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Badwan O, Mirzai S, Skoza W, Hawk F, Braghieri L, Persits I, Krishnaswamy A, Puri R, Kapadia SR. Clinical outcomes following tricuspid transcatheter edge-to-edge repair with PASCAL: A meta-analysis. Int J Cardiol 2023; 389:131194. [PMID: 37473817 DOI: 10.1016/j.ijcard.2023.131194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/11/2023] [Accepted: 07/14/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Patients with severe tricuspid regurgitation (TR) exhibit high morbidity and mortality. Tricuspid transcatheter edge-to-edge repair (T-TEER) is a rapidly evolving strategy to address the unmet clinical need of severe TR therapies. OBJECTIVE Organize the current body of evidence on outcomes following use of the PASCAL (Edwards Lifesciences) system for T-TEER. METHODS For this meta-analysis, we searched the MEDLINE/PubMed, Embase, and Cochrane databases for keywords ["tricuspid"] and ["transcatheter" or "edge-to-edge"] and ["PASCAL" or "leaflet repair" or "valve repair"] from the database inception until January 11, 2023. Primary outcomes of interest were procedural success, mortality, New York Heart Association (NYHA) functional class, 6-min walking distance (6MWD), and TR severity. RESULTS A total of 549 patients undergoing PASCAL or PASCAL Ace T-TEER were included. The mean age ranged from 71.0 to 80.3 years, with 25.0 to 63.6% females. The follow-up duration ranged from 30 days to 1 year. The success rate was 83.5% (409/490). There was improvement in symptoms based on NYHA classification (at 1- to 6-months; NYHA ≥3 RR 0.27 [95% CI 0.19-0.39]; p < 0.001) and 6MWD (at 1-month; 50.96 [95% CI 32.34-69.59]; p < 0.001) post-procedure. On imaging, there was improvement in TR severity post-procedure (at 1- to 12-months; ≥ severe TR 0.21 [95% CI 0.14-0.31]; p < 0.001), which remained significant with each study removed. CONCLUSION PASCAL for T-TEER is associated with high procedural success rates along with improvements in NYHA functional class, TR severity, 6MWD, and patient-reported outcomes.
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Affiliation(s)
- Osamah Badwan
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States of America
| | - Saeid Mirzai
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States of America
| | - Warren Skoza
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States of America
| | - Fahad Hawk
- Division of Cardiovascular Medicine, University of South Florida College of Medicine, Tampa, FL, United States of America
| | - Lorenzo Braghieri
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States of America
| | - Ian Persits
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, United States of America
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States of America
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States of America.
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Lee DH, Hawk F, Seok K, Gliksman M, Emole J, Rhea IB, Viganego F, Welter-Frost A, Armanious M, Shah B, Chavez JC, Pinilla-Ibarz J, Schabath MB, Fradley M. Association between ibrutinib treatment and hypertension. Heart 2022; 108:445-450. [PMID: 34210750 PMCID: PMC9809112 DOI: 10.1136/heartjnl-2021-319110] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 02/05/2021] [Accepted: 06/03/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Ibrutinib is a tyrosine kinase inhibitor most commonly associated with atrial fibrillation. However, additional cardiotoxicities have been identified, including accelerated hypertension. The incidence and risk factors of new or worsening hypertension following ibrutinib treatment are not as well known. METHODS We conducted a retrospective study of 144 patients diagnosed with B cell malignancies treated with ibrutinib (n=93) versus conventional chemoimmunotherapy (n=51) and evaluated their effects on blood pressure at 1, 2, 3 and 6 months after treatment initiation. Descriptive statistics were used to compare baseline characteristics for each treatment group. Fisher's exact test was used to identify covariates significantly associated with the development of hypertension. Repeated measures analyses were conducted to analyse longitudinal blood pressure changes. RESULTS Both treatments had similar prevalence of baseline hypertension at 63.4% and 66.7%, respectively. There were no differences between treatments by age, sex and baseline cardiac comorbidities. Both systolic and diastolic blood pressure significantly increased over time with ibrutinib compared with baseline, whereas conventional chemoimmunotherapy was not associated with significant changes in blood pressure. Baseline hypertensive status did not affect the degree of blood pressure change over time. A significant increase in systolic blood pressure (defined as more than 10 mm Hg) was noted for ibrutinib (36.6%) compared with conventional chemoimmunotherapy (7.9%) at 1 month after treatment initiation. Despite being hypertensive at follow-up, 61.2% of patients who were treated with ibrutinib did not receive adequate blood pressure management (increase or addition of blood pressure medications). Within the ibrutinib group, of patients who developed more than 20 mm Hg increase in systolic blood pressure, only 52.9% had hypertension management changes. CONCLUSIONS Ibrutinib is associated with the development of hypertension and worsening of blood pressure. Cardiologists and oncologists must be aware of this cardiotoxicity to allow timely management of blood pressure elevations.
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Affiliation(s)
- Dae Hyun Lee
- Division of Cardiovascular Medicine, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Fahad Hawk
- Division of Cardiovascular Medicine, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Kieun Seok
- Department of Internal Medicine, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Matthew Gliksman
- University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Josephine Emole
- Department of Medical Oncology, Henry Ford Health System, Detroit, Michigan, USA
| | - Isaac B Rhea
- Cardio-Oncology Division, University of Tennessee Health Science Center Bookstore, Memphis, Tennessee, USA
| | - Federico Viganego
- Cardio-Oncology Program, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Allan Welter-Frost
- Division of Cardiovascular Medicine, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Merna Armanious
- Division of Cardiovascular Medicine, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Bijal Shah
- Malignant Hematology Program, Moffitt Cancer Center, Tampa, Florida, USA
| | - Juliio C Chavez
- Malignant Hematology Program, Moffitt Cancer Center, Tampa, Florida, USA
| | | | - Matthew B Schabath
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Michael Fradley
- Cardio-Oncology Center of Excellence, Division of Cardiology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Vautier R, Lee DH, Ayoubi Y, Hernandez Burgos P, Hawk F, Chen A. Abstract 323: Assessment of Coronary Artery Calcium on Routine Non-gated Chest Computed Tomography to Risk Stratify Patients Presenting With Chest Pain. Circ Cardiovasc Qual Outcomes 2020. [DOI: 10.1161/hcq.13.suppl_1.323] [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: 11/16/2022]
Abstract
Background:
Coronary artery calcium (CAC) scoring is an important tool for cardiovascular risk stratification. CAC scoring in both asymptomatic and symptomatic, low-intermediate risk patients has also shown prognostic utility and has a high negative predictive value for obstructive coronary artery disease (CAD). Patients who present with chest pain frequently undergo non-gated chest computed tomography (CT) to evaluate for non-cardiac etiologies. In fact, several studies have demonstrated that a CAC score from a non-gated chest CT correlates well with a dedicated calcium-scoring CT. However, the predictive value on CAD through assessing the presence (CAC>0) or the absence of calcium (CAC=0) detected on non-gated chest CT in patients presenting with chest pain is unknown.
Methods:
Low-intermediate risk patients (n=92) presenting to the emergency department with chest pain who underwent non-gated chest CT and were subsequently evaluated with either a cardiac stress test or invasive coronary angiography were included. Dichotomous CAC was assessed in a blinded fashion and classified as CAC=0 or CAC>0. Obstructive CAD was defined as either: ischemia on stress testing or any coronary artery stenosis greater than 70% (left main coronary artery stenosis greater than 50%) on invasive coronary angiography.
Results:
CAC=0 on non-gated chest CT was found in 59.2% (n=42). Patients with CAC=0 had a significantly lower age and TIMI score compared to patients with a CAC>0. (p<0.01 ) Patients with a CAC>0 were found to more likely have obstructive CAD on subsequent testing: cardiac stress test (Likelihood ratio[LR]:6.42, p=0.022); and invasive angiography (LR:12.46, p=0.002). There were no patients with a CAC=0 that were found to have obstructive CAD on invasive coronary angiography, resulting in a 100% sensitivity and 100% negative predictive value.
Conclusion:
Patient who presents with chest pain frequently undergo evaluation with a non-gated chest CT to assess non-cardiac etiologies. Exclusion of CAC on non-gated chest CT may be useful as an adjunct for further risk stratification to avoid potential adverse events and cost associated with further testing.
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Affiliation(s)
| | - Dae Hyun Lee
- Univ of South Florida, College of Morsani, Tampa, FL
| | - Yasmin Ayoubi
- Univ of South Florida, College of Morsani, Tampa, FL
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