highest quartile (> 45.0 pg/mL), N-terminal pro-B-type natriuretic peptide in the highest quartile (> 3595 pg/mL), grade III-IV tricuspid regurgitation, pulmonary arterial hypertension, life-threatening bleeding, AKIN Stage 3 and disabling stroke. CONCLUSIONS Low GNRI score was associated with an increased risk of all-cause mortality in patients undergoing TAVR, implying that this vulnerable group may benefit from improved preventive measures.
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Affiliation(s)
- Hatim Seoudy
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein Kiel, Kiel, Germany.,Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research, Kiel, Germany
| | | | | | | | - Johanne Frank
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein Kiel, Kiel, Germany.,Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research, Kiel, Germany
| | - Mohammed Saad
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein Kiel, Kiel, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Anna Katharina Seoudy
- Department of Internal Medicine I, Division of Endocrinology, Diabetes and Clinical Nutrition, University of Kiel, Kiel, Germany
| | - Thomas Puehler
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein Kiel, Kiel, Germany
| | - Georg Lutter
- Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research, Kiel, Germany.,Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein Kiel, Kiel, Germany
| | - Dominik M Schulte
- Department of Internal Medicine I, Division of Endocrinology, Diabetes and Clinical Nutrition, University of Kiel, Kiel, Germany
| | - Matthias Laudes
- Department of Internal Medicine I, Division of Endocrinology, Diabetes and Clinical Nutrition, University of Kiel, Kiel, Germany
| | - Georg Nickenig
- Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Norbert Frey
- Department of Cardiology, Heidelberg University, Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg University, Heidelberg, Germany
| | | | - Derk Frank
- Department of Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, University Hospital Schleswig-Holstein Kiel, Kiel, Germany.,Partner Site Hamburg/Kiel/Lübeck, German Centre for Cardiovascular Research, Kiel, Germany
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33
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Sedaghat A, Vij V, Al-Kassou B, Gloekler S, Galea R, Fürholz M, Meier B, Valgimigli M, O'Hara G, Arzamendi D, Agudelo V, Asmarats L, Freixa X, Flores-Umanzor E, De Backer O, Søndergaard L, Nombela-Franco L, McInerney A, Korsholm K, Nielsen-Kudsk JE, Afzal S, Zeus T, Operhalski F, Schmidt B, Montalescot G, Guedeney P, Iriart X, Miton N, Saw J, Gilhofer T, Fauchier L, Veliqi E, Meincke F, Petri N, Nordbeck P, Rycerz S, Ognerubov D, Merkulov E, Cruz-González I, Gonzalez-Ferreiro R, Bhatt DL, Laricchia A, Mangieri A, Omran H, Schrickel JW, Rodes-Cabau J, Nickenig G. Device-Related Thrombus After Left Atrial Appendage Closure: Data on Thrombus Characteristics, Treatment Strategies, and Clinical Outcomes From the EUROC-DRT-Registry. Circ Cardiovasc Interv 2021; 14:e010195. [PMID: 34003661 DOI: 10.1161/circinterventions.120.010195] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [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] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
| | - Vivian Vij
- University Hospital Bonn, Germany (A.S., V.V., B.A.-K., J.W.S., G.N.)
| | - Baravan Al-Kassou
- University Hospital Bonn, Germany (A.S., V.V., B.A.-K., J.W.S., G.N.)
| | - Steffen Gloekler
- University Hospital Bern, Switzerland (S.G., R.G., M.F., B.M., M.V.)
| | - Roberto Galea
- University Hospital Bern, Switzerland (S.G., R.G., M.F., B.M., M.V.)
| | - Monika Fürholz
- University Hospital Bern, Switzerland (S.G., R.G., M.F., B.M., M.V.)
| | - Bernhard Meier
- University Hospital Bern, Switzerland (S.G., R.G., M.F., B.M., M.V.)
| | - Marco Valgimigli
- University Hospital Bern, Switzerland (S.G., R.G., M.F., B.M., M.V.).,Cardiocentro Ticino, Lugano, Switzerland (M.V.)
| | - Gilles O'Hara
- Quebec Heart & Lung Institute, Laval University, Canada (G.O., L.A., J.R.-C.)
| | - Dabit Arzamendi
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (D.A., V.A., L.A.)
| | - Victor Agudelo
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (D.A., V.A., L.A.)
| | - Lluis Asmarats
- Quebec Heart & Lung Institute, Laval University, Canada (G.O., L.A., J.R.-C.).,Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (D.A., V.A., L.A.)
| | | | | | - Ole De Backer
- Rigshospitalet Copenhagen University Hospital, Denmark (O.D.B., L.S.)
| | - Lars Søndergaard
- Rigshospitalet Copenhagen University Hospital, Denmark (O.D.B., L.S.)
| | | | - Angela McInerney
- Hospital Clinico San Carlos Madrid, Spain (L.N.-F., A. McInerney)
| | | | | | - Shazia Afzal
- University Hospital Düsseldorf, Germany (S.A., T.Z.)
| | - Tobias Zeus
- University Hospital Düsseldorf, Germany (S.A., T.Z.)
| | - Felix Operhalski
- Agaplesion Bethanien Krankenhaus, CBB, Frankfurt, Germany (F.O., B.S.)
| | - Boris Schmidt
- Agaplesion Bethanien Krankenhaus, CBB, Frankfurt, Germany (F.O., B.S.)
| | - Gilles Montalescot
- Surbonne University Pitié-Salpêtrière Hospital (AP-HP) Paris, France (G.M., P.G.)
| | - Paul Guedeney
- Surbonne University Pitié-Salpêtrière Hospital (AP-HP) Paris, France (G.M., P.G.)
| | | | - Noelie Miton
- University Hospital Bordeaux, France (X.I., N.M.)
| | | | | | | | - Egzon Veliqi
- St. Georg Hospital Hamburg, Germany (E.V., F.M.)
| | | | - Nils Petri
- University Hospital Würzburg, Germany (N.P., P.N.)
| | | | - Szymon Rycerz
- Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany (S.R.)
| | - Dmitrii Ognerubov
- Russian Cardiology Research and Production Complex, Moscow (D.O., E.M.)
| | - Evgeny Merkulov
- Russian Cardiology Research and Production Complex, Moscow (D.O., E.M.)
| | | | | | - Deepak L Bhatt
- Heart and Vascular Center, Brigham and Women's Hospital Harvard Medical School, Boston (D.L.B.)
| | | | | | | | | | - Josep Rodes-Cabau
- Quebec Heart & Lung Institute, Laval University, Canada (G.O., L.A., J.R.-C.)
| | - Georg Nickenig
- University Hospital Bonn, Germany (A.S., V.V., B.A.-K., J.W.S., G.N.)
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Zietzer A, Al-Kassou B, Jamme P, Steffen E, Werner N, Nickenig G, Jansen F. Levels of platelet derived extracellular vesicles in the left atrial appendage are higher in patients with permanent atrial fibrillation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0473] [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
Introduction
Atrial fibrillation (AF) is a frequent arrhythmic disease and one of the most important causes of thrombembolic disease due to intracardiac thrombus formation. The left atrial appendage has been identified as the structure, where thrombus formation typically takes place in AF patients. Previous studies have shown thrombus formation is more frequent in permanent, than in paroxysmal or persistent AF. Underlying causes for this finding, however, remain unclear. Recently, it has been shown, that large extracellular vesicles (Microvesicles, MVs) are mediators of platelet activation. The aim of this study is therefore to investigate if the AF subtype correlates with the regional abundance of platelet derived MVs in the left atrial appendage.
Methods and results
In order to address this question blood samples from 59 consecutive patients undergoing left and right atrial catheterization were collected from the right atrium (RA), the left atrium (LA) and the left atrial appendage (LAA). 49% of the patients had permanent AF, 34% had non-permanent AF and 17% had no history of AF. MVs were isolated from 150 μL citrate plasma by a four-step differential centrifugation protocol (20000g x 40 min as main pelleting step). The MVs were characterized by immunoblotting and nanoparticle tracking analysis. The size of the MVs ranged between 50 and 600 nm and the MVs were shown to carry typical markers such as Annexin V. For flowcytometric analysis and quantification, Calcein AM was used to identify vesicles and CD31-PE, CD41-APC, CD235a-PE-Cy7 were applied to differentiate between platelet-derived MVs (PMVs, CD41+ CD31+), endothelial cell-derived MVs (EMVs, CD41- CD31+) and Red blood cell-derived MVs (RMVs, CD235a+). Fluorescence minus one controls, a concentration row and detergent mediated degradation were used to confirm specific staining of MVs. Total MV numbers (Calcein + events) did not differ significantly between the three cardiac localizations. In the left atrial appendage, the proportion of PMV was significantly higher in permanent AF patients compared to non-permanent AF. EMV numbers only differed in the right atrium, where permanent AF patients exhibited significantly lower numbers of EMVs compared to no AF controls. No differences between the groups were detected for RMV.
Conclusion
In the present study, we found that PMV levels in the left atrial appendage correlate with the type of atrial fibrillation (permanent vs non-permanent). PMVs have been connected to platelet activation and thrombus formation. These results may help to better understand how different types of atrial fibrillation cause different rates of thrombus formation in the LAA.
PMV and EMV numbers by AF subtype
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Medical Faculty University Bonn
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Affiliation(s)
- A Zietzer
- Heartcenter Bonn, University Hospital Bonn, Bonn, Germany
| | - B Al-Kassou
- Heartcenter Bonn, University Hospital Bonn, Bonn, Germany
| | - P Jamme
- Heartcenter Bonn, University Hospital Bonn, Bonn, Germany
| | - E Steffen
- Heartcenter Bonn, University Hospital Bonn, Bonn, Germany
| | - N Werner
- University Hospital Bonn, Medical Department II, Bonn, Germany
| | - G Nickenig
- Heartcenter Bonn, University Hospital Bonn, Bonn, Germany
| | - F Jansen
- Heartcenter Bonn, University Hospital Bonn, Bonn, Germany
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35
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Seoudy H, Shamekhi J, Frank J, Herfett I, Al-Kassou B, Sugiura A, Puehler T, Lutter G, Treede H, Nickenig G, Frey N, Sinning JM, Frank D. TCT CONNECT-147 Limitations of Established Cardiac Biomarkers in Low-to Intermediate-Risk TF-TAVR Patients With Advanced CKD. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.558] [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] [Indexed: 10/23/2022]
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36
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Wolff G, Shamekhi J, Al-Kassou B, Tabata N, Parco C, Klein K, Maier O, Sedaghat A, Polzin A, Sugiura A, Jung C, Grube E, Westenfeld R, Icks A, Zeus T, Sinning JM, Baldus S, Nickenig G, Kelm M, Veulemans V. Risk modeling in transcatheter aortic valve replacement remains unsolved: an external validation study in 2946 German patients. Clin Res Cardiol 2020; 110:368-376. [PMID: 32851491 PMCID: PMC7907023 DOI: 10.1007/s00392-020-01731-9] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/12/2020] [Indexed: 12/31/2022]
Abstract
Background Surgical risk prediction models are routinely used to guide decision-making for transcatheter aortic valve replacement (TAVR). New and updated TAVR-specific models have been developed to improve risk stratification; however, the best option remains unknown. Objective To perform a comparative validation study of six risk models for the prediction of 30-day mortality in TAVR Methods and results A total of 2946 patients undergoing transfemoral (TF, n = 2625) or transapical (TA, n = 321) TAVR from 2008 to 2018 from the German Rhine Transregio Aortic Diseases cohort were included. Six surgical and TAVR-specific risk scoring models (LogES I, ES II, STS PROM, FRANCE-2, OBSERVANT, GAVS-II) were evaluated for the prediction of 30-day mortality. Observed 30-day mortality was 3.7% (TF 3.2%; TA 7.5%), mean 30-day mortality risk prediction varied from 5.8 ± 5.0% (OBSERVANT) to 23.4 ± 15.9% (LogES I). Discrimination performance (ROC analysis, c-indices) ranged from 0.60 (OBSERVANT) to 0.67 (STS PROM), without significant differences between models, between TF or TA approach or over time. STS PROM discriminated numerically best in TF TAVR (c-index 0.66; range of c-indices 0.60 to 0.66); performance was very similar in TA TAVR (LogES I, ES II, FRANCE-2 and GAVS-II all with c-index 0.67). Regarding calibration, all risk scoring models—especially LogES I—overestimated mortality risk, especially in high-risk patients. Conclusions Surgical as well as TAVR-specific risk scoring models showed mediocre performance in prediction of 30-day mortality risk for TAVR in the German Rhine Transregio Aortic Diseases cohort. Development of new or updated risk models is necessary to improve risk stratification. Graphic abstract ![]()
Electronic supplementary material The online version of this article (10.1007/s00392-020-01731-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Georg Wolff
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Heinrich Heine University, Medical Faculty, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Jasmin Shamekhi
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Baravan Al-Kassou
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Noriaki Tabata
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Claudio Parco
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Heinrich Heine University, Medical Faculty, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Kathrin Klein
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Heinrich Heine University, Medical Faculty, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Oliver Maier
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Heinrich Heine University, Medical Faculty, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Alexander Sedaghat
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Amin Polzin
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Heinrich Heine University, Medical Faculty, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Atsushi Sugiura
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Heinrich Heine University, Medical Faculty, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Eberhard Grube
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Heinrich Heine University, Medical Faculty, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Heinrich Heine University, Medical Faculty, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Jan-Malte Sinning
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.,Transregio 259: Aortic Diseases-Scientific Network of University Heart Centers in Düsseldorf/Bonn/Cologne, Düsseldorf/Bonn/Cologne, Germany
| | - Stephan Baldus
- Division of Cardiology, Pneumology, Angiology and Intensive Care, Department of Internal Medicine III, University of Cologne, Cologne, Germany.,Transregio 259: Aortic Diseases-Scientific Network of University Heart Centers in Düsseldorf/Bonn/Cologne, Düsseldorf/Bonn/Cologne, Germany
| | - Georg Nickenig
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.,Transregio 259: Aortic Diseases-Scientific Network of University Heart Centers in Düsseldorf/Bonn/Cologne, Düsseldorf/Bonn/Cologne, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Heinrich Heine University, Medical Faculty, Moorenstr. 5, 40225, Düsseldorf, Germany.,Transregio 259: Aortic Diseases-Scientific Network of University Heart Centers in Düsseldorf/Bonn/Cologne, Düsseldorf/Bonn/Cologne, Germany
| | - Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, Department of Internal Medicine, Heinrich Heine University, Medical Faculty, Moorenstr. 5, 40225, Düsseldorf, Germany
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Modolo R, Chang CC, Abdelghani M, Kawashima H, Ono M, Tateishi H, Miyazaki Y, Pighi M, Wykrzykowska JJ, de Winter RJ, Ruck A, Chieffo A, van Mourik MS, Yamaji K, Richardt G, de Brito FS, Lemos PA, Al-Kassou B, Piazza N, Tchetche D, Sinning JM, Abdel-Wahab M, Soliman O, Søndergaard L, Mylotte D, Onuma Y, Van Mieghem NM, Serruys PW. Quantitative Assessment of Acute Regurgitation Following TAVR. JACC Cardiovasc Interv 2020; 13:1303-1311. [DOI: 10.1016/j.jcin.2020.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 12/30/2022]
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Al-Kassou B, Kandt J, Lohde L, Shamekhi J, Sedaghat A, Tabata N, Weber M, Sugiura A, Fimmers R, Werner N, Grube E, Treede H, Nickenig G, Sinning JM. Safety and Efficacy of Protamine Administration for Prevention of Bleeding Complications in Patients Undergoing TAVR. JACC Cardiovasc Interv 2020; 13:1471-1480. [DOI: 10.1016/j.jcin.2020.03.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/23/2020] [Accepted: 03/31/2020] [Indexed: 12/17/2022]
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Shamekhi J, Sugiura A, Tabata N, Al-Kassou B, Weber M, Sedaghat A, Werner N, Grube E, Nickenig G, Sinning JM. Impact of Tricuspid Regurgitation in Patients Undergoing Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2020; 13:1135-1137. [PMID: 31954675 DOI: 10.1016/j.jcin.2019.09.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
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Landes U, Webb JG, De Backer O, Sondergaard L, Abdel-Wahab M, Crusius L, Kim WK, Hamm C, Buzzatti N, Montorfano M, Ludwig S, Schofer N, Voigtlaender L, Guerrero M, El Sabbagh A, Rodés-Cabau J, Guimaraes L, Kornowski R, Codner P, Okuno T, Pilgrim T, Fiorina C, Colombo A, Mangieri A, Eltchaninoff H, Nombela-Franco L, Van Wiechen MP, Van Mieghem NM, Tchétché D, Schoels WH, Kullmer M, Tamburino C, Sinning JM, Al-Kassou B, Perlman GY, Danenberg H, Ielasi A, Fraccaro C, Tarantini G, De Marco F, Witberg G, Redwood SR, Lisko JC, Babaliaros VC, Laine M, Nerla R, Castriota F, Finkelstein A, Loewenstein I, Eitan A, Jaffe R, Ruile P, Neumann FJ, Piazza N, Alosaimi H, Sievert H, Sievert K, Russo M, Andreas M, Bunc M, Latib A, Govdfrey R, Hildick-Smith D, Sathananthan J, Hensey M, Alkhodair A, Blanke P, Leipsic J, Wood DA, Nazif TM, Kodali S, Leon MB, Barbanti M. Repeat Transcatheter Aortic Valve Replacement for Transcatheter Prosthesis Dysfunction. J Am Coll Cardiol 2020; 75:1882-1893. [DOI: 10.1016/j.jacc.2020.02.051] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 01/15/2020] [Accepted: 02/14/2020] [Indexed: 01/01/2023]
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Sugiura A, Weber M, von Depka A, Tabata N, Shamekhi J, Al-Kassou B, Nickenig G, Werner N, Sinning JM, Sedaghat A. Outcomes of myocardial fibrosis in patients undergoing transcatheter aortic valve replacement. EUROINTERVENTION 2020; 15:1417-1423. [DOI: 10.4244/eij-d-19-00641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Modolo RGP, Chang CC, Kawashima H, Ono M, Tateishi H, Miyazaki Y, Pighi M, Abdelghani M, Wykrzykowska J, de Winter R, Ruck A, Chieffo A, Yamaji K, Brito FS, Lemos PA, Al-Kassou B, Piazza N, Tchetche D, Sinning JM, Abdel-Wahab M, Soliman O, Sondergaard L, Onuma Y, Van Mieghem N, Serruys P. QUANTITATIVE ASSESSMENT OF ACUTE REGURGITATION FOLLOWING TRANSCATHETER AORTIC VALVE IMPLANTATION: A MULTICENTER POOLED ANALYSIS OF 2,258 VALVES. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32741-8] [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] [Indexed: 12/01/2022]
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Tabata N, Al-Kassou B, Sugiura A, Kandt J, Shamekhi J, Stundl A, Zimmer S, Treede H, Ishii M, Tsujita K, Nickenig G, Werner N, Sinning JM. Prognostic impact of cancer history in patients undergoing transcatheter aortic valve implantation. Clin Res Cardiol 2020; 109:1243-1250. [PMID: 32072264 DOI: 10.1007/s00392-020-01615-y] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/31/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND The benefit of TAVI in cancer patients is currently unclear. OBJECTIVES The purpose of this study is to investigate prognostic impact of cancer status (active cancer or previous cancer) in severe aortic stenosis (AS) patients undergoing transcatheter aortic valve implantation (TAVI). METHODS Consecutive TAVI patients in the Heart Center Bonn were enrolled and we stratified the patients into three groups: current cancer (active cancer), non-current cancer (previous cancer), or no cancer. The primary outcome was all-cause death within a 5-year follow-up. We evaluated mean aortic pressure gradient (mPG) values following TAVI (baseline mPG) and at the final follow-up (follow-up mPG). RESULTS In total, 1568 TAVI patients were eligible and 298 patients (19.0%) had active or previous cancer. At the 5-year follow-up, cancer patients had a significantly worse prognosis than non-cancer patients (log rank, P < 0.001). In a multivariable analysis, previous cancer was a significant predictor for 5-year mortality (hazard ratio [HR], 1.56; P < 0.001). Estimated mortality rates at 5-year follow-up rates among active cancer, previous cancer, and non-cancer were 84.0%, 65.8%, and 50.2% (long-rank P < 0.001), respectively. The hazard ratios of active cancer and previous cancer for 5-year mortality were 2.79 (P < 0.001) and 1.38 (P = 0.019) compared to non-cancer patients. We found significantly higher mPG during follow-up than at baseline in cancer patients (follow-up 8.10 vs baseline 7.40 mmHg; Wilcoxon P = 0.012). CONCLUSIONS Active, and also previous, cancer status are associated with less beneficial long-term prognosis in TAVI patients.
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Affiliation(s)
- Noriaki Tabata
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
- Department of Cardiovascular Medicine Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Baravan Al-Kassou
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Atsushi Sugiura
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Julian Kandt
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Jasmin Shamekhi
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Anja Stundl
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Sebastian Zimmer
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Hendrik Treede
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Masanobu Ishii
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Georg Nickenig
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Nikos Werner
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Jan-Malte Sinning
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
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Luetkens JA, Faron A, Geissler HL, Al-Kassou B, Shamekhi J, Stundl A, Sprinkart AM, Meyer C, Fimmers R, Treede H, Grube E, Nickenig G, Sinning JM, Thomas D. Opportunistic Computed Tomography Imaging for the Assessment of Fatty Muscle Fraction Predicts Outcome in Patients Undergoing Transcatheter Aortic Valve Replacement. Circulation 2020; 141:234-236. [PMID: 31958246 DOI: 10.1161/circulationaha.119.042927] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 11/16/2022]
Affiliation(s)
- Julian A Luetkens
- University Hospital Bonn, Department of Radiology (J.A.L, A.F., H.L.G., A.M.S., C.M., D.T.), Bonn, Germany
| | - Anton Faron
- University Hospital Bonn, Department of Radiology (J.A.L, A.F., H.L.G., A.M.S., C.M., D.T.), Bonn, Germany
| | - Helena L Geissler
- University Hospital Bonn, Department of Radiology (J.A.L, A.F., H.L.G., A.M.S., C.M., D.T.), Bonn, Germany
| | - Baravan Al-Kassou
- Department of Internal Medicine II (B.A.K., J.S., A.S., E.G., G.N., J.M.S.), Bonn, Germany
| | - Jasmin Shamekhi
- Department of Internal Medicine II (B.A.K., J.S., A.S., E.G., G.N., J.M.S.), Bonn, Germany
| | - Anja Stundl
- Department of Internal Medicine II (B.A.K., J.S., A.S., E.G., G.N., J.M.S.), Bonn, Germany
| | - Alois M Sprinkart
- University Hospital Bonn, Department of Radiology (J.A.L, A.F., H.L.G., A.M.S., C.M., D.T.), Bonn, Germany
| | - Carsten Meyer
- University Hospital Bonn, Department of Radiology (J.A.L, A.F., H.L.G., A.M.S., C.M., D.T.), Bonn, Germany
| | - Rolf Fimmers
- Department of Medical Biometry, Informatics, and Epidemiology (R.F.), Bonn, Germany
| | - Hendrik Treede
- Department of Cardio-Thoracic Surgery (H.T.), Bonn, Germany
| | - Eberhard Grube
- Department of Internal Medicine II (B.A.K., J.S., A.S., E.G., G.N., J.M.S.), Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II (B.A.K., J.S., A.S., E.G., G.N., J.M.S.), Bonn, Germany
| | - Jan-Malte Sinning
- Department of Internal Medicine II (B.A.K., J.S., A.S., E.G., G.N., J.M.S.), Bonn, Germany
| | - Daniel Thomas
- University Hospital Bonn, Department of Radiology (J.A.L, A.F., H.L.G., A.M.S., C.M., D.T.), Bonn, Germany
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Shamekhi J, Stundl A, Al-Kassou B, Weber M, Sedaghat A, Grube E, Nickenig G, Werner N, Sinning JM. P918Tricuspid regurgitation in patients undergoing transcatheter aortic valve implantation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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
Background
Transcatheter aortic valve implantation (TAVI) has become the treatment of choice in elderly patients with severe aortic stenosis and increased surgical risk. A significant number of these elderly patients have concomitant tricuspid valve regurgitation. The impact on outcome, however, is still matter of debate.
Objectives
In this prospective observational study, we investigated the impact of concomitant tricuspid regurgitation (TR) on outcome in patients undergoing transcatheter aortic valve implantation.
Methods
Between February 2008 and May 2018, 1411 patients with severe symptomatic aortic stenosis and increased operative risk underwent TAVI at the Heart Center Bonn and participated in this study, after written informed consent was obtained.
Before TAVI procedure, all patients underwent a careful cardiac evaluation and interdisciplinary discussion within the local, institutional Heart Team.
The pre-interventional 3D echocardiography was used to determine the degree of tricuspid valve regurgitation. According to the severity of TR, patients were divided into two groups; patients with TR < II and patients with moderate to severe TR ≥ II andcompared regarding rates of mortality after 1 year of follow-up between the two groups.
Results
Out of 1411 TAVI patients, 802 (56.8%) had tricuspid regurgitation < II, 610 (43.2%) patients suffered from tricuspid regurgitation ≥ II.
The mean age of our study population was 81.1 (±6.5). The baseline characteristics did not differ significantly between the two groups, such as extracardiac arteriopathy (TR < II: 44% vs TR ≥ II: 41.6%; p=0.37), diabetes (TR < II: 27.5% vs TR ≥ II: 27.7%; p=0.92) or arterial hypertension (TR < II: 91% vs TR ≥ II: 93.2%; p=0.64). However, patients with concomitant TR ≥ II had significantly more often NYHA class IV (TR < II: 5.0% vs TR ≥ II: 15.4%; p<0.001) and a higher logistic EuroSCORE (TR < II: 12.9 (8.8/21.2) vs TR ≥ II: 20.6 (13.1/33.4); p<0.001). Additionally, patients with a TR ≥ II had significantly more often a concomitant mitral regurgitation ≥ II (TR < II: 43.3% vs TR ≥ II: 60.4%; p<0.001). Comparing rates of mortality, we found a significant association between the degree of tricuspid regurgitation and 1-year mortality in patients undergoing TAVI (TR < II: 85 (10.6%) vs. TR ≥ II: 136 (22.3%); p<0.001), as presented in Figure 1.
Figure 1
Conclusion
Moderate to severe tricuspid valve regurgitation is associated with higher rates of mortality in patients undergoing transcatheter aortic valve implantation. Our results are hypothesis-generating and it has to be elucidated whether the severity of TR is only a surrogate for more advanced stage of aortic stenosis or whether it is causative so that mortality could be reduced by its treatment.
Acknowledgement/Funding
None
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Affiliation(s)
- J Shamekhi
- University Hospital Bonn, Cardiology, Bonn, Germany
| | - A Stundl
- University Hospital Bonn, Cardiology, Bonn, Germany
| | - B Al-Kassou
- University Hospital Bonn, Cardiology, Bonn, Germany
| | - M Weber
- University Hospital Bonn, Cardiology, Bonn, Germany
| | - A Sedaghat
- University Hospital Bonn, Cardiology, Bonn, Germany
| | - E Grube
- University Hospital Bonn, Cardiology, Bonn, Germany
| | - G Nickenig
- University Hospital Bonn, Cardiology, Bonn, Germany
| | - N Werner
- University Hospital Bonn, Cardiology, Bonn, Germany
| | - J M Sinning
- University Hospital Bonn, Cardiology, Bonn, Germany
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Vij VO, Al-Kassou B, Nelles D, Stuhr M, Schueler R, Omran H, Schrickel J, Hammerstingl C, Nickenig G, Sedaghat A. P1002Echocardiographic assessment of optimal device position after percutaneous left atrial appendage occlusion - introduction of a novel classification and its impact on outcome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0595] [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
Left atrial appendage occlusion (LAAo) is an established therapy in patients with atrial fibrillation. However, criteria regarding optimal device position are not well defined making comparability of procedural results virtually impossible. We therefore sought to a) introduce a classification describing optimal vs. suboptimal device-position by assessing predefined parameters in transoesophageal echocardiography (TEE) and to b) analyze the impact of device-position on outcome in patients treated with different LAAo devices.
Methods and results
We retrospectively analyzed 120 patients who were treated by LAAo and had undergone follow-up TEEs after 3 or 6 months. Patients were at mean age: 76±8 years; female 40% and presented an increased CHADS-VASC- (4.6±1.4) and HAS-BLED-score (3.7±1). TEE-guidance was performed in all cases.
In 62.5% (75/120) pacifier occluders (PO) (ACP/Amulet, Lambre, Ultraseal) were used, whereas 37.5% (45/120) were treated with non-pacifier occluders (NPO) (Watchman, Wavecrest, Occlutech). To assess device position, TEE images in a commissural view (60–90°) were analyzed and characterised by 1) implantation depth in the left atrial appendage, 2) peridevice flow (PF) and 3) the angle between occluder disc and pulmonal ridge (LUPV). For the purpose of this study, optimal device position was defined as a) ostial (LUPV length <10mm) or slightly subostial position (LUPV length ≤15mm, angle ≥100°) with b) the absence of major PF (>3mm).
Overall, occluders were implanted at a depth of 12±7.8 mm with ostial positioning being achieved in 47.5% (57/120). Major PF was seen in 7.5% (9/120). NPOs were implanted deeper than POs (depth: 15.6±7.1 vs. 9.8±7.4 mm, p<0.01; ostial position: 31.1% vs. 57.3%, p<0.01) and were associated with a higher incidence of major PF (15.6% vs. 2.7%, p=0.01). Also, the depth/angle ratio was higher (i.e. “worse”) in NPOs (18.3±9 vs. 14.6±8, p<0.04). As a result, optimal device position was achieved in 48.3% (58/120) of all patients, with lower rates in NPOs than in POs (26.7% vs. 61.3%, p<0.01). Procedural aspects revealed slight differences in occluder size (optimal: 23.7±3.2 vs. suboptimal: 24.5±3.7 mm, p=0.3), need for repositioning (10.3% vs. 17.7%, p=0.25) and procedural duration (48±36 vs. 52±34 min, p=0.3).
Of interest, device related thrombi (DRT) occurred less frequently in optimally implanted devices (3.4% vs. 12.9%, p=0.06). Hereby, implantation depth and depth/angle ratio were found to be predictors for DRT in ROC-analysis, respectively (AUC: 0.7, 95% Confidence interval [CI]: 0.56–0.84, p=0.05 and AUC: 0.72, 95% CI: 0.58–0.86, p=0.03).
Optimal vs. suboptimal position
Conclusion
Echocardiographic classification of device-position is warranted to provide comparability and appears to be feasible. Based on the novel classification provided, optimal device-position is achieved in 50% and is found more often with the use of POs. DRT appeared to occur more often in suboptimal device-position.
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Affiliation(s)
- V O Vij
- University Hospital Bonn, Bonn, Germany
| | | | - D Nelles
- University Hospital Bonn, Bonn, Germany
| | - M Stuhr
- University Hospital Bonn, Bonn, Germany
| | | | - H Omran
- St. Marien Hospital Bonn, Bonn, Germany
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Al-Kassou B, Shamekhi J, Feldmann K, Germeroth J, Gillrath J, Weber M, Sedaghat A, Grube E, Nickenig G, Werner N, Sinning JM. P3723Impact of frailty status on 30-day mortality in patients with valvular heart disease undergoing percutaneous transcatheter valve interventions. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0577] [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
Transcatheter strategies to treat valvular heart disease (VHD) are an established therapeutic option in elderly patients, not suitable for open heart surgery. The current ESC guidelines recommend the STS score and EuroSCORE II as tools for risk stratification. However, these surgical risk score do not consider important risk factors such as frailty, cognitive and nutritional status of the patients.
Aims
The aim of this study was to assess the frailty status in patients with severe VHD evaluated for transcatheter treatment strategies and to investigate the impact on mortality of these patients.
Methods and results
Our study cohort consisted of 456 consecutive patients (mean age 79±7.9 years, median STS-score 3.15 and EuroSCORE II 3.65) who were evaluated for percutaneous treatment of severe aortic valve stenosis (n=311), mitral valve regurgitation (n=100), and tricuspid valve regurgitation (n=45) in 2018. The frailty status in these patients was assessed using the Katz Index of Independence in Activities of Daily Living, the Lawton Instrumental Activities of Daily Living Scale, the five times chair rise, and the Score for assessment of frailty phenotype. The Mini Nutritional Assessment (MNA) and the Controlling Nutritional Status score were used for the assessment of the nutritional status of the cohort.
Assessment by the score for frailty phenotype showed that 220 (48.2%) cases were considered frail, 200 (37.3%) cases as prefrail, and only 36 (6.7%) patients considered robust. Regarding the MNA, 212 (46.5%) patients were at normal nutritional status, whereas 207 (45.4%) patients were at risk for malnutrition, and 37 (8.1%) patients were already malnourished.
The overall 30-day mortality rate was 3.1% (n=14). Multivariate analysis showed a significant association of 30-day mortality with baseline serum creatinine (1.2 mg/dl [IQR: 0.9–1.5 mg/dl] for survivors vs 1.6 mg/dl [IQR: 1.4–2.2 mg/dl] for non-survivors, p=0.14), high-sensitive cardiac troponin T (24.3 ng/l [IQR: 16.0–42.6 ng/l] for survivors vs 55.6 ng/l [IQR: 40.4–84.7 ng/l] for non-survivors, p=0.002), and the five chair rise test (p=0.005). Interestingly, there was no significant correlation of nutrition scores and frailty tests with 30-day mortality except for the five chair rise test. Linear regression analysis showed serum creatinine (p=0.04; OR: 1.4, CI: 1.0–1.8) and the five chair rise test (p=0.03; OR: 0.7, CI: 0.5–1) as independent predictors of the mortality.
Frailty Kaplan Meier Analysis
Conclusion
A comprehensive assessment of the clinical patient condition including frailty status is thought to be crucial for risk stratification and the decision-making process which treatment option a specific patient should undergo. However, in our study only the five chair rise test was found to be an independent predictor of 30-day mortality in patients with VHD undergoing percutaneous therapeutic options and seems to be an easy-to-assess test to assess the mortality risk of a specific patient.
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Affiliation(s)
- B Al-Kassou
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology, Bonn, Germany
| | - J Shamekhi
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology, Bonn, Germany
| | - K Feldmann
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology, Bonn, Germany
| | - J Germeroth
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology, Bonn, Germany
| | - J Gillrath
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology, Bonn, Germany
| | - M Weber
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology, Bonn, Germany
| | - A Sedaghat
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology, Bonn, Germany
| | - E Grube
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology, Bonn, Germany
| | - G Nickenig
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology, Bonn, Germany
| | - N Werner
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology, Bonn, Germany
| | - J.-M Sinning
- University Hospital Bonn, Department of Cardiology, Angiology and Pneumology, Bonn, Germany
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Seoudy H, Ludwig S, Al-Kassou B, Shamekhi J, Sugiura A, Grube E, Kuhn C, Conradi L, Nickenig G, Seiffert M, Westermann D, Sinning JM, Frank D. TCT-141 C-Reactive Protein/Albumin Ratio in Patients Undergoing Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.192] [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] [Indexed: 11/27/2022]
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49
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Jansen C, Chatterjee DA, Thomsen KL, Al-Kassou B, Sawhney R, Jones H, Gallego-Leon A, Lehmann J, Pohlmann A, Nickenig G, Strassburg CP, Andrié R, Jalan R, Linhart M, Trebicka J, Mookerjee RP. Significant reduction in heart rate variability is a feature of acute decompensation of cirrhosis and predicts 90-day mortality. Aliment Pharmacol Ther 2019; 50:568-579. [PMID: 31286545 DOI: 10.1111/apt.15365] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 01/20/2019] [Revised: 02/18/2019] [Accepted: 05/17/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Heart rate variability (HRV) is reduced in cirrhosis and in conditions of systemic inflammation. Whether HRV is associated with cirrhosis decompensation and development of acute-on-chronic liver failure (ACLF) is unknown. AIMS To (a) validate wireless remote HRV monitoring in cirrhosis decompensation; (b) determine if severely reduced HRV is a surrogate for inflammation and progression of cirrhosis decompensation; (c) assess if measuring HRV determines prognosis in cirrhosis decompensation. METHODS One hundred and eleven patients at risk of cirrhosis decompensation at two clinical sites were monitored for HRV. Standard deviation of all normal beat-beat intervals (SDNN) reflecting HRV was assessed using remote monitoring (Isansys Lifetouch) and/or Holter ECG recording. Clinical outcomes and major prognostic scores were recorded during 90-day follow-up. RESULTS Reduced HRV denoted by lower baseline SDNN, correlated with severity of decompensation (median 14 (IQR 11-23) vs 33 (25-42); P < 0.001, decompensated patients vs stable outpatient cirrhosis). Furthermore, SDNN was significantly lower in patients developing ACLF compared to those with only decompensation (median 10 (IQR9-12) vs 16 (11-24); P = 0.02), and correlated inversely with MELD and Child-Pugh scores, and C-reactive protein (all P < 0.0001) and white cell count (P < 0.001). SDNN predicted disease progression on repeat measures and appeared an independent predictor of 90-day mortality (12 patients). An SDNN cut-off of 13.25 ms had a 98% negative predictive value. CONCLUSIONS This study demonstrates that remote wireless HRV monitoring identifies cirrhosis patients at high risk of developing ACLF and death, and suggests such monitoring might guide the need for early intervention in such patients. Clinical Trial number: NIHR clinical research network CPMS ID 4949.
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Affiliation(s)
- Christian Jansen
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Devnandan Amor Chatterjee
- Institiute of Liver and Digestive Health, University College London Medical School Royal Free Hospital Campus, London, UK
| | - Karen Louise Thomsen
- Institiute of Liver and Digestive Health, University College London Medical School Royal Free Hospital Campus, London, UK.,Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Baravan Al-Kassou
- Department of Internal Medicine I, University of Bonn, Bonn, Germany.,Department of Internal Medicine II, University of Bonn, Bonn, Germany
| | - Rohit Sawhney
- Institiute of Liver and Digestive Health, University College London Medical School Royal Free Hospital Campus, London, UK
| | - Helen Jones
- Institiute of Liver and Digestive Health, University College London Medical School Royal Free Hospital Campus, London, UK
| | | | - Jennifer Lehmann
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | | | - Georg Nickenig
- Department of Internal Medicine II, University of Bonn, Bonn, Germany
| | | | - René Andrié
- Department of Internal Medicine II, University of Bonn, Bonn, Germany
| | - Rajiv Jalan
- Institiute of Liver and Digestive Health, University College London Medical School Royal Free Hospital Campus, London, UK
| | - Markus Linhart
- Department of Internal Medicine II, University of Bonn, Bonn, Germany
| | - Jonel Trebicka
- Department of Internal Medicine I, University of Bonn, Bonn, Germany.,European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain.,Department of Internal Medicine I, University of Frankfurt am Main, Frankfurt, Germany
| | - Rajeshwar P Mookerjee
- Institiute of Liver and Digestive Health, University College London Medical School Royal Free Hospital Campus, London, UK
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50
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Sedaghat A, Vij V, Streit SR, Schrickel JW, Al-Kassou B, Nelles D, Kleinecke C, Windecker S, Meier B, Valglimigli M, Nietlispach F, Nickenig G, Gloekler S. Incidence, predictors, and relevance of acute kidney injury in patients undergoing left atrial appendage closure with Amplatzer occluders: a multicentre observational study. Clin Res Cardiol 2019; 109:444-453. [DOI: 10.1007/s00392-019-01524-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 06/30/2019] [Indexed: 11/30/2022]
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