1
|
Masson R, Vuyisile NT, Holmes DR, Pislaru SV, Arsanjani R, Chao CJ, Klanderman M, Abraham B, Morsy M, Fortuin FD, Sweeney JP, Sell-Dotten K, Alsidawi S. Disproportionately High Aortic Valve Calcium Scores in Atrial Fibrillation: Implications for Transcatheter Aortic Valve Replacement. Eur Heart J Cardiovasc Imaging 2024:jeae113. [PMID: 38669204 DOI: 10.1093/ehjci/jeae113] [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: 01/30/2024] [Revised: 03/23/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
AIMS Doppler mean gradient (MG) can underestimate aortic stenosis (AS) severity in patients with atrial fibrillation (AF) compared to patients in sinus rhythm (SR), potentially delaying intervention in AF. This study compared outcomes in patients with AF and SR following transcatheter aortic valve replacement (TAVR) and investigated delay in TAVR based on computed tomography aortic valve calcium score (AVCS). METHODS AND RESULTS Patients who underwent TAVR from 2013 to 2017 for native valve severe AS were identified from an institutional database. Baseline characteristics and overall survival were compared between those in SR and AF. There were 820 patients (mean age 81 years; 41.6% female) included. AF was present in 356 patients. Patients in AF were older (82.2 vs. 80.5, p = 0.003), had lower MG compared to SR patients (42.0 vs. 44.9, p = 0.002) with similar indexed aortic valve area (0.4 vs. 0.4, p = 0.17). Median AVCS was higher in AF (males: AF 2850.0 vs. SR 2561.0, p = 0.044; females: AF 1942.0 vs. SR 1610.5, p = 0.025). Projected AVCS assuming same age of diagnosis was similar between AF and SR. Median survival post-TAVR was worse in AF compared to SR (3.2 vs 5.4 years, log rank p < 0.001). AF, lower MG, higher RVSP, dialysis, diabetes, and significant TR were associated with higher mortality (p < 0.05 for all). CONCLUSION Older age and higher AVCS in patients with AF compared to SR suggests that AS was both underestimated and more advanced at TAVR referral.
Collapse
Affiliation(s)
- Rajeev Masson
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Nkomo T Vuyisile
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Molly Klanderman
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Bishoy Abraham
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Mahmoud Morsy
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - F David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - John P Sweeney
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Kristen Sell-Dotten
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Said Alsidawi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| |
Collapse
|
2
|
Patel KP, Sawatari H, Chahal A, Vuyisile NT, Somers V, Mullen MJ, Ricci F, Khanji MY. Health Care Resource, Economic, and Readmission Implications After Acute Decompensated Aortic Stenosis-A Nationwide Study. Am J Cardiol 2023; 204:200-206. [PMID: 37544145 DOI: 10.1016/j.amjcard.2023.07.081] [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: 04/11/2023] [Revised: 06/22/2023] [Accepted: 07/13/2023] [Indexed: 08/08/2023]
Abstract
Acute decompensated aortic stenosis (ADAS) is common. The cumulative burden of ADAS from a clinical, health care resource, and financial perspective is unknown. This study sought to assess the national impact of ADAS compared with electively treated, stable patients with aortic stenosis (non-ADAS). Using the National Readmissions Database between 2016 and 2019, patients with ADAS and non-ADAS were identified using International Classification of Diseases, Tenth Revision codes. Patients with ADAS were propensity-matched to non-ADAS patients (1:2) using age, gender, and Charlson co-morbidity index. We compared in-hospital mortality, length of stay (LOS), health care-associated costs, and 90-day readmission data between the 2 cohorts. A total of 51,498 propensity-matched patients were included in this study: median age 75 years, 64% men. The in-hospital mortality for ADAS was higher than non-ADAS (2.8% vs 1.5%, p <0.0001). The LOS during the index admission was longer for ADAS (9 [5 to 13] vs 4 [2 to 6] days, p <0.0001). The health care-associated costs per patient was greater for ADAS ($55,450.0 [41,860.4 to 74,500.7] vs $43,405.7 [34,218.5 to 56,034.8], p <0.0001). Readmission to hospital within 90 days was more frequent in ADAS (21.1 vs 16.8%, p <0.001). The in-hospital mortality during readmission was higher with ADAS (3.9% vs 2.8%, p = 0.004). The readmission LOS was longer with ADAS (4 [2 to 7] vs 3 [2 to 6] days, p <0.0001). In conclusion, ADAS imposes a significant burden clinically and financially and on health care resources compared with non-ADAS during the index admission and 90-day follow-up. There is an urgent need to predict ADAS and optimize the timing of aortic valve replacement to reduce the incidence and the burden associated with ADAS.
Collapse
Affiliation(s)
- Kush P Patel
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Hiroyuki Sawatari
- Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Anwar Chahal
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nkomo T Vuyisile
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Virend Somers
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Michael J Mullen
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, G.d'Annunzio University of Chieti-Pescara, Chieti, Italy; Clinical Research Center, Department of Clinical Sciences, Malmö, Faculty of Medicine, Lund University, Malmö, Sweden; Fondazione Villaserena per la Ricerca, Città Sant'Angelo, Italy
| | - Mohammed Y Khanji
- Department of Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Department of Cardiology, Newham University Hospital, Barts Health NHS Trust, London, United Kingdom.
| |
Collapse
|