1
|
Giuliani C, Zanuttini A, Nuche J, Farjat Pasos JI, Bernard J, Lionel T, Jacob S, Abu-Alhayja'a R, Beaudoin J, Côté N, DeLarochellière R, Paradis JM, Clavel MA, Arsenault BJ, Rodés-Cabau J, Pibarot P, Hecht S. Human Epididymis Protein 4 in Transcatheter Aortic Valve Implantation: Diagnostic and Prognostic Value. JACC. ADVANCES 2025; 4:101722. [PMID: 40286377 PMCID: PMC12103096 DOI: 10.1016/j.jacadv.2025.101722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Revised: 02/12/2025] [Accepted: 03/06/2025] [Indexed: 04/29/2025]
Abstract
BACKGROUND The utility of the human epididymis protein 4 (HE4) in patients undergoing transcatheter aortic valve implantation (TAVI) has not been established yet. OBJECTIVES The present study aimed at examining the prognostic value of HE4 in patients undergoing TAVI. METHODS In this prospective study, the prognostic value of HE4 to predict adverse clinical events was evaluated in 362 patients who underwent TAVI. The association between HE4 and diffuse myocardial fibrosis was also assessed using T1 mapping on cardiac magnetic resonance in a subgroup of 43 patients. RESULTS During a median follow-up of 2.5 (IQR: 1.9-3.2) years, 34/362 (9.4%) patients were rehospitalized for heart failure, 99/362 (27.3%) died, and 113/362 (31.2%) met the composite endpoint of rehospitalization for heart failure or all-cause mortality. In multivariable Cox regression analyses, patients with higher HE4 serum levels (ie, HE4 ≥130 pmol/L) vs lower serum levels (ie, HE4 <130 pmol/L) had increased risk of all-cause mortality (adjusted HR: 3.26 [95% CI: 2.04-5.20], P < 0.001), and of the composite endpoint (adjusted HR: 2.48 [95% CI: 1.64-3.74], P < 0.001) following TAVI, respectively. Patients with higher HE4 serum levels had higher median native T1 mapping values (1,278 [95% CI: 1,239-1,280] ms vs 1,352 [95% CI: 1,303-1,376] ms, P < 0.001) at 1 to 3 months following the procedure. CONCLUSIONS Elevated HE4 serum levels are associated with diffuse myocardial fibrosis and increased risk of adverse clinical events following TAVI. This promising blood biomarker may be helpful to enhance risk stratification in patients undergoing TAVI.
Collapse
Affiliation(s)
- Carlos Giuliani
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec City, Québec, Canada; Faculté de médecine, Université Laval, Québec City, Québec, Canada
| | - Antonela Zanuttini
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec City, Québec, Canada; Faculté de médecine, Université Laval, Québec City, Québec, Canada
| | - Jorge Nuche
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec City, Québec, Canada; Faculté de médecine, Université Laval, Québec City, Québec, Canada
| | - Julio I Farjat Pasos
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec City, Québec, Canada; Faculté de médecine, Université Laval, Québec City, Québec, Canada
| | - Jérémy Bernard
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec City, Québec, Canada; Faculté de médecine, Université Laval, Québec City, Québec, Canada
| | - Tastet Lionel
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec City, Québec, Canada; Faculté de médecine, Université Laval, Québec City, Québec, Canada
| | - Simon Jacob
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec City, Québec, Canada; Faculté de médecine, Université Laval, Québec City, Québec, Canada
| | - Rami Abu-Alhayja'a
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec City, Québec, Canada; Faculté de médecine, Université Laval, Québec City, Québec, Canada
| | - Jonathan Beaudoin
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec City, Québec, Canada; Faculté de médecine, Université Laval, Québec City, Québec, Canada
| | - Nancy Côté
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec City, Québec, Canada; Faculté de médecine, Université Laval, Québec City, Québec, Canada
| | - Robert DeLarochellière
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec City, Québec, Canada; Faculté de médecine, Université Laval, Québec City, Québec, Canada
| | - Jean-Michel Paradis
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec City, Québec, Canada; Faculté de médecine, Université Laval, Québec City, Québec, Canada
| | - Marie-Annick Clavel
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec City, Québec, Canada; Faculté de médecine, Université Laval, Québec City, Québec, Canada
| | - Benoit J Arsenault
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec City, Québec, Canada; Faculté de médecine, Université Laval, Québec City, Québec, Canada
| | - Josep Rodés-Cabau
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec City, Québec, Canada; Faculté de médecine, Université Laval, Québec City, Québec, Canada
| | - Philippe Pibarot
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec City, Québec, Canada; Faculté de médecine, Université Laval, Québec City, Québec, Canada
| | - Sébastien Hecht
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec City, Québec, Canada; Faculté de médecine, Université Laval, Québec City, Québec, Canada.
| |
Collapse
|
2
|
Vekstein AM, Wegermann ZK, Manandhar P, Mack MJ, Cohen DJ, Hughes GC, Harrison JK, Kaneko T, Kapadia SR, Stathogiannis K, Fearon WF, Arnold S, Kosinski AS, Leon MB, Batchelor WB, Thourani VH, Vemulapalli S. Outcomes of Transcatheter Aortic Valve Replacement in Low-Risk Patients in the United States: A Report From the STS/ACC TVT Registry. Circulation 2025; 151:1134-1146. [PMID: 40177743 DOI: 10.1161/circulationaha.124.071838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Accepted: 03/04/2025] [Indexed: 04/05/2025]
Abstract
BACKGROUND Real-world low-risk transcatheter aortic valve replacement (TAVR) outcomes in the United States have not been assessed comprehensively versus pivotal trials, which is a key component of measuring the quality of clinical technology adoption. METHODS We identified heart team-designated low-risk patients undergoing TAVR for trileaflet severe, symptomatic aortic stenosis in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Registry, as well as a subset of patients who met low-risk trial inclusion and exclusion criteria, from January 2020 to March 2024. Outcomes (mortality, stroke, new pacemaker, and "alive and well," defined as alive at 1 year with Kansas City Cardiomyopathy Questionnaire score ≥60 and ≤10-point decrease from baseline) at 30 days and 1 year were assessed. Multivariable models were developed to assess predictors of death and stroke within 1 year after TAVR. RESULTS Among 383 030 patients who underwent TAVR during the study period, 108 407 (28%) were designated low-risk by the heart team, and 68 194 (18%) met other study inclusion and exclusion criteria. Of these, 62% (n=42 093) would have been eligible for the low-risk trials. In the overall heart team-designated low-risk population, 30-day outcomes included 0.8% mortality, 1.5% stroke, and 8.4% new permanent pacemaker requirement; 1-year outcomes included 4.6% mortality, 2.6% stroke, and 90% alive and well. In the trial-eligible population, 0.6% mortality, 1.4% stroke, and 8.0% new permanent pacemaker requirement had occurred by 30 days; values at 1 year included 3.1% mortality, 2.4% stroke, and 92% alive and well. Notable multivariable predictors of 1-year mortality were atrial fibrillation, nontransfemoral access, and lower baseline Kansas City Cardiomyopathy Questionnaire score. CONCLUSIONS One-year outcomes among real-world trial-eligible patients are excellent, but adverse events are higher compared with published clinical trial data, likely because of greater comorbidity burden and lower baseline Kansas City Cardiomyopathy Questionnaire score. These data can help inform expected outcomes and health status after low-risk TAVR.
Collapse
Affiliation(s)
- Andrew M Vekstein
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery (A.M.V., G.C.H.), Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC (A.M.V., Z.K.W., P.M., A.S.K., S.V.)
| | - Zachary K Wegermann
- Division of Cardiology, Department of Medicine (Z.K.W., J.K.H., S.V.), Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC (A.M.V., Z.K.W., P.M., A.S.K., S.V.)
| | - Pratik Manandhar
- Duke Clinical Research Institute, Durham, NC (A.M.V., Z.K.W., P.M., A.S.K., S.V.)
| | | | - David J Cohen
- St. Francis Hospital and Heart Center, Roslyn, NY (D.J.C.)
- Cardiovascular Research Foundation, New York, NY (D.J.C.)
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery (A.M.V., G.C.H.), Duke University Medical Center, Durham, NC
| | - J Kevin Harrison
- Division of Cardiology, Department of Medicine (Z.K.W., J.K.H., S.V.), Duke University Medical Center, Durham, NC
| | - Tsuyoshi Kaneko
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University Barnes-Jewish Hospital, St. Louis, MO (T.K.)
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH (S.R.K.)
| | - Konstantinos Stathogiannis
- Division of Cardiovascular Medicine, Department of Medicine, Stanford Health Care, Palo Alto, CA (K.S., W.F.F.)
| | - William F Fearon
- Division of Cardiovascular Medicine, Department of Medicine, Stanford Health Care, Palo Alto, CA (K.S., W.F.F.)
| | - Suzanne Arnold
- Saint Luke's Mid America Heart Institute and University of Missouri, Kansas City (S.A.)
| | - Andrzej S Kosinski
- Duke Clinical Research Institute, Durham, NC (A.M.V., Z.K.W., P.M., A.S.K., S.V.)
| | - Martin B Leon
- Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York (M.B.L.)
| | | | - Vinod H Thourani
- Marcus Heart and Valve Center, Piedmont Heart Institute, Atlanta, GA (V.H.T.)
| | - Sreekanth Vemulapalli
- Division of Cardiology, Department of Medicine (Z.K.W., J.K.H., S.V.), Duke University Medical Center, Durham, NC
- Duke Clinical Research Institute, Durham, NC (A.M.V., Z.K.W., P.M., A.S.K., S.V.)
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC (S.V.)
| |
Collapse
|
3
|
Goyal A, Shoaib A, Fareed A, Jawed S, Khan MT, Salim N, Zameer U, Siddiqui A, Thakur T, Sulaiman SA. Outcomes of periprocedural continuation vs interruption of oral anticoagulation in transcatheter aortic valve replacement. World J Cardiol 2025; 17:104000. [PMID: 40161570 PMCID: PMC11947949 DOI: 10.4330/wjc.v17.i3.104000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Revised: 01/27/2025] [Accepted: 02/21/2025] [Indexed: 03/21/2025] Open
Abstract
BACKGROUND Up to one-third of patients undergoing transcatheter aortic valve replacement (TAVR) have an indication for oral anticoagulation (OAC), primarily due to underlying atrial fibrillation. The optimal approach concerning periprocedural continuation vs interruption of OAC in patients undergoing TAVR remains uncertain, which our meta-analysis aims to address. AIM To explore safety and efficacy outcomes for patients undergoing TAVR, comparing periprocedural continuation vs interruption of OAC therapy. METHODS A literature search was conducted across major databases to retrieve eligible studies that assessed the safety and effectiveness of TAVR with periprocedural continuous vs interrupted OAC. Data were pooled using a random-effects model with risk ratio (RR) and their 95% confidence interval (CI) as effect measures. All statistical analyses were conducted using Review Manager with statistical significance set at P < 0.05. RESULTS Four studies were included, encompassing a total of 1813 patients with a mean age of 80.6 years and 49.8% males. A total of 733 patients underwent OAC interruption and 1080 continued. Stroke incidence was significantly lower in the OAC continuation group (RR = 0.62, 95%CI: 0.40-0.94; P = 0.03). No significant differences in major vascular complications were found between the two groups (RR = 0.95, 95%CI: 0.77-1.16; P = 0.60) and major bleeding (RR = 0.90, 95%CI: 0.72-1.12; P = 0.33). All-cause mortality was non-significant between the two groups (RR = 0.83, 95%CI: 0.57-1.20; P = 0.32). CONCLUSION Continuation of OAC significantly reduced stroke risk, whereas it showed trends toward lower bleeding and mortality that were not statistically significant. Further large-scale studies are crucial to determine clinical significance.
Collapse
Affiliation(s)
- Aman Goyal
- Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai 400012, Maharashtra, India
| | - Aqsa Shoaib
- Department of Internal Medicine, Karachi Medical and Dental College, Karachi 74700, Sindh, Pakistan
| | - Areeba Fareed
- Department of Internal Medicine, Karachi Medical and Dental College, Karachi 74700, Sindh, Pakistan
| | - Sara Jawed
- Department of Internal Medicine, Karachi Medical and Dental College, Karachi 74700, Sindh, Pakistan
| | - Muhammad Taha Khan
- Department of Internal Medicine, Karachi Medical and Dental College, Karachi 74700, Sindh, Pakistan
| | - Najwa Salim
- Department of Internal Medicine, Karachi Medical and Dental College, Karachi 74700, Sindh, Pakistan
| | - Ushna Zameer
- Department of Internal Medicine, Karachi Medical and Dental College, Karachi 74700, Sindh, Pakistan
| | - Amna Siddiqui
- Department of Internal Medicine, Karachi Medical and Dental College, Karachi 74700, Sindh, Pakistan
| | - Tanya Thakur
- Department of Internal Medicine, Government Medical College, Patiala 147001, Punjab, India
| | - Samia Aziz Sulaiman
- Department of Internal Medicine, The University of Jordan, Amman 11183, Jordan.
| |
Collapse
|
4
|
Van Mieghem NM, Elmariah S, Spitzer E, Pibarot P, Nazif TM, Bax JJ, Hahn RT, Popma A, Ben-Yehuda O, Kallel F, Redfors B, Chuang ML, Alu MC, Lindeboom W, Kolte D, Zahr FE, Kodali SK, Strote JA, Hermanides RS, Cohen DJ, Tijssen JGP, Leon MB. Transcatheter Aortic Valve Replacement in Patients With Systolic Heart Failure and Moderate Aortic Stenosis: TAVR UNLOAD. J Am Coll Cardiol 2025; 85:878-890. [PMID: 39480381 DOI: 10.1016/j.jacc.2024.10.070] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Revised: 10/10/2024] [Accepted: 10/11/2024] [Indexed: 04/26/2025]
Abstract
BACKGROUND Neurohormonal modulation and afterload reduction are key for treatment of heart failure with reduced ejection fraction (HFrEF). In HFrEF patients with concomitant moderate aortic stenosis (AS), treatment with transcatheter aortic valve replacement (TAVR) may be complementary to guideline-directed medical therapy (GDMT). OBJECTIVES This study sought to determine whether TAVR for moderate AS provides clinical benefit in patients with HFrEF on top of GDMT. METHODS We performed an investigator-initiated, international, randomized controlled trial in patients with HFrEF on GDMT with moderate AS who were suitable for transfemoral TAVR with a balloon-expandable valve. Patients were randomized 1:1 to TAVR or clinical aortic stenosis surveillance (CASS) with aortic valve replacement upon progression to severe AS. The primary endpoint was the hierarchical occurrence of: 1) all-cause death; 2) disabling stroke; 3) disease-related hospitalizations and heart failure equivalents; and 4) change from baseline in the Kansas City Cardiomyopathy Questionnaire Overall Summary Score analyzed using the win ratio. RESULTS From January 2017 to December 2022, 178 patients were randomized to TAVR (n = 89) or AS surveillance (n = 89). The mean age was 77 years, 20.8% were female, and 55.6% were in NYHA functional class III or IV. The median follow-up duration was 23 months (Q1-Q3: 12-33 months). A total of 38 (43%) patients in the CASS group (of whom 35 had progressed to severe AS) underwent TAVR at a median of 12 months postrandomization. TAVR was associated with wins in 47.6% of pairs, compared with 36.6% in the CASS group, resulting in a win ratio of 1.31 (95% CI: 0.91-1.88; P = 0.14). At 1 year, TAVR resulted in a greater improvement in the Kansas City Cardiomyopathy Questionnaire Overall Summary Score compared with the CASS group (12.8 ± 21.9 points vs 3.2 ± 22.8 points; P = 0.018). CONCLUSIONS TAVR was not superior to AS surveillance for the primary hierarchical composite endpoint in patients with moderate AS and HFrEF on GDMT. Preemptive TAVR for moderate AS was safe and may provide clinically meaningful quality-of-life benefits.
Collapse
Affiliation(s)
- Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Cardiovascular Institute, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Sammy Elmariah
- Division of Cardiology, University of San Francisco, San Francisco, California, USA
| | - Ernest Spitzer
- Department of Cardiology, Thoraxcenter, Cardiovascular Institute, Erasmus University Medical Center, Rotterdam, the Netherlands; Cardialysis, Rotterdam, the Netherlands
| | - Philippe Pibarot
- Department of Medicine, Québec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Tamim M Nazif
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rebecca T Hahn
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | | | - Ori Ben-Yehuda
- Division of Cardiovascular Medicine, University of California San Diego, San Diego, California, USA
| | | | - Björn Redfors
- Cardiovascular Research Foundation, New York, New York, USA; Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Maria C Alu
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | | | - Dhaval Kolte
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - Firas E Zahr
- Oregon Health and Science University, Portland, Oregon, USA
| | - Susheel K Kodali
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | | | | | - David J Cohen
- Cardiovascular Research Foundation, New York, New York, USA; St Francis Hospital, Roslyn, New York, USA
| | - Jan G P Tijssen
- Cardialysis, Rotterdam, the Netherlands; Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Martin B Leon
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| |
Collapse
|
5
|
Hashem A, Khalouf A, Mohamed MS, Adra S, Alkhatib D, Ismayl M, Kashou A, Rai D, Depta JP, Sulaiman S, Goldsweig AM, Balla S. Early vs. late transcatheter aortic valve replacement in acute heart failure hospitalizations: A comparative nationwide analysis. J Cardiol 2025; 85:248-256. [PMID: 39154780 DOI: 10.1016/j.jjcc.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 08/01/2024] [Accepted: 08/10/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Severe aortic stenosis (AS) is the most common valvular disease in the USA. Patients undergoing urgent or emergent transcatheter aortic valve replacement (TAVR) have worse clinical outcomes than those undergoing non-urgent procedures. No studies have examined the impact of procedural TAVR timing on outcomes in AS complicated by acute heart failure (AHF). AIMS We aimed to evaluate differences in in-hospital mortality and clinical outcomes between early (<48 h) vs. late (≥48 h) TAVR in patients hospitalized with AHF using a real-world US database. METHODS We queried the National Inpatient Sample database to identify hospitalizations with a diagnosis of AHF, aortic valve disease, and a TAVR procedure (2015-2020). The associations between TAVR timing and clinical outcomes were examined using logistic regression model. RESULTS A total of 25,290 weighted AHF hospitalizations were identified, of which 6855 patients (27.1 %) underwent early TAVR, and 18,435 (72.9 %) late TAVR. Late TAVR patients had higher in-hospital mortality rate (2.2 % vs. 2.8 %, p < 0.01) on unadjusted analysis but no significant difference following adjustment for demographic, clinical, and hospital characteristics [aOR 1.00 (0.82-1.23)]. Late TAVR was associated with higher odds of cardiac arrest (aOR 1.50, 95 % CI: 1.18-1.90) and use of mechanical circulatory support (aOR 2.05, 95 % CI: 1.68-2.51). Late TAVR was associated with longer hospital stay (11 days vs. 4 days, p < 0.01) and higher costs ($72,851 vs. $53,209, p < 0.01). CONCLUSION Early TAVR was conducted in approximately 25 % of the AS patients admitted with AHF, showing improved in-hospital outcomes before adjustment, with no significant differences observed after adjustment.
Collapse
Affiliation(s)
- Anas Hashem
- Department of Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Amani Khalouf
- Department of Medicine, Rochester General Hospital, Rochester, NY, USA
| | | | - Saryia Adra
- University of Sharjah, Sharjah, United Arab Emirates
| | - Deya Alkhatib
- Division of Cardiovascular Disease, Yale School of Medicine, New Haven, CT, USA
| | - Mahmoud Ismayl
- Cardiovascular Disease Department, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Anthony Kashou
- Cardiovascular Disease Department, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Devesh Rai
- Cardiovascular Disease Department, Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, NY, USA
| | - Jeremiah P Depta
- Cardiovascular Disease Department, Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, NY, USA
| | - Samian Sulaiman
- Cardiovascular Disease Department, West Virginia University, Morgantown, WV, USA
| | | | - Sudarshan Balla
- Cardiovascular Disease Department, West Virginia University, Morgantown, WV, USA.
| |
Collapse
|
6
|
Compagnone M, Dall’Ara G, Grotti S, Mambelli G, Fabbri E, Savini C, Balducelli M, Santarelli A, Iorio E, Vaquerizo B, Marchese A, Tarantini G, Saia F, Zingaretti C, Moretti C, Cavazza C, Vertogen B, Ottani F, Rubboli A, Nanni O, Pizzi C, Galvani M, Tarantino FF. Transfemoral Transcatheter Aortic Valve Implantation at Hospitals Without On-Site Cardiac Surgery (TAVI at Home): A Multicenter Prospective Interventional Study. J Cardiovasc Dev Dis 2025; 12:63. [PMID: 39997497 PMCID: PMC11856494 DOI: 10.3390/jcdd12020063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Revised: 02/06/2025] [Accepted: 02/07/2025] [Indexed: 02/26/2025] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has become the standard of care for elderly patients with aortic stenosis. International guidelines recommend that TAVI should be performed only in centers with on-site cardiac surgery (CS). However, rapidly evolving TAVI technology and increasing operator expertise have significantly reduced peri-procedural complications, including those requiring rescue surgery, which occur in less than 0.5% of cases. Furthermore, only a minority of major complications are treated with CS, and the outcomes remain unfavorable. TAVI in centers without CS could represent a solution to reduce waiting times and ensure continuity of care for fragile patients. "TAVI at Home" is a single-arm prospective interventional study. According to sample size calculations based on literature data, the study aims to enroll a total of 200 patients, beginning with a run-in phase of 20 patients to establish safety. The primary endpoint is 30-day all-cause mortality. Secondary endpoints include technical success and the evaluation of single complications 30 days after the procedure. Hospitals without CS that are eligible to perform TAVI must have a high volume of coronary percutaneous interventions, operators with established TAVI experience, collaboration with vascular surgeons, and regular Heart Team meetings to ensure rigorous patient selection.
Collapse
Affiliation(s)
- Miriam Compagnone
- Interventional and Structural Cardiology Unit Forlì-Cesena, 47121 Forlì, Italy
| | - Gianni Dall’Ara
- Interventional and Structural Cardiology Unit Forlì-Cesena, 47121 Forlì, Italy
- Department of Medical and Surgical Sciences—DIMEC—Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Simone Grotti
- Interventional and Structural Cardiology Unit Forlì-Cesena, 47121 Forlì, Italy
| | - Greta Mambelli
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Elisabetta Fabbri
- U.O. Ricerca Valutativa e Policy dei Servizi Sanitari, AUSL Romagna, 48121 Ravenna, Italy
| | - Carlo Savini
- Department of Medical and Surgical Sciences—DIMEC—Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
- GVM Care & Research Maria Cecilia Hospital, 48033 Cotignola, Italy
| | - Marco Balducelli
- Division of Cardiology, S. Maria delle Croci Hospital, Ravenna, AUSL Romagna, 48121 Ravenna, Italy
| | | | - Elia Iorio
- UOC Cardiologia e UTIC, Ente Ecclesiastico Ospedale Generale Regionale F Miulli, Acquaviva delle Fonti, 70021 Bari, Italy
| | | | | | - Giuseppe Tarantini
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, 35128 Padua, Italy
| | - Francesco Saia
- Interventional Cardiology Unit, IRCCS University Hospital of Bologna, Policlinico S. Orsola, 40138 Bologna, Italy
| | - Chiara Zingaretti
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Carolina Moretti
- Division of Cardiology, S. Maria delle Croci Hospital, Ravenna, AUSL Romagna, 48121 Ravenna, Italy
| | - Caterina Cavazza
- Cardiovascular Department, Infermi Hospital, AUSL Romagna, 47921 Rimini, Italy
| | - Bernadette Vertogen
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Filippo Ottani
- Cardiovascular Department, Infermi Hospital, AUSL Romagna, 47921 Rimini, Italy
| | - Andrea Rubboli
- Division of Cardiology, S. Maria delle Croci Hospital, Ravenna, AUSL Romagna, 48121 Ravenna, Italy
| | - Oriana Nanni
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) “Dino Amadori”, 47014 Meldola, Italy
| | - Carmine Pizzi
- Department of Medical and Surgical Sciences—DIMEC—Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
- Cardiology Division, Morgagni Pierantoni University Hospital, AUSL Romagna, 47121 Forlì, Italy
| | - Marcello Galvani
- Cardiovascular Research Unit, Fondazione Cardiologica Sacco, 47100 Forlì, Italy
| | | |
Collapse
|
7
|
Tremamunno G, Vecsey-Nagy M, Schoepf UJ, Zsarnoczay E, Aquino GJ, Kravchenko D, Laghi A, Jacob A, Sharma P, Rapaka S, O'Doherty J, Suranyi PS, Kabakus IM, Amoroso NS, Steinberg DH, Emrich T, Varga-Szemes A. Artificial Intelligence Improves Prediction of Major Adverse Cardiovascular Events in Patients Undergoing Transcatheter Aortic Valve Replacement Planning CT. Acad Radiol 2025; 32:702-711. [PMID: 39389811 DOI: 10.1016/j.acra.2024.09.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Revised: 09/10/2024] [Accepted: 09/20/2024] [Indexed: 10/12/2024]
Abstract
RATIONALE AND OBJECTIVES Coronary CT angiography (CCTA) is mandatory before transcatheter aortic valve replacement (TAVR). Our objective was to evaluate the efficacy of artificial intelligence (AI)-powered software in automatically analyzing cardiac parameters from pre-procedural CCTA to predict major adverse cardiovascular events (MACE) in TAVR patients. MATERIALS AND METHODS Patients undergoing pre-TAVR CCTA were retrospectively included. AI software automatically extracted 34 morphologic and volumetric cardiac parameters characterizing the ventricles, atria, myocardium, and epicardial adipose tissue. Clinical information and outcomes were recorded from institutional database. Cox regression analysis identified predictors of MACE, including non-fatal myocardial infarction, heart failure hospitalization, unstable angina, and cardiac death. Model performance was evaluated with Harrell's C-index, and nested models were compared using the likelihood ratio test. Manual analysis of 170 patients assessed agreement with automated measurements. RESULTS Among the 648 enrolled patients (77 ± 9.3 years, 58.9% men), 116 (17.9%) experienced MACE within a median follow-up of 24 months (interquartile range 10-40). After adjusting for clinical parameters, only left ventricle long axis shortening (LV-LAS) was an independent predictor of MACE (hazard ratio [HR], 1.05 [95% confidence interval, 1.05-1.11]; p = 0.04), with significantly improved C-index (0.620 vs. 0.633; p < 0.001). When adjusted for the Society of Thoracic Surgeons Predicted Risk of Mortality score, LV-LAS was also predictive of MACE (HR, 1.08 [95%CI, 1.03-1.13]; p = 0.002), while improving model performance (C-index: 0.557 vs. 0.598; p < 0.001). All parameters showed good or excellent agreement with manual measurements. CONCLUSION Automated AI-based comprehensive cardiac assessment enables pre-TAVR MACE prediction, with LV-LAS outperforming all other parameters.
Collapse
Affiliation(s)
- Giuseppe Tremamunno
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, South Carolina 29425, USA (G.T., M.V.N., U.J.S., E.Z., G.J.A., D.K., J.O., P.S.S., I.M.K., T.E., A.V.S.); Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University, Hospital Via di Grottarossa, 1035-1039 00189 Rome, Italy (G.T., A.L.)
| | - Milan Vecsey-Nagy
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, South Carolina 29425, USA (G.T., M.V.N., U.J.S., E.Z., G.J.A., D.K., J.O., P.S.S., I.M.K., T.E., A.V.S.); Heart and Vascular Center, Semmelweis University, Varosmajor utca 68, Budapest 1122, Hungary (M.V.N.)
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, South Carolina 29425, USA (G.T., M.V.N., U.J.S., E.Z., G.J.A., D.K., J.O., P.S.S., I.M.K., T.E., A.V.S.)
| | - Emese Zsarnoczay
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, South Carolina 29425, USA (G.T., M.V.N., U.J.S., E.Z., G.J.A., D.K., J.O., P.S.S., I.M.K., T.E., A.V.S.); MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Semmelweis University, Koranyi Sandor street 2, Budapest 1083, Hungary (E.Z.)
| | - Gilberto J Aquino
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, South Carolina 29425, USA (G.T., M.V.N., U.J.S., E.Z., G.J.A., D.K., J.O., P.S.S., I.M.K., T.E., A.V.S.)
| | - Dmitrij Kravchenko
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, South Carolina 29425, USA (G.T., M.V.N., U.J.S., E.Z., G.J.A., D.K., J.O., P.S.S., I.M.K., T.E., A.V.S.); Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany (D.K.); Quantitative Imaging Laboratory Bonn (QILaB), Venusberg-Campus 1, 53127, Bonn, Germany (D.K.)
| | - Andrea Laghi
- Department of Medical Surgical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University, Hospital Via di Grottarossa, 1035-1039 00189 Rome, Italy (G.T., A.L.)
| | - Athira Jacob
- Siemens Healthineers, 755 College Rd E, Princeton, New Jersey 08540, USA (A.J., P.S., S.R.)
| | - Puneet Sharma
- Siemens Healthineers, 755 College Rd E, Princeton, New Jersey 08540, USA (A.J., P.S., S.R.)
| | - Saikiran Rapaka
- Siemens Healthineers, 755 College Rd E, Princeton, New Jersey 08540, USA (A.J., P.S., S.R.)
| | - Jim O'Doherty
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, South Carolina 29425, USA (G.T., M.V.N., U.J.S., E.Z., G.J.A., D.K., J.O., P.S.S., I.M.K., T.E., A.V.S.); Siemens Medical Solutions, 40 Liberty Blvd, Malvern, Pennsylvania 19355, USA (J.O.)
| | - Pal Spruill Suranyi
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, South Carolina 29425, USA (G.T., M.V.N., U.J.S., E.Z., G.J.A., D.K., J.O., P.S.S., I.M.K., T.E., A.V.S.)
| | - Ismail Mikdat Kabakus
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, South Carolina 29425, USA (G.T., M.V.N., U.J.S., E.Z., G.J.A., D.K., J.O., P.S.S., I.M.K., T.E., A.V.S.)
| | - Nicholas S Amoroso
- Division in Cardiology, Department of Medicine, Medical University of South Carolina, 25 Courtenay Dr, Charleston, South Carolina 29425, USA (N.S.A., D.H.S.)
| | - Daniel H Steinberg
- Division in Cardiology, Department of Medicine, Medical University of South Carolina, 25 Courtenay Dr, Charleston, South Carolina 29425, USA (N.S.A., D.H.S.)
| | - Tilman Emrich
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, South Carolina 29425, USA (G.T., M.V.N., U.J.S., E.Z., G.J.A., D.K., J.O., P.S.S., I.M.K., T.E., A.V.S.); Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University, Langenbeckstraße 1, Mainz 55131, Germany (T.E.)
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Dr, Charleston, South Carolina 29425, USA (G.T., M.V.N., U.J.S., E.Z., G.J.A., D.K., J.O., P.S.S., I.M.K., T.E., A.V.S.).
| |
Collapse
|
8
|
Brown JY, Fernandez GV, De La Torre Hernández JM, Murphy M, Wessler BS, Edelman ER. Clinical Validation of Non-invasive Simulation-Based Determination of Vascular Impedance, Wave Intensity, and Hydraulic Work in Patients Undergoing Transcatheter Aortic Valve Replacement. Ann Biomed Eng 2025; 53:536-546. [PMID: 39562410 PMCID: PMC11805843 DOI: 10.1007/s10439-024-03635-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/24/2024] [Indexed: 11/21/2024]
Abstract
PURPOSE The impact of Aortic Stenosis (AS) on the left ventricle (LV) extends beyond the influence of the pressure drop across the stenotic valve, but also includes the additional serial afterload imposed by the vascular system. Aortic input impedance is the gold standard for comprehensively studying the contribution of the vascular system to total myocardial afterload, but in the past measurement has been challenging arising from the need for invasive catheterization or specialized equipment to precisely record time-resolved blood pressure and flow signals. The goal of this work was to develop and validate a novel simulation-based method for determining aortic input impedance using only clinically available echocardiographic data and a simple blood pressure measurement. METHODS A simulation-based method to determine vascular impedance was developed using echocardiographic data and a brachial blood pressure measurement. Simulation-based impedance was compared to impedance calculated from echocardiographic flow data and pressure data from a non-invasive central pressure measurement device. RESULTS In validation analysis comparing patient-specific simulation-based vascular impedance to non-invasively measured impedance, correlation between methods across a range of vascular parameters varied between R2 = 0.40 and 0.99. A tendency was seen toward underestimation of pressure waveforms in point-by-point comparison of measured and simulated waveforms with an overall mean difference of 4.01 mmHg. CONCLUSIONS Requiring only non-invasive clinical data that are widely available, simulation-based vascular impedance has the potential to allow for easier, more widespread, and larger-scale investigation of the effect of vascular impedance on total LV afterload.
Collapse
Affiliation(s)
- Jonathan Y Brown
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 77 Massachusetts Ave Building E25-RM442, Cambridge, MA, USA.
- Clinical and Translation Science Institute, Tufts University, Boston, MA, USA.
- Tufts Medical Center, Boston, MA, USA.
| | | | | | - Michael Murphy
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 77 Massachusetts Ave Building E25-RM442, Cambridge, MA, USA
| | - Benjamin S Wessler
- Clinical and Translation Science Institute, Tufts University, Boston, MA, USA
- Tufts Medical Center, Boston, MA, USA
| | - Elazer R Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, 77 Massachusetts Ave Building E25-RM442, Cambridge, MA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| |
Collapse
|
9
|
Nicosia FM, Zamora K, Ashcraft L, Krautner G, Groot M, Kinosian B, Schubert CC, Chhatre S, Moriarty H, Intrator O, Schwartz AW, Orkaby AR, Prigge J, Brown RT. Study protocol: type II hybrid effectiveness-implementation study of routine functional status screening in VA primary care. Implement Sci Commun 2025; 6:15. [PMID: 39891277 PMCID: PMC11786338 DOI: 10.1186/s43058-025-00698-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2024] [Accepted: 01/22/2025] [Indexed: 02/03/2025] Open
Abstract
BACKGROUND Maintaining functional status, defined as the ability to perform daily activities such as bathing, dressing, and preparing meals, is central to older adults' quality of life, health, and ability to remain independent. Identifying functional impairments - defined as having difficulty or needing help performing these activities - is essential for clinicians to provide optimal care to older adults, and on a population level, understanding function can help anticipate service needs. Yet uptake of standardized measurement of functional status into routine patient care has been slow and inconsistent due to the burden posed by current tools. The goal of the Patient-Aligned Care Team (PACT) Functional Status Screening Initiative is to implement and evaluate a patient-centered, low-burden intervention to improve identification and management of functional impairment among older veterans in Veterans Health Administration (VHA) primary care settings. METHODS We will conduct a hybrid type 2 implementation-effectiveness cluster-randomized adaptive trial at 8 VHA sites using the Practical, Robust Implementation and Sustainability Model (PRISM) to guide implementation and evaluation. During a Pre-Implementation phase, we will engage clinical partners and develop local adaptations to maximize intervention-setting fit. During an Implementation phase, we will launch a standard bundle of implementation strategies (coalition building, champions, technical assistance) and system-level audit and feedback, identify sites with low uptake, and randomize those sites to receive continued standard vs. enhanced strategies (standard strategies plus clinician-level audit and feedback). The primary implementation outcome is reach (proportion of eligible patients at each site who receive screening/assessment) and the primary effectiveness outcome is appropriate management of impairment (proportion of patients with identified impairments who receive related referrals). DISCUSSION Implementing routine measurement of functional status in primary care has the potential to improve identification and management of functional impairment for older veterans. Improved management includes increasing access to services and supports for veterans and family caregivers, reducing potentially preventable acute care utilization, and allowing veterans to live in the least restrictive setting for as long as possible. Implementation will also provide data to inform the delivery of proactive interventions to prevent and delay development of functional impairment and improve quality of life, health, and independence. TRIAL REGISTRATION Registered at ClinicalTrials.gov on May 7, 2024, at NCT06404970 ( https://clinicaltrials.gov/ ). REPORTING GUIDELINES Standards for Reporting Implementation Studies (Additional file 1).
Collapse
Affiliation(s)
- Francesca M Nicosia
- Center for Data to Discovery to Delivery Innovation (3DI), San Francisco Veterans Affairs (VA) Healthcare System, San Francisco, CA, USA
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, CA, USA
| | - Kara Zamora
- San Francisco VA Healthcare System, San Francisco, CA, USA
| | - LauraEllen Ashcraft
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory Krautner
- Central Office of Geriatrics and Extended Care, District of Columbia, Washington, USA
| | - Marybeth Groot
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Bruce Kinosian
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Geriatrics & Extended Care Data & Analyses Center (GECDAC), Canandaigua VAMC, Canandaigua, NY, USA
- Geriatrics and Extended Care Program, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Division of Geriatric Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Cathy C Schubert
- Community, Home, and Geriatrics Service, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA
- Division of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sumedha Chhatre
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Helene Moriarty
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Nursing Service, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
| | - Orna Intrator
- Geriatrics & Extended Care Data & Analyses Center (GECDAC), Canandaigua VAMC, Canandaigua, NY, USA
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Andrea Wershof Schwartz
- New England Geriatric Research Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA
- Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Cambridge, MA, USA
| | - Ariela R Orkaby
- New England Geriatric Research Education and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA
- Division of Aging, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jason Prigge
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Rebecca T Brown
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
- Geriatrics and Extended Care Program, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
- Division of Geriatric Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| |
Collapse
|
10
|
Kansakar S, Qureshi WT, Sharma NR, Shrestha DB, Shtembari J, Shetty V, Moskovits N, Dahal K, Mattumpuram J, Katz DH. Impact of Right Heart Failure on Outcomes of Transcatheter Aortic Valve Implantation: Insights from the National Inpatient Sample. J Clin Med 2025; 14:841. [PMID: 39941512 PMCID: PMC11818276 DOI: 10.3390/jcm14030841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2024] [Revised: 01/24/2025] [Accepted: 01/24/2025] [Indexed: 02/16/2025] Open
Abstract
Background: There are limited data on the impact of right heart failure (RHF) on patients undergoing transcatheter aortic valve implantation (TAVI). We investigated the mortality, in-hospital complications, length of stay, and total hospitalization charges for TAVI admissions, with and without RHF. Methods: We analyzed the National Inpatient Sample data from 2018 to 2022. The International Classification of Diseases-Tenth Revision (ICD-10) codes were used to define the patient cohorts. Propensity score weighting was used to balance patient demographic, hospital-level, and comorbidity data. Results: From 2018 to 2022, there were 383,860 TAVI admissions, among which 1915 (0.50%) had the presence of RHF. Compared to patients without RHF, mortality was higher in patients with RHF (7.57% vs. 1.11%, p < 0.01). Similarly, acute kidney injury (37.10% vs. 8.56%, p < 0.01), respiratory failure (12.79% vs. 1.91%, p < 0.01), and use of mechanical circulatory support (11.48% vs. 0.83%, p < 0.01) was higher in the cohort with RHF. Median length of stay (7 days vs. 2 days, p < 0.01) and hospitalization charges ($257,239 vs. $180,501, p < 0.01) were higher in patients with RHF. Conclusions: In conclusion, we report that RHF is associated with increased mortality risk, complications, and resource utilization in patients undergoing TAVI. Right ventricular function should be a part of the evaluation for TAVI, given significantly elevated risks associated with its presence.
Collapse
Affiliation(s)
- Sajog Kansakar
- Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA; (S.K.); (N.R.S.)
| | - Waqas T. Qureshi
- Division of Cardiology, Department of Internal Medicine, Houston Methodist, Houston, TX 77030, USA;
| | - Nava Raj Sharma
- Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA; (S.K.); (N.R.S.)
| | - Dhan Bahadur Shrestha
- Division of Cardiology, Department of Internal Medicine, Bassett Medical Center, 1 Atwell Rd., Cooperstown, NY 13326, USA;
| | - Jurgen Shtembari
- Division of Cardiology, Department of Internal Medicine, Carle Foundation Hospital, 611 W Park St., Urbana, IL 61801, USA;
| | - Vijay Shetty
- Division of Cardiology, Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA; (V.S.); (N.M.)
| | - Norbert Moskovits
- Division of Cardiology, Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA; (V.S.); (N.M.)
| | - Khagendra Dahal
- Division of Structural Interventional Cardiology, Department of Internal Medicine, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA;
| | - Jishanth Mattumpuram
- Division of Cardiology, Department of Internal Medicine, University of Louisville School of Medicine, 550 S Jackson St., Louisville, KY 40202, USA;
| | - Daniel H. Katz
- Division of Cardiology, Department of Internal Medicine, Bassett Medical Center, 1 Atwell Rd., Cooperstown, NY 13326, USA;
| |
Collapse
|
11
|
Skaar E, Rostoft S, Cruz-Jentoft A, Jackson T, Bleie Ø, Packer E, Øksnes A, Schaufel MA. 'If you've lost your personality, there's no point in changing the valve'-a qualitative study of older adults' attitudes towards treatment of aortic stenosis with comorbid dementia. BMJ Open 2024; 14:e086674. [PMID: 39532382 PMCID: PMC11574473 DOI: 10.1136/bmjopen-2024-086674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2024] Open
Abstract
OBJECTIVES Due to prognostic uncertainty and limited decision-making capacity, the choice to perform transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS) and comorbid dementia is challenging. This study explores older adults' perspectives on complex decision-making preceding TAVI in the hypothetical setting of comorbid dementia. DESIGN Qualitative study entailing semistructured interviews. Analysis was by systematic text condensation. The interview guide addressed their attitudes regarding treatment dilemmas before TAVI in patients living with dementia. SETTING Patients were recruited from the TAVI outpatient clinic at a university hospital performing TAVI. PARTICIPANTS A purposive sample of 10 older adults (5 women) with AS and without dementia (range 77-94 years), where 8/10 had undergone TAVI were included. RESULTS Three main challenges were identified: (1) Risk assessment. Participants found it hard to compare the burden of aortic stenosis vs dementia. They acknowledged the dilemma of implanting a new heart valve to achieve symptom relief while risking severe dementia in the future due to prolonged life span. (2) Autonomous capacity. A profound uncertainty was described regarding who should participate in decision-making if the person was incapacitated due to dementia. (3) Customised information. Participants advocated for thorough information describing facts and uncertainty, aiming to protect and support the person living with dementia. CONCLUSION Older adults with severe aortic stenosis find it hard relating to dilemmas arising from providing TAVI in patients living with dementia. There is a need for tailor-made information to support autonomy and decision-making under uncertainty.
Collapse
Affiliation(s)
- Elisabeth Skaar
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Siri Rostoft
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo Faculty of Medicine, Oslo, Norway
| | | | | | - Øyvind Bleie
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Erik Packer
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Anja Øksnes
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Margrethe Aase Schaufel
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Vestland, Norway
| |
Collapse
|
12
|
Zhou W. Looking beyond the valve: Myocardial ischemia, left ventricular remodeling, and adverse outcomes in aortic stenosis. J Nucl Cardiol 2024; 40:102037. [PMID: 39270745 DOI: 10.1016/j.nuclcard.2024.102037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Accepted: 09/04/2024] [Indexed: 09/15/2024]
Affiliation(s)
- Wunan Zhou
- Washington DC VA Medical Center, Washington, DC, USA.
| |
Collapse
|
13
|
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; 39:224-231. [PMID: 38389116 DOI: 10.1097/rti.0000000000000776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [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.
Collapse
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
| |
Collapse
|
14
|
Gard EK, Noaman S, Stub D, Vriesendorp P, Htun N, Johnston R, Gartner E, Dick R, Walton A, Kaye D, Nanayakkara S. The Role of Comorbidities in Predicting Functional Improvement After Transcatheter Aortic Valve Implantation. Heart Lung Circ 2024; 33:1018-1026. [PMID: 38582702 DOI: 10.1016/j.hlc.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 01/05/2024] [Accepted: 02/04/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Patients undergoing transcatheter aortic valve implantation (TAVI) have a high comorbidity burden. We sought to stratify patients into functional outcomes using the Kansas City Cardiomyopathy Questionnaire (KCCQ-12), a patient-reported outcome with benefits over both the New York Heart Association (NYHA) classification and the original 23-item KCCQ, and to evaluate the importance of comorbidities in predicting failure of functional improvement post-TAVI in a contemporary cohort. METHODS In total, 366 patients with severe aortic stenosis undergoing TAVI with baseline KCCQ-12 were retrospectively analysed and divided into two groups. Failure to improve was defined as a score <60 and a change in score <10 at 1 year in either overall score (KCCQ-OS) or clinical summary score (KCCQ-CSS). RESULTS Failure to improve was noted in 13% of patients, who were more likely to have lower KCCQ-OS at baseline (47 [35-59] vs 56 [42-74]), chronic obstructive pulmonary disease (COPD) (19% vs 8%), severe chronic kidney disease (CKD) (13% vs 2%), a clinical frailty score (CFS) ≥5 (41% vs 14%), and lower serum albumin (36 g/L [34-38] vs 38 g/L [35-40]). On multivariate analysis, with an area under the curve of 0.71 (0.63-0.78), baseline KCCQ-OS (adjusted odds ratio [aOR] 0.3 [0.1-0.6], p=0.04), COPD (aOR 2.8 [1.2-6.5], p=0.02), and severe CKD (aOR 5.7 [1.7-18.5], p=0.004) remained independent predictors. CFS alone had a similar predictive value as the multivariable model (OR 2.0 [1.3-3.4], area under the curve 0.69 [0.59-0.80], p<0.001). CONCLUSIONS KCCQ scores were effective in delineating functional outcomes, with most patients in our relatively lower surgical risk cohort showing significant functional improvements post-TAVI. Low baseline KCCQ, moderate or worse COPD, and severe CKD were associated with failure of improvement post-TAVI. Baseline CFS appears to be a good screening tool to predict poor improvement. These factors should be evaluated and weighted accordingly in pre-TAVI assessments and decision-making.
Collapse
Affiliation(s)
- Emma K Gard
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
| | - Samer Noaman
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Cabrini Hospital, Melbourne, Vic, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, Vic, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Australia
| | - Pieter Vriesendorp
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Epworth Hospital, Melbourne, Vic, Australia
| | - Nay Htun
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Cabrini Hospital, Melbourne, Vic, Australia
| | - Rozanne Johnston
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
| | - Elisha Gartner
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia
| | - Ronald Dick
- Department of Cardiology, Epworth Hospital, Melbourne, Vic, Australia
| | - Antony Walton
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Epworth Hospital, Melbourne, Vic, Australia
| | - David Kaye
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Australia; Baker Heart & Diabetes Institute, Melbourne, Vic, Australia
| | - Shane Nanayakkara
- Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Department of Cardiology, Cabrini Hospital, Melbourne, Vic, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Australia; Department of Cardiology, Epworth Hospital, Melbourne, Vic, Australia; Baker Heart & Diabetes Institute, Melbourne, Vic, Australia.
| |
Collapse
|
15
|
Brown RT, Zamora K, Rizzo A, Spar MJ, Fung KZ, Santiago L, Campbell A, Nicosia FM. Improving measurement of functional status among older adults in primary care: A pilot study. PLoS One 2024; 19:e0303402. [PMID: 38739582 PMCID: PMC11090365 DOI: 10.1371/journal.pone.0303402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 04/23/2024] [Indexed: 05/16/2024] Open
Abstract
Despite its importance for clinical care and outcomes among older adults, functional status-the ability to perform basic activities of daily living (ADLs) and instrumental ADLs (IADLs)-is seldom routinely measured in primary care settings. The objective of this study was to pilot test a person-centered, interprofessional intervention to improve identification and management of functional impairment among older adults in Veterans Affairs (VA) primary care practices. The four-component intervention included (1) an interprofessional educational session; (2) routine, standardized functional status measurement among patients aged ≥75; (3) annual screening by nurses using a standardized instrument and follow-up assessment by primary care providers; and (4) electronic tools and templates to facilitate increased identification and improved management of functional impairment. Surveys, semi-structured interviews, and electronic health record data were used to measure implementation outcomes (appropriateness, acceptability and satisfaction, feasibility, fidelity, adoption/reach, sustainability). We analyzed qualitative interviews using rapid qualitative analysis. During the study period, all 959 eligible patients were screened (100% reach), of whom 7.3% (n = 58) reported difficulty or needing help with ≥1 ADL and 11.8% (n = 113) reported difficulty or needing help with ≥1 IADL. In a chart review among a subset of 50 patients with functional impairment, 78% percent of clinician notes for the visit when screening was completed had content related to function, and 48% of patients had referrals ordered to address impairments (e.g., physical therapy) within 1 week. Clinicians highly rated the quality of the educational session and reported increased ability to measure and communicate about function. Clinicians and patients reported that the intervention was appropriate, acceptable, and feasible to complete, even during the COVID pandemic. These findings suggest that this intervention is a promising approach to improve identification and management of functional impairment for older patients in primary care. Broader implementation and evaluation of this intervention is currently underway.
Collapse
Affiliation(s)
- Rebecca T. Brown
- Geriatrics and Extended Care Program, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America
- Division of Geriatric Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Kara Zamora
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Anael Rizzo
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Malena J. Spar
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Kathy Z. Fung
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Lea Santiago
- San Francisco VA Health Care System, San Francisco, California, United States of America
| | - Annie Campbell
- Martinez VA Medical Center, Martinez, California, United States of America
| | - Francesca M. Nicosia
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Institute for Health & Aging, School of Nursing, University of California, San Francisco, California, United States of America
| |
Collapse
|
16
|
Jneid H, Chikwe J, Arnold SV, Bonow RO, Bradley SM, Chen EP, Diekemper RL, Fugar S, Johnston DR, Kumbhani DJ, Mehran R, Misra A, Patel MR, Sweis RN, Szerlip M. 2024 ACC/AHA Clinical Performance and Quality Measures for Adults With Valvular and Structural Heart Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Performance Measures. J Am Coll Cardiol 2024; 83:1579-1613. [PMID: 38493389 DOI: 10.1016/j.jacc.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
|
17
|
Jneid H, Chikwe J, Arnold SV, Bonow RO, Bradley SM, Chen EP, Diekemper RL, Fugar S, Johnston DR, Kumbhani DJ, Mehran R, Misra A, Patel MR, Sweis RN, Szerlip M. 2024 ACC/AHA Clinical Performance and Quality Measures for Adults With Valvular and Structural Heart Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Performance Measures. Circ Cardiovasc Qual Outcomes 2024; 17:e000129. [PMID: 38484039 DOI: 10.1161/hcq.0000000000000129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Affiliation(s)
- Hani Jneid
- ACC/AHA Joint Committee on Clinical Data Standards liaison
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Merenda M, Earnest A, Ruseckaite R, Tse WC, Elder E, Hopper I, Ahern S. Patient-Reported Outcome Measures in High-Risk Medical Device Registries: A Scoping Review. Aesthet Surg J Open Forum 2024; 6:ojae015. [PMID: 38650972 PMCID: PMC11033681 DOI: 10.1093/asjof/ojae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Little is known about the methods and outcomes of patient-reported outcome measure (PROM) use among high-risk medical device registries. The objective of this scoping review was to assess the utility and predictive ability of PROMs in high-risk medical device registries. We searched Ovid Medline, Embase, APA PsychINFO, Cochrane Library, and Scopus databases for published literature. After searching, 4323 titles and abstracts were screened, and 262 full texts were assessed for their eligibility. Seventy-six papers from across orthopedic (n = 64), cardiac (n = 10), penile (n = 1), and hernia mesh (n = 1) device registries were identified. Studies predominantly used PROMs as an outcome measure when comparing cohorts or surgical approaches (n = 45) or to compare time points (n = 13) including pre- and postintervention. Fifteen papers considered the predictive ability of PROMs. Of these, 8 treated PROMs as an outcome, 5 treated PROMs as a risk factor through regression analysis, and 2 papers treated PROMs as both a risk factor and as an outcome. One paper described PROMs to study implant survival. To advance methods of PROM integration into clinical decision-making for medical devices, an understanding of their use in high-risk device registries is needed. This scoping review found that there is a paucity of studies using PROMs to predict long-term patient and clinical outcomes in high-risk medical device registries. Determination as to why PROMs are rarely used for predictive purposes in long-term data collection is needed if PROM data are to be considered suitable as real-world evidence for high-risk device regulatory purposes, as well as to support clinical decision-making. Level of Evidence 4
Collapse
Affiliation(s)
- Michelle Merenda
- Corresponding Author: Mrs Michelle Merenda, Level 3, 553 St Kilda Rd, Melbourne, Victoria 3004, Australia. E-mail:
| | | | | | | | | | | | | |
Collapse
|
19
|
Stalikas N, Anastasiou V, Botis I, Daios S, Karagiannidis E, Zegkos T, Karamitsos T, Vassilikos V, Ziakas A, Kamperidis V, Giannakoulas G, Giannopoulos G. The prognostic impact of diastolic dysfunction after transcatheter aortic valve replacement: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102228. [PMID: 38043876 DOI: 10.1016/j.cpcardiol.2023.102228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Diastolic dysfunction (DD) is a long-established marker of disease progression in patients with aortic valve stenosis (AS), indicating valvular myocardial damage. Recently, substantial observational data have emerged demonstrating that worse pre-operative DD assessed using echocardiography is associated with adverse long-term clinical outcomes after transcatheter aortic valve replacement (TAVR). AIM To systematically appraise and quantitatively synthesize current evidence on the prognostic impact of echocardiographic severe DD derived by echocardiography before TAVR. METHODS A systemic literature review was undertaken in electronic databases to identify studies reporting the predictive value of severe DD in AS subjects undergoing TAVR. A random-effects meta-analysis was conducted to quantify the adjusted and unadjusted hazard ratios (HRs) for all-cause mortality and major adverse cardiovascular events (MACEs) for the presence of severe DD. RESULTS Ten studies were deemed eligible for inclusion. Of those, 9 provided appropriate quantitative data for the meta-analysis, encompassing a total of 4,619 patients. The presence of severe DD was associated with increased risk for all-cause mortality (pooled unadjusted HR=2.56 [1.46-4.48]; p<0.01; I2=76 %) and MACEs (pooled unadjusted HR=1.82 [1.29-2.58]; p<0.01; I2=86 %). When adjusted for clinically-relevant parameters, the presence of severe DD retained independent association with all-cause mortality (pooled adjusted HR=2.35 [1.26-4.37]; p<0.01; I2=79 %) and MACEs (pooled adjusted HR= 2.52 [1.72-3.65]; p<0.01; I2=0 %). In subgroup analysis there was no difference on post-TAVR risk between the use of different diastolic function grading scores. CONCLUSION Presence of severe DD assessed by echocardiography pre-TAVR is a major determinant of long-term adverse outcomes after the procedure.
Collapse
Affiliation(s)
- Nikolaos Stalikas
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece.
| | - Vasileios Anastasiou
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - Ioannis Botis
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - Stylianos Daios
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | | | - Thomas Zegkos
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - Theodoros Karamitsos
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - Vassilios Vassilikos
- Ippokratio General Hospital, Medical School, Aristotle University, Thessaloniki, Greece
| | - Antonios Ziakas
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - Vasileios Kamperidis
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - George Giannakoulas
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - George Giannopoulos
- Ippokratio General Hospital, Medical School, Aristotle University, Thessaloniki, Greece
| |
Collapse
|
20
|
Kusunose K, Tsuji T, Hirata Y, Takahashi T, Sata M, Sato K, Albakaa N, Ishizu T, Kotoku J, Seo Y. Unsupervised cluster analysis reveals different phenotypes in patients after transcatheter aortic valve replacement. EUROPEAN HEART JOURNAL OPEN 2024; 4:oead136. [PMID: 38188937 PMCID: PMC10766904 DOI: 10.1093/ehjopen/oead136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/23/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024]
Abstract
Aims The aim of this study was to identify phenotypes with potential prognostic significance in aortic stenosis (AS) patients after transcatheter aortic valve replacement (TAVR) through a clustering approach. Methods and results This multi-centre retrospective study included 1365 patients with severe AS who underwent TAVR between January 2015 and March 2019. Among demographics, laboratory, and echocardiography parameters, 20 variables were selected through dimension reduction and used for unsupervised clustering. Phenotypes and outcomes were compared between clusters. Patients were randomly divided into a derivation cohort (n = 1092: 80%) and a validation cohort (n = 273: 20%). Three clusters with markedly different features were identified. Cluster 1 was associated predominantly with elderly age, a high aortic valve gradient, and left ventricular (LV) hypertrophy; Cluster 2 consisted of preserved LV ejection fraction, larger aortic valve area, and high blood pressure; and Cluster 3 demonstrated tachycardia and low flow/low gradient AS. Adverse outcomes differed significantly among clusters during a median of 2.2 years of follow-up (P < 0.001). After adjustment for clinical and echocardiographic data in a Cox proportional hazards model, Cluster 3 (hazard ratio, 4.18; 95% confidence interval, 1.76-9.94; P = 0.001) was associated with increased risk of adverse outcomes. In sequential Cox models, a model based on clinical data and echocardiographic variables (χ2 = 18.4) was improved by Cluster 3 (χ2 = 31.5; P = 0.001) in the validation cohort. Conclusion Unsupervised cluster analysis of patients after TAVR revealed three different groups for assessment of prognosis. This provides a new perspective in the categorization of patients after TAVR that considers comorbidities and extravalvular cardiac dysfunction.
Collapse
Affiliation(s)
- Kenya Kusunose
- Department of Cardiovascular Medicine, Nephrology, and Neurology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara Town, Okinawa 903-0215, Japan
- Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima 770-8503, Japan
| | - Takumasa Tsuji
- Department of Radiological Technology, Graduate School of Medical Care and Technology, Teikyo University, Tokyo, Japan
| | - Yukina Hirata
- Ultrasound Examination Center, Tokushima University Hospital, Tokushima, Japan
| | - Tomonori Takahashi
- Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima 770-8503, Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima 770-8503, Japan
| | - Kimi Sato
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Noor Albakaa
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomoko Ishizu
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Jun’ichi Kotoku
- Department of Radiological Technology, Graduate School of Medical Care and Technology, Teikyo University, Tokyo, Japan
| | - Yoshihiro Seo
- Department of Cardiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| |
Collapse
|
21
|
de la Torre Hernandez JM, Veiga Fernandez G, Ben-Assa E, Iribarren J, Sainz Laso F, Lee DH, Ruisanchez Villar C, Lerena P, Garcia Camarero T, Iribarren Sarrias JL, Cuesta Cosgaya JM, Maza Fernandez ME, Garilleti C, Fradejas-Sastre V, Benito M, Barrera S, Gil Ongay A, Vazquez de Prada JA, Zueco J. First description and validation of a new method for estimating aortic stenosis burden and predicting the functional response to TAVI. Front Cardiovasc Med 2023; 10:1215826. [PMID: 38034386 PMCID: PMC10682652 DOI: 10.3389/fcvm.2023.1215826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/23/2023] [Indexed: 12/02/2023] Open
Abstract
Background Up to one-fifth of patients continue to have poor quality of life after transcatheter aortic valve implantation (TAVI), with an additional similar proportion not surviving 1 year after the procedure. We aimed to assess the value of a new method based on an integrated analysis of left ventricular outflow tract flow velocity and aortic pressure to predict objective functional improvement and prognosis after TAVI. Methods In a cohort of consecutive patients undergoing TAVI, flow velocity-pressure integrated analysis was obtained from simultaneous pressure recordings in the ascending aorta and flow velocity recordings in the left ventricular outflow tract by echocardiography. Objective functional improvement 6 months after TAVI was assessed through changes in a 6-min walk test and NT-proBNP levels. A clinical follow-up was conducted at 2 years. Results Of the 102 patients studied, 82 (80.4%) showed objective functional improvement. The 2-year mortality of these patients was significantly lower (9% vs. 44%, p = 0.001). In multivariate analysis, parameter "(Pressure at Vmax - Pressure at Vo)/Vmax" was found to be an independent predictor for objective improvement. The C-statistic was 0.70 in the overall population and 0.78 in the low-gradient subgroup. All echocardiographic parameters and the valvuloarterial impedance showed a C-statistic of <0.6 for the overall and low-gradient patients. In a validation cohort of 119 patients, the C-statistic was 0.67 for the total cohort and 0.76 for the low-gradient subgroup. Conclusion This new method allows predicting objective functional improvement after TAVI more precisely than the conventional parameters used to assess the severity of aortic stenosis, particularly in low-gradient patients.
Collapse
Affiliation(s)
- Jose M. de la Torre Hernandez
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
- Department of Cardiology, Medical School, University of Cantabria, Santander, Spain
| | | | - Eyal Ben-Assa
- Cardiology Division, Assuta Ashdod University Hospital, Ben Gurion University, Ashdod, Israel
| | - Julia Iribarren
- School of Mathematics, Universidad de la Laguna, San Cristobal de la Laguna, Spain
| | - Fermin Sainz Laso
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - Dae-Hyun Lee
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | | | - Piedad Lerena
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - Tamara Garcia Camarero
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | | | - Jose M. Cuesta Cosgaya
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - Maria E. Maza Fernandez
- Hydrodynamics and Coastal Infrastructures Group of IH Cantabria, Instituto de Hidraulica Ambiental, Universidad de Cantabria, Santander, Spain
| | - Celia Garilleti
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - Victor Fradejas-Sastre
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - Mercedes Benito
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - Sergio Barrera
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - Aritz Gil Ongay
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - Jose A. Vazquez de Prada
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
- Department of Cardiology, Medical School, University of Cantabria, Santander, Spain
| | - Javier Zueco
- Cardiology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| |
Collapse
|
22
|
Khaleel I, Harris AW, Seth M, Sukul D, Deeb GM, Joseph MS, Grossman PM, Fukuhara S, Chetcuti S. Quality of Life After Transcatheter Aortic Valve Replacement in Normal-Flow, Low-Gradient Aortic Stenosis. JACC. ADVANCES 2023; 2:100641. [PMID: 38938726 PMCID: PMC11198257 DOI: 10.1016/j.jacadv.2023.100641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/31/2023] [Accepted: 08/14/2023] [Indexed: 06/29/2024]
Abstract
Background Prior studies of aortic valve replacement (AVR) in patients with normal-flow, low-gradient aortic stenosis (NF-LG AS) have demonstrated conflicting results regarding the survival benefit of AVR. Changes in quality of life (QoL) after transcatheter AVR (TAVR) have not been reported in this population. Objectives The purpose of this study was to compare changes in QoL after TAVR for patients with NF-LG AS to patients with high-gradient aortic stenosis (HG-AS). Methods Patients who underwent TAVR for severe aortic stenosis (AS) were divided into 4 hemodynamic profiles of AS, including NF-LG AS. Changes in Kansas City Cardiomyopathy Questionnaire-12 score from baseline to 1 year were compared between AS groups. The primary composite outcome indicating clinical improvement consisted of survival to 1 year and improved Kansas City Cardiomyopathy Questionnaire overall summary score of ≥5 points while adjusting for relevant baseline factors. Results Out of 860 patients who underwent TAVR, high gradient AS was present in 368 (42.8%) patients and NF-LG AS in 245 (28.5%). HG-AS and NF-LG AS groups had a similar proportion of patients who met the primary unadjusted outcome of clinical improvement (70.4% vs 63.9%, respectively; P = 0.189). One-year Kaplan-Meier mortality estimates were higher for NF-LG AS patients than HG-AS patients (12.9% vs 5.8%, P < 0.001). In the primary adjusted analysis, there was no significant difference in the composite outcome between HG and NF-LG AS groups (adjusted OR: 0.72, 95% CI: 0.47-1.11). Conclusions Selected patients with NF-LG AS experienced similar improvement in QoL after TAVR compared with HG-AS. Further investigation of patients with NF-LG AS will help to inform optimal selection for treatment with TAVR.
Collapse
Affiliation(s)
- Ibrahim Khaleel
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew W. Harris
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Milan Seth
- BMC2 Cardiovascular Consortium, Ann Arbor, Michigan, USA
| | - Devraj Sukul
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - G. Michael Deeb
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Megan S. Joseph
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - P. Michael Grossman
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Shinichi Fukuhara
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Stanley Chetcuti
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
23
|
Jakulla RS, Gunta SP, Huded CP. Heart Failure after Aortic Valve Replacement: Incidence, Risk Factors, and Implications. J Clin Med 2023; 12:6048. [PMID: 37762989 PMCID: PMC10531882 DOI: 10.3390/jcm12186048] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Severe aortic stenosis (AS) carries a poor prognosis with the onset of heart failure (HF) symptoms, and surgical or transcatheter aortic valve replacement (AVR) is its only definitive treatment. The management of AS has seen a paradigm shift with the adoption of transcatheter aortic valve replacement (TAVR), allowing for the treatment of AS in patients who would not otherwise be candidates for surgical AVR. Despite improving long-term survival after TAVR in recent years, residual HF symptoms and HF hospitalization are common and are associated with an increased mortality and a poor health status. This review article summarizes the incidence and risk factors for HF after AVR. Strategies for preventing and better managing HF after AVR are necessary to improve outcomes in this patient population. Extensive research is underway to assess whether earlier timing for AVR, prior to the development of severe symptomatic AS and associated extra-valvular cardiac damage, can improve post-AVR patient outcomes.
Collapse
Affiliation(s)
- Roopesh Sai Jakulla
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64110, USA
| | - Satya Preetham Gunta
- Department of Cardiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Chetan P. Huded
- Department of Cardiology, University of Missouri-Kansas City, Kansas City, MO 64110, USA
| |
Collapse
|
24
|
Nicosia FM, Zamora K, Rizzo A, Spar MJ, Silvestrini M, Brown RT. Using multiple qualitative methods to inform intervention development: Improving functional status measurement for older veterans in primary care settings. PLoS One 2023; 18:e0290741. [PMID: 37616266 PMCID: PMC10449158 DOI: 10.1371/journal.pone.0290741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023] Open
Abstract
Functional status, or the ability to perform activities of daily living, is central to older adults' health and quality of life. However, health systems have been slow to incorporate routine measurement of function into patient care. We used multiple qualitative methods to develop a patient-centered, interprofessional intervention to improve measurement of functional status for older veterans in primary care settings. We conducted semi-structured interviews with patients, clinicians, and operations staff (n = 123) from 7 Veterans Health Administration (VHA) Medical Centers. Interviews focused on barriers and facilitators to measuring function. We used concepts from the Consolidated Framework for Implementation Science and sociotechnical analysis to inform rapid qualitative analyses and a hybrid deductive/inductive approach to thematic analysis. We mapped qualitative findings to intervention components. Barriers to measurement included time pressures, cumbersome electronic tools, and the perception that measurement would not be used to improve patient care. Facilitators included a strong interprofessional environment and flexible workflows. Findings informed the development of five intervention components, including (1) an interprofessional educational session; (2) routine, standardized functional status measurement among older patients; (3) annual screening by nurses using a standardized instrument and follow-up assessment by primary care providers; (4) electronic tools and templates to facilitate increased identification and improved management of functional impairment; and (5) tailored reports on functional status for clinicians and operations leaders. These findings show how qualitative methods can be used to develop interventions that are more responsive to real-world contexts, increasing the chances of successful implementation. Using a conceptually-grounded approach to intervention development has the potential to improve patient and clinician experience with measuring function in primary care.
Collapse
Affiliation(s)
- Francesca M. Nicosia
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, Department of Medicine of the University of California, San Francisco, San Francisco, California, United States of America
| | - Kara Zamora
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, Department of Medicine of the University of California, San Francisco, San Francisco, California, United States of America
| | - Anael Rizzo
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, Department of Medicine of the University of California, San Francisco, San Francisco, California, United States of America
| | - Malena J. Spar
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, Department of Medicine of the University of California, San Francisco, San Francisco, California, United States of America
| | - Molly Silvestrini
- San Francisco VA Health Care System, San Francisco, California, United States of America
- Division of Geriatrics, Department of Medicine of the University of California, San Francisco, San Francisco, California, United States of America
| | - Rebecca T. Brown
- Geriatrics and Extended Care Program, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States of America
- Division of Geriatric Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| |
Collapse
|
25
|
El-Sabawi B, Cloud H, Patel JN, Bell SP, Elmariah S, Fearon WF, Kim JB, Piana RN, Kapadia SR, Kumbhani DJ, Gillam LD, Whisenant BK, Quader N, Zajarias A, Welt FG, Bavry AA, Coylewright M, Vatterott A, Jackson N, Huang S, Lindman BR. Association of Depression and Cognitive Dysfunction With Patient-Centered Outcomes After Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2023; 16:e012875. [PMID: 37503662 DOI: 10.1161/circinterventions.123.012875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 07/05/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Depression and cognitive dysfunction (CD) are not routinely screened for in patients before transcatheter aortic valve replacement (TAVR) and their association with postprocedural outcomes is poorly understood. The objectives of this study are to determine the prevalence of depression and CD in patients with aortic stenosis undergoing TAVR and evaluate their association with mortality and quality of life. METHODS We analyzed a prospective, multicenter TAVR registry that systematically screened patients for preexisting depression and CD with the Patient Health Questionnaire-2 and Mini-Cog, respectively. The associations with mortality were assessed with Cox proportional hazard models and quality of life (Kansas City Cardiomyopathy Questionnaire and EuroQol visual analogue scale) were evaluated using multivariable ordinal regression models. RESULTS A total of 884 patients were included; median follow-up was 2.88 years (interquartile range=1.2-3.7). At baseline, depression was observed in 19.6% and CD in 31.8%. In separate models, after adjustment, depression (HR, 1.45 [95% CI, 1.13-1.86]; P<0.01) and CD (HR, 1.27 [95% CI, 1.02-1.59]; P=0.04) were each associated with increased mortality. Combining depression and CD into a single model, mortality was greatest among those with both depression and CD (n=62; HR, 2.06 [CI, 1.44-2.96]; P<0.01). After adjustment, depression was associated with 6.6 (0.3-13.6) points lower on the Kansas City Cardiomyopathy Questionnaire 1-year post-TAVR and 6.7 (0.5-12.7) points lower on the EuroQol visual analogue scale. CD was only associated with lower EuroQol visual analogue scale. CONCLUSIONS Depression and CD are common in patients that undergo TAVR and are associated with increased mortality and worse quality of life. Depression may be a modifiable therapeutic target to improve outcomes after TAVR.
Collapse
Affiliation(s)
- Bassim El-Sabawi
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (B.E.-S., H.C., J.N.P., S.P.B., R.N.P., A.V., N.J., B.R.L.)
| | - Harrison Cloud
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (B.E.-S., H.C., J.N.P., S.P.B., R.N.P., A.V., N.J., B.R.L.)
| | - Jay N Patel
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (B.E.-S., H.C., J.N.P., S.P.B., R.N.P., A.V., N.J., B.R.L.)
| | - Susan P Bell
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (B.E.-S., H.C., J.N.P., S.P.B., R.N.P., A.V., N.J., B.R.L.)
| | - Sammy Elmariah
- Department of Medicine, Division of Cardiology, University of California San Francisco (S.E.)
| | - William F Fearon
- Department of Medicine, Division of Cardiology, Stanford Medical Center, Palo Alto, CA (W.F.F., J.B.K.)
| | - Juyong B Kim
- Department of Medicine, Division of Cardiology, Stanford Medical Center, Palo Alto, CA (W.F.F., J.B.K.)
| | - Robert N Piana
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (B.E.-S., H.C., J.N.P., S.P.B., R.N.P., A.V., N.J., B.R.L.)
| | - Samir R Kapadia
- Department of Medicine, Division of Cardiology, Cleveland Clinic Foundation, OH (S.R.K.)
| | - Dharam J Kumbhani
- Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.J.K., A.A.B.)
| | - Linda D Gillam
- Department of Cardiovascular Medicine, Morristown Medical Center, NJ (L.D.G.)
| | - Brian K Whisenant
- Department of Medicine, Division of Cardiology, Intermountain Heart Institute, Murray, UT (B.K.W.)
| | - Nishath Quader
- Department of Medicine, Division of Cardiology, Barnes-Jewish Hospital, St Louis, MO (N.Q., A.Z.)
| | - Alan Zajarias
- Department of Medicine, Division of Cardiology, Barnes-Jewish Hospital, St Louis, MO (N.Q., A.Z.)
| | - Frederick G Welt
- Department of Medicine, Division of Cardiology, University of Utah Hospital, Salt Lake City (F.G.W.)
| | - Anthony A Bavry
- Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (D.J.K., A.A.B.)
| | - Megan Coylewright
- Department of Internal Medicine, Division of Cardiovascular Medicine, Erlanger Heart and Lung Institute, Chattanooga, TN (M.C.)
| | - Anna Vatterott
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (B.E.-S., H.C., J.N.P., S.P.B., R.N.P., A.V., N.J., B.R.L.)
| | - Natalie Jackson
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (B.E.-S., H.C., J.N.P., S.P.B., R.N.P., A.V., N.J., B.R.L.)
- Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (N.J., B.R.L.)
| | - Shi Huang
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN (S.H.)
| | - Brian R Lindman
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (B.E.-S., H.C., J.N.P., S.P.B., R.N.P., A.V., N.J., B.R.L.)
- Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (N.J., B.R.L.)
| |
Collapse
|
26
|
Lauridsen MD, Valentin JB, Strange JE, Jacobsen PA, Køber L, Weinreich U, Johnsen SP, Fosbøl E. Mortality in patients with chronic obstructive pulmonary disorder undergoing transcatheter aortic valve replacement: The importance of chronic obstructive pulmonary disease exacerbation. Am Heart J 2023; 262:100-109. [PMID: 37116603 DOI: 10.1016/j.ahj.2023.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Severe chronic obstructive pulmonary disease (COPD) has been associated with futile outcome after transcatheter aortic valve replacement (TAVR). Data on outcomes according to COPD severity are warranted to aid identification of patients who may not benefit from TAVR. We aimed to examine the association between risk of COPD exacerbation and 1-year mortality after TAVR. METHODS Using Danish nationwide registries we identified patients undergoing first-time TAVR during 2008-2021 by COPD status. COPD severity levels were defined as low or high risk of acute exacerbation of COPD (AE-COPD) and treatment intensity levels (none or short-term, mono/dual, triple therapy, or home oxygen). Kaplan-Meier functions and adjusted Cox regression models were used to assess 1-year mortality comparing COPD severity groups with patients without COPD. RESULTS We identified 7,047 patients with TAVR of whom 644 had a history of COPD (low risk of AE-COPD: 439, high risk of AE-COPD: 205). The median age of the TAVR cohort was 81.4 years (IQR: 76.8-85.1) and 55.8% were males. One-year mortality for TAVR patients without COPD was 8.5% (95% CI: 7.8-9.2) and 15.4% (95% CI: 12.5-18.2) for those with COPD (adjusted HR: 1.63 [95% CI: 1.28-2.07]). Patients with low or high risk of AE-COPD had 1-year mortality of 13.1% (95% CI: 9.8-16.3) and 20.2% (95% CI: 14.6-25.8) corresponding to adjusted HRs of 1.31 (95% CI: 0.97-1.78) and 2.44 (95% CI: 1.70-3.50) compared with patients without COPD. Patients with high risk of AE-COPD and no/short term therapy or use of home oxygen represented the subgroups of patients with the highest 1-year mortality (31.6% [95% CI: 14.5-48.7] and 30.9% [95% CI: 10.3-51.6]). CONCLUSION Among patients undergoing TAVR, increasing risk of exacerbation with COPD was associated with increasing 1-year mortality compared with non-COPD patients. Patients with a high risk of exacerbation with COPD not using any guideline recommended COPD medication and those using home oxygen had the highest 1-year mortality.
Collapse
Affiliation(s)
- Marie Dam Lauridsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Danish Center for Clinical Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; The Clinical Institute, Aalborg University, Aalborg, Denmark; Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.
| | - Jan Brink Valentin
- Danish Center for Clinical Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; The Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Jarl Emanuel Strange
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Peter A Jacobsen
- The Clinical Institute, Aalborg University, Aalborg, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ulla Weinreich
- The Clinical Institute, Aalborg University, Aalborg, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; The Clinical Institute, Aalborg University, Aalborg, Denmark
| | - Emil Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
27
|
Généreux P, Cohen DJ, Pibarot P, Redfors B, Bax JJ, Zhao Y, Prince H, Makkar RR, Kapadia S, Thourani VH, Mack MJ, Nazif TM, Lindman BR, Babaliaros V, Russo M, McCabe JM, Gillam LD, Alu MC, Hahn RT, Webb JG, Leon MB, Arnold SV. Cardiac Damage and Quality of Life After Aortic Valve Replacement in the PARTNER Trials. J Am Coll Cardiol 2023; 81:743-752. [PMID: 36813373 PMCID: PMC9982840 DOI: 10.1016/j.jacc.2022.11.059] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/09/2022] [Accepted: 11/22/2022] [Indexed: 02/22/2023]
Abstract
BACKGROUND The extent of extravalvular cardiac damage is associated with increased risk of adverse events among patients with severe aortic stenosis undergoing aortic valve replacement (AVR). OBJECTIVES The goal was to describe the association of cardiac damage on health status before and after AVR. METHODS Patients from the PARTNER (Placement of Aortic Transcatheter Valves) 2 and 3 trials were pooled and classified by echocardiographic cardiac damage stage at baseline and 1 year as previously described (stage 0-4). We examined the association between baseline cardiac damage and 1-year health status (assessed by the Kansas City Cardiomyopathy Questionnaire Overall Score [KCCQ-OS]). RESULTS Among 1,974 patients (794 surgical AVR, 1,180 transcatheter AVR), the extent of cardiac damage at baseline was associated with lower KCCQ scores both at baseline and at 1 year after AVR (P < 0.0001) and with increased rates of a poor outcome (death, KCCQ-OS <60, or a decrease in KCCQ-OS of ≥10 points) at 1 year (stages 0-4: 10.6% vs 19.6% vs 29.0% vs 44.7% vs 39.8%; P < 0.0001). In a multivariable model, each 1-stage increase in baseline cardiac damage was associated with a 24% increase in the odds of a poor outcome (95% CI: 9%-41%; P = 0.001). Change in stage of cardiac damage at 1 year after AVR was associated with the extent of improvement in KCCQ-OS over the same period (mean change in 1-year KCCQ-OS: improvement of ≥1 stage +26.8 [95% CI: 24.2-29.4] vs no change +21.4 [95% CI: 20.0-22.7] vs deterioration of ≥1 stage +17.5 [95% CI: 15.4-19.5]; P < 0.0001). CONCLUSIONS The extent of cardiac damage before AVR has an important impact on health status outcomes, both cross-sectionally and after AVR. (PARTNER II Trial: Placement of AoRTic TraNscathetER Valves II - XT Intermediate and High Risk (PII A), NCT01314313; The PARTNER II Trial: Placement of AoRTic TraNscathetER Valves - PII B [PARTNERII B], NCT02184442; PARTNER 3 Trial: Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients With Aortic Stenosis [P3], NCT02675114).
Collapse
Affiliation(s)
- Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA.
| | - David J Cohen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; St. Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Philippe Pibarot
- Department of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Columbia University Irving Medical Center, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Yanglu Zhao
- Edwards Lifesciences, Irvine, California, USA
| | | | - Raj R Makkar
- Cedars Sinai Medical Center, Los Angeles, California, USA
| | | | | | - Michael J Mack
- Baylor Scott & White Research Institute, Plano, Texas, USA
| | - Tamim M Nazif
- Columbia University Irving Medical Center, New York, New York, USA
| | - Brian R Lindman
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Mark Russo
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | | | - Linda D Gillam
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - Maria C Alu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Columbia University Irving Medical Center, New York, New York, USA
| | - Rebecca T Hahn
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Columbia University Irving Medical Center, New York, New York, USA
| | - John G Webb
- St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Martin B Leon
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Columbia University Irving Medical Center, New York, New York, USA
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri Kansas City, Kansas City, Missouri, USA
| |
Collapse
|
28
|
Savitz ST, Leong T, Sung SH, Kitzman DW, McNulty E, Mishell J, Rassi A, Ambrosy AP, Go AS. Predicting short-term outcomes after transcatheter aortic valve replacement for aortic stenosis. Am Heart J 2023; 256:60-72. [PMID: 36372246 PMCID: PMC9840674 DOI: 10.1016/j.ahj.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/25/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The approved use of transcatheter aortic valve replacement (TAVR) for aortic stenosis has expanded substantially over time. However, gaps remain with respect to accurately delineating risk for poor clinical and patient-centered outcomes. Our objective was to develop prediction models for 30-day clinical and patient-centered outcomes after TAVR within a large, diverse community-based population. METHODS We identified all adults who underwent TAVR between 2013-2019 at Kaiser Permanente Northern California, an integrated healthcare delivery system, and were monitored for the following 30-day outcomes: all-cause death, improvement in quality of life, all-cause hospitalizations, all-cause emergency department (ED) visits, heart failure (HF)-related hospitalizations, and HF-related ED visits. We developed prediction models using gradient boosting machines using linked demographic, clinical and other data from the Society for Thoracic Surgeons (STS)/American College of Cardiology (ACC) TVT Registry and electronic health records. We evaluated model performance using area under the curve (AUC) for model discrimination and associated calibration plots. We also evaluated the association of individual predictors with outcomes using logistic regression for quality of life and Cox proportional hazards regression for all other outcomes. RESULTS We identified 1,565 eligible patients who received TAVR. The risks of adverse 30-day post-TAVR outcomes ranged from 1.3% (HF hospitalizations) to 15.3% (all-cause ED visits). In models with the highest discrimination, discrimination was only moderate for death (AUC 0.60) and quality of life (AUC 0.62), but better for HF-related ED visits (AUC 0.76). Calibration also varied for different outcomes. Importantly, STS risk score only independently predicted death and all-cause hospitalization but no other outcomes. Older age also only independently predicted HF-related ED visits, and race/ethnicity was not significantly associated with any outcomes. CONCLUSIONS Despite using a combination of detailed STS/ACC TVT Registry and electronic health record data, predicting short-term clinical and patient-centered outcomes after TAVR remains challenging. More work is needed to identify more accurate predictors for post-TAVR outcomes to support personalized clinical decision making and monitoring strategies.
Collapse
Affiliation(s)
- Samuel T Savitz
- Division of Research, Kaiser Permanente Northern California, Oakland, CA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN
| | - Thomas Leong
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Sue Hee Sung
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Dalane W Kitzman
- Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Edward McNulty
- Kaiser Permanente San Francisco Medical Center, San Francisco, CA
| | - Jacob Mishell
- Kaiser Permanente San Francisco Medical Center, San Francisco, CA
| | - Andrew Rassi
- Kaiser Permanente San Francisco Medical Center, San Francisco, CA
| | - Andrew P Ambrosy
- Division of Research, Kaiser Permanente Northern California, Oakland, CA; Kaiser Permanente San Francisco Medical Center, San Francisco, CA
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA; Department of Medicine, University of California, San Francisco, CA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA; Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, CA; Department of Medicine, Stanford University, Palo Alto, CA.
| |
Collapse
|
29
|
de la Torre Hernandez JM, Veiga Fernandez G, Ben-Assa E, Sainz Laso F, Lee DH, Ruisanchez Villar C, Lerena P, Garcia Camarero T, Cuesta Cosgaya JM, Fradejas-Sastre V, Benito M, Barrera S, Garcia-Unzueta MT, Brown J, Gil Ongay A, Zueco J, Vazquez de Prada JA, Edelman ER. A new integrative approach to assess aortic stenosis burden and predict objective functional improvement after TAVR. Front Cardiovasc Med 2023; 10:1118409. [PMID: 36937938 PMCID: PMC10017439 DOI: 10.3389/fcvm.2023.1118409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/30/2023] [Indexed: 03/06/2023] Open
Abstract
Background A non-negligible rate of patients undergoing transcatheter aortic valve replacement (TAVR) do not report symptomatic improvement or even die in the short-midterm. We sought to assess the degree of objective functional recovery after TAVR and its prognostic implications and to develop a predictive model. Methods In a cohort of patients undergoing TAVR, a prospective evaluation of clinical, anatomical, and physiological parameters was conducted before and after the procedure. These parameters were derived from echocardiography, non-invasive analysis of arterial pulse waves, and cardiac tomography. Objective functional improvement 6 months after TAVR was assessed using a 6-min walk test and nitro-terminal pro-brain natriuretic peptide (NT-proBNP) levels. The derived predictive model was prospectively validated in a different cohort. A clinical follow-up was conducted at 2 years. Results Among the 212 patients included, objective functional improvement was observed in 169 patients (80%) and subjective improvement in 187 (88%). Patients with objective functional improvement showed a much lower death rate at 2 years (9% vs. 31% p = 0.0002). Independent predictors of improvement were as follows: mean aortic gradient of ≥40 mmHg, augmentation index75 of ≥45%, the posterior wall thickness of ≤12 mm, and absence of atrial fibrillation. A simple integer-based point score was developed (GAPA score), which showed an area under the curve of 0.81 for the overall cohort and 0.78 for the low-gradient subgroup. In a validation cohort of 216 patients, these values were 0.75 and 0.76, respectively. Conclusion A total of 80% of patients experienced objective functional improvement after TAVR, showing a significantly lower 2-year mortality rate. A predictive score was built that showed a good discriminative performance in overall and low-gradient populations.
Collapse
Affiliation(s)
- Jose M. de la Torre Hernandez
- Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
- Department of Cardiology, Medical School, University of Cantabria, Santander, Spain
- *Correspondence: Jose M. de la Torre Hernandez, ;
| | - Gabriela Veiga Fernandez
- Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - Eyal Ben-Assa
- Division of Cardiology, Assuta Ashdod University Hospital, Ben-Gurion University of the Negev, Ashdod, Israel
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Fermin Sainz Laso
- Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - Dae-Hyun Lee
- Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - Cristina Ruisanchez Villar
- Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - Piedad Lerena
- Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - Tamara Garcia Camarero
- Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - Jose M. Cuesta Cosgaya
- Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - Victor Fradejas-Sastre
- Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - Mercedes Benito
- Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - Sergio Barrera
- Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - Maria T. Garcia-Unzueta
- Análisis clínicos, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - Jonathan Brown
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
- Cardiovascular Division, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, United States
| | - Aritz Gil Ongay
- Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - Javier Zueco
- Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
| | - Jose A. Vazquez de Prada
- Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Valdecilla (IDIVAL), Santander, Spain
- Department of Cardiology, Medical School, University of Cantabria, Santander, Spain
| | - Elazer R. Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
- Cardiovascular Division, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, United States
| |
Collapse
|
30
|
Goldwater D, Wenger NK. Patient-centered care in geriatric cardiology. Trends Cardiovasc Med 2023; 33:13-20. [PMID: 34758389 DOI: 10.1016/j.tcm.2021.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/21/2021] [Accepted: 11/03/2021] [Indexed: 02/01/2023]
Abstract
Geriatric cardiology involves providing cardiovascular care to older adults in relation to aging. Although cardiovascular diseases are the most common diseases faced by older adults, they often co-occur with numerous aging-related challenges, such as multimorbidity, frailty, polypharmacy, falls, functional and cognitive impairment, which present challenges to implementing standard disease-based treatment strategies. Faced with these complexities, patient-centered care in geriatric cardiology strives to direct all management toward the achievement of an individual's prioritized health and life goals by employing shared decision-making to align treatment with goals, utilizing stated goals to navigate situations of treatment uncertainty, and pro-actively mitigating aging-related risks. This fundamental change in cardiovascular medicine from disease-centered management to patient-centered goal-directed care is necessary to facilitate wellness, independence, and favorable quality of life outcomes in the older adult population.
Collapse
Affiliation(s)
| | - Nanette K Wenger
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
31
|
Natanzon SS, Koseki K, Kaewkes D, Koren O, Patel V, Nakamura M, Chakravarty T, Makkar R. Quality of Life, Procedural Success, and Clinical Outcomes following Transcatheter Mitral Valve Repair. Int J Clin Pract 2023; 2023:1977911. [PMID: 36923520 PMCID: PMC10010880 DOI: 10.1155/2023/1977911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/04/2023] [Accepted: 02/08/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Limited data exist regarding the association between the quality of life (QoL) and clinical outcomes following transcatheter mitral valve repair (TMVr). We aimed to evaluate the prognostic significance of QoL assessment following TMVr and to characterize those who had procedural success, yet reported a low Kansas City Cardiomyopathy Questionnaire (KCCQ-12) score. METHODS We reported the experience of Cedars-Sinai Medical Center patients between 2013 and 2020. Patients were allocated into four groups according to the 30-day KCCQ: <25, 25-49, 50-74, and ≥75. Primary outcome included 1-year all-cause death or heart failure (HF) hospitalizations. We also examined the association between QoL and the primary outcome in those with procedural success. RESULTS A total of 555 patients were included in our analysis, median follow-up of 650 days (IQR 243-1113). The lower KCCQ groups had a higher prevalence of functional mitral regurgitation (65%, 60%, 56%, and 43%, p = 0.001), as well as a higher Society of Thoracic Surgeon (STS) score. These groups had a significantly higher occurrence of 1-year all-cause death or HF hospitalizations in a stepwise fashion (40%, 22%, 16%, and 10%, p < 0.001). Multivariable Cox regression analysis revealed 30-day KCCQ as the strongest predictor of the 1-year primary outcome (HR 0.98, 95%CI (0.97-0.99), p = 0.006). Approximately a quarter of patients with procedural success had a low KCCQ score. These patients had a higher rate of the combined 1-year outcome regardless of procedural success or failure. CONCLUSION QoL following TMVr is a powerful prognostic factor. KCCQ assessment is an important indicator for identifying patients prone to adverse outcomes even after procedural success.
Collapse
Affiliation(s)
- Sharon Shalom Natanzon
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Keita Koseki
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
- Department of Cardiovascular Medicine, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Danon Kaewkes
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ofir Koren
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
- Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Vivek Patel
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
| | - Mamoo Nakamura
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
| | - Tarun Chakravarty
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
| | - Raj Makkar
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
| |
Collapse
|
32
|
Fraccaro C, Tarantini G, Rosato S, Baglio G, Biancari F, Barbanti M, Tamburino C, Bedogni F, Ranucci M, Ussia GP, Seccareccia F, D'Errigo P. Early and mid-term outcome of patients with low-flow-low-gradient aortic stenosis treated with newer-generation transcatheter aortic valves. Front Cardiovasc Med 2022; 9:991729. [PMID: 36277797 PMCID: PMC9583539 DOI: 10.3389/fcvm.2022.991729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Patients with non-paradoxical low-flow-low-gradient (LFLG) aortic stenosis (AS) are at increased surgical risk, and thus, they may particularly benefit from transcatheter aortic valve replacement (TAVR). However, data on this issue are still limited and based on the results with older-generation transcatheter heart valves (THVs). The aim of this study was to investigate early and mid-term outcome of TAVR with newer-generation THVs in the setting of LFLG AS. Data for the present analysis were gathered from the OBSERVANT II dataset, a national Italian observational, prospective, multicenter cohort study that enrolled 2,989 consecutive AS patients who underwent TAVR at 30 Italian centers between December 2016 and September 2018, using newer-generation THVs. Overall, 420 patients with LVEF ≤50% and mean aortic gradient <40 mmHg were included in this analysis. The primary outcomes were 1-year all-cause mortality and a combined endpoint including all-cause mortality and hospital readmission due to congestive heart failure (CHF) at 1 year. A risk-adjusted analysis was performed to compare the outcome of LFLG AS patients treated with TAVR (n = 389) with those who underwent surgical aortic valve replacement (SAVR, n = 401) from the OBSERVANT I study. Patients with LFLG AS undergoing TAVR were old (mean age, 80.8 ± 6.7 years) and with increased operative risk (mean EuroSCORE II, 11.5 ± 10.2%). VARC-3 device success was 83.3% with 7.6% of moderate/severe paravalvular leak. Thirty-day mortality was 3.1%. One-year all-cause mortality was 17.4%, and the composite endpoint was 34.8%. Chronic obstructive pulmonary disease (HR 1.78) and EuroSCORE II (HR 1.02) were independent predictors of 1-year mortality, while diabetes (HR 1.53) and class NYHA IV (HR 2.38) were independent predictors of 1-year mortality or CHF. Compared with LFLG AS treated with SAVR, TAVR patients had a higher rate of major vascular complications and permanent pacemaker, while SAVR patients underwent more frequently to blood transfusion, cardiogenic shock, AKI, and MI. However, 30-day and 1-year outcomes were similar between groups. Patients with non-paradoxical LFLG AS treated by TAVR were older and with higher surgical risk compared with SAVR patients. Notwithstanding, TAVR was safe and effective with a similar outcome to SAVR at both early and mid-term.
Collapse
Affiliation(s)
- Chiara Fraccaro
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giuseppe Tarantini
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy,*Correspondence: Giuseppe Tarantini
| | - Stefano Rosato
- Centro Nazionale per la Salute Globale, National Center for Global Health, Istituto Superiore di Sanità Italiana, Roma, Italy
| | - Giovanni Baglio
- Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - Fausto Biancari
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy,Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico—San Marco”, University of Catania, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico—San Marco”, University of Catania, Catania, Italy
| | - Francesco Bedogni
- Interventional Cardiology Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Marco Ranucci
- Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy
| | - Gian Paolo Ussia
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Fulvia Seccareccia
- Centro Nazionale per la Salute Globale, National Center for Global Health, Istituto Superiore di Sanità Italiana, Roma, Italy
| | - Paola D'Errigo
- Centro Nazionale per la Salute Globale, National Center for Global Health, Istituto Superiore di Sanità Italiana, Roma, Italy
| |
Collapse
|
33
|
Incidence and Predictors of Early Death in Patients Undergoing Percutaneous Left Atrial Appendage Closure. JACC Clin Electrophysiol 2022; 8:1093-1102. [DOI: 10.1016/j.jacep.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/25/2022] [Accepted: 06/09/2022] [Indexed: 11/17/2022]
|
34
|
Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Rafael Sádaba J, Tribouilloy C, Wojakowski W. Guía ESC/EACTS 2021 sobre el diagnóstico y tratamiento de las valvulopatías. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
35
|
Tuttle MK, Kiaii B, Van Mieghem NM, Laham RJ, Deeb GM, Windecker S, Chetcuti S, Yakubov SJ, Chawla A, Hockmuth D, Teefy P, Li S, Reardon MJ. Functional Status After Transcatheter and Surgical Aortic Valve Replacement: 2-Year Analysis From the SURTAVI Trial. JACC Cardiovasc Interv 2022; 15:728-738. [PMID: 35393106 DOI: 10.1016/j.jcin.2022.01.284] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 01/06/2022] [Accepted: 01/14/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study sought to evaluate patient-centered metrics in intermediate-surgical-risk aortic stenosis patients enrolled in the SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial treated with self-expanding transcatheter aortic valve replacement (TAVR) or surgery. BACKGROUND Studies have shown TAVR to be an alternative to surgery in patients with severe symptomatic aortic stenosis but have focused on "hard endpoints," including all-cause mortality and stroke, rather than on comparative patient-centered metrics, such as functional status and symptom burden. METHODS The study analyzed functional status (6-minute walk test [6MWT]) and symptom burden (Kansas City Cardiomyopathy Questionnaire) in 1,492 patients from the SURTAVI trial at baseline, 30 days, 1 year, and 2 years. Patients were categorized by baseline functional status into tertiles of slow, medium, and fast walkers. RESULTS Patients with lowest capacity baseline functional status were commonly women, had higher Society of Thoracic Surgeons scores, and had more New York Heart Association functional class III or IV symptoms; reduced baseline functional status was associated with higher aortic valve- and heart failure-related hospitalization at 2 years. There was greater improvement in 6MWT distance in TAVR compared with surgery patients at 30 days (P < 0.001) and 1 year (P = 0.012), but at 2 years, both groups had similar improvement (P = 0.091). The percentage of patients with large improvement in 6MWT was greatest in patients categorized as slow walkers and lowest in fast walkers. Symptom burden improved after TAVR at 30 days and after both procedures at 1 and 2 years. CONCLUSIONS In this substudy of patients from the SURTAVI trial, patients receiving TAVR demonstrated a more rapid improvement in functional status and symptom burden compared with patients undergoing surgery; however, both groups had similar improvements in long-term follow-up. (Safety and Efficacy Study of the Medtronic CoreValve® System in the Treatment of Severe, Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement [SURTAVI]; NCT01586910).
Collapse
Affiliation(s)
- Mark K Tuttle
- CardioVascular Institute of North Colorado, Banner Health, Greeley, Colorado, USA.
| | - Bob Kiaii
- Department of Cardiothoracic Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Roger J Laham
- CardioVascular Institute of North Colorado, Banner Health, Greeley, Colorado, USA
| | - G Michael Deeb
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Stanley Chetcuti
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Steven J Yakubov
- Department of Cardiac Surgery, Riverside Methodist Hospital, Columbus, Ohio, USA; Department of Interventional Cardiology, Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Atul Chawla
- Department of Cardiology, Iowa Heart Center, Des Moines, Iowa, USA
| | - David Hockmuth
- Department of Cardiology, Iowa Heart Center, Des Moines, Iowa, USA
| | - Patrick Teefy
- Department of Medicine, Cardiology Division, London Health Sciences Centre, London, Ontario, Canada
| | - Shuzhen Li
- Coronary and Structural Heart, Medtronic, Minneapolis, Minnesota, USA
| | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA; Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| |
Collapse
|
36
|
Roule V, Rebouh I, Lemaitre A, Sabatier R, Blanchart K, Briet C, Bignon M, Beygui F. Impact of wait times on late postprocedural mortality after successful transcatheter aortic valve replacement. Sci Rep 2022; 12:5967. [PMID: 35395869 PMCID: PMC8993919 DOI: 10.1038/s41598-022-09995-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 03/21/2022] [Indexed: 11/30/2022] Open
Abstract
Wait times are associated with mortality on waiting list for transcatheter aortic valve replacement (TAVR). Whether longer wait times are associated with long term mortality after successful TAVR remains unassessed. Consecutive patients successfully treated with elective TAVR in our center between January 2013 and August 2019 were included. The primary end point was one-year all-cause mortality. TAVR wait times were defined as the interval from referral date for valve replacement to the date of TAVR procedure. A total of 383 patients were included with a mean wait time of 144.2 ± 83.87 days. Death occurred in 55 patients (14.4%) at one year. Increased wait times were independently associated with a relative increase of 1-year mortality by 2% per week after referral (Adjusted Hazard Ratio 1.02 [1.002–1.04]; p = 0.02) for TAVR. Chronic kidney disease, left ventricular ejection fraction ≤ 30%, access site and STS score were other independent correlates of 1-year mortality. Our study shows that wait times are relatively long in routine practice and associated with increased 1-year mortality after successful TAVR. Such findings underscore the need of strategies to minimize delays in access to TAVR.
Collapse
Affiliation(s)
- Vincent Roule
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France. .,INSERM UMRS 1237, GIP Cyceron, 14000, Caen, France. .,Cardiology Department, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France.
| | - Idir Rebouh
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France
| | - Adrien Lemaitre
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France
| | - Rémi Sabatier
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France
| | | | - Clément Briet
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France
| | - Mathieu Bignon
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France
| | - Farzin Beygui
- CHU de Caen Normandie, Service de Cardiologie, 14000, Caen, France.,INSERM UMRS 1237, GIP Cyceron, 14000, Caen, France.,ACTION Study Group, Cardiology Department, Pitié-Salpêtrière University Hospital, Paris, France
| |
Collapse
|
37
|
Milne B, Lucas de Carvalho J, Ayis S, Chaubey S, Khan H, Kunst G. Frailty and perioperative patient-reported disability in patients undergoing cardiac surgery: a pilot study. Br J Anaesth 2022; 128:949-958. [PMID: 35465950 PMCID: PMC9204662 DOI: 10.1016/j.bja.2022.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 02/06/2022] [Accepted: 03/04/2022] [Indexed: 11/16/2022] Open
Abstract
Background Methods Results Conclusions
Collapse
Affiliation(s)
- Benjamin Milne
- Department of Anaesthesia & Pain Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Joshua Lucas de Carvalho
- Department of Anaesthesia & Pain Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Salma Ayis
- Department of Statistics, School of Population Health & Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, UK
| | - Sanjay Chaubey
- Department of Cardiothoracic Surgery, King's College NHS Foundation Trust, London, UK
| | - Habib Khan
- Department of Cardiothoracic Surgery, King's College NHS Foundation Trust, London, UK
| | - Gudrun Kunst
- Department of Anaesthesia & Pain Medicine, King's College Hospital NHS Foundation Trust, London, UK; British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK.
| |
Collapse
|
38
|
Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. EUROINTERVENTION 2022; 17:e1126-e1196. [PMID: 34931612 PMCID: PMC9725093 DOI: 10.4244/eij-e-21-00009] [Citation(s) in RCA: 200] [Impact Index Per Article: 66.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
39
|
Seoudy H, Eberstein M, Frank J, Thomann M, Puehler T, Lutter G, Lutz M, Bramlage P, Frey N, Saad M, Frank D. HFA‐PEFF score: prognosis in patients with preserved ejection fraction after transcatheter aortic valve implantation. ESC Heart Fail 2022; 9:1071-1079. [PMID: 35092186 PMCID: PMC8934930 DOI: 10.1002/ehf2.13774] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/31/2021] [Accepted: 12/02/2021] [Indexed: 12/19/2022] Open
Affiliation(s)
- Hatim Seoudy
- Department of Internal Medicine III, Cardiology and Angiology University Hospital Schleswig‐Holstein, Campus Kiel Arnold‐Heller‐Str.3, Haus K3 Kiel 24105 Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck Kiel Germany
| | - Mira Eberstein
- Department of Internal Medicine III, Cardiology and Angiology University Hospital Schleswig‐Holstein, Campus Kiel Arnold‐Heller‐Str.3, Haus K3 Kiel 24105 Germany
| | - Johanne Frank
- Department of Internal Medicine III, Cardiology and Angiology University Hospital Schleswig‐Holstein, Campus Kiel Arnold‐Heller‐Str.3, Haus K3 Kiel 24105 Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck Kiel Germany
| | - Maren Thomann
- Department of Internal Medicine III, Cardiology and Angiology University Hospital Schleswig‐Holstein, Campus Kiel Arnold‐Heller‐Str.3, Haus K3 Kiel 24105 Germany
| | - Thomas Puehler
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck Kiel Germany
- Department of Cardiac and Vascular Surgery University Hospital Schleswig‐Holstein, Campus Kiel Kiel Germany
| | - Georg Lutter
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck Kiel Germany
- Department of Cardiac and Vascular Surgery University Hospital Schleswig‐Holstein, Campus Kiel Kiel Germany
| | - Matthias Lutz
- Department of Internal Medicine III, Cardiology and Angiology University Hospital Schleswig‐Holstein, Campus Kiel Arnold‐Heller‐Str.3, Haus K3 Kiel 24105 Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck Kiel Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine Cloppenburg Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology Heidelberg University Hospital Heidelberg Germany
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim Heidelberg Germany
| | - Mohammed Saad
- Department of Internal Medicine III, Cardiology and Angiology University Hospital Schleswig‐Holstein, Campus Kiel Arnold‐Heller‐Str.3, Haus K3 Kiel 24105 Germany
| | - Derk Frank
- Department of Internal Medicine III, Cardiology and Angiology University Hospital Schleswig‐Holstein, Campus Kiel Arnold‐Heller‐Str.3, Haus K3 Kiel 24105 Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck Kiel Germany
| |
Collapse
|
40
|
Patel KP, Treibel TA, Scully PR, Fertleman M, Searle S, Davis D, Moon JC, Mullen MJ. Futility in Transcatheter Aortic Valve Implantation: A Search for Clarity. Interv Cardiol 2022; 17:e01. [PMID: 35111240 PMCID: PMC8790725 DOI: 10.15420/icr.2021.15] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/05/2021] [Indexed: 12/12/2022] Open
Abstract
Although transcatheter aortic valve implantation (TAVI) has revolutionised the landscape of treatment for aortic stenosis, there exists a cohort of patients where TAVI is deemed futile. Among the pivotal high-risk trials, one-third to half of patients either died or received no symptomatic benefit from the procedure at 1 year. Futility of TAVI results in the unnecessary exposure of risk for patients and inefficient resource utilisation for healthcare services. Several cardiac and extra-cardiac conditions and frailty increase the risk of mortality despite TAVI. Among the survivors, these comorbidities can inhibit improvements in symptoms and quality of life. However, certain conditions are reversible with TAVI (e.g. functional mitral regurgitation), attenuating the risk and improving outcomes. Quantification of disease severity, identification of reversible factors and a systematic evaluation of frailty can substantially improve risk stratification and outcomes. This review examines the contribution of pre-existing comorbidities towards futility in TAVI and suggests a systematic approach to guide patient evaluation.
Collapse
Affiliation(s)
- Kush P Patel
- Institute of Cardiovascular Sciences, University College London London, UK.,Barts Heart Centre, St Bartholomew's Hospital London, UK
| | - Thomas A Treibel
- Institute of Cardiovascular Sciences, University College London London, UK.,Barts Heart Centre, St Bartholomew's Hospital London, UK
| | - Paul R Scully
- Institute of Cardiovascular Sciences, University College London London, UK.,Barts Heart Centre, St Bartholomew's Hospital London, UK
| | - Michael Fertleman
- Cutrale Perioperative and Ageing Group, Department of Bioengineering, Imperial College London London, UK
| | - Samuel Searle
- MRC Unit for Lifelong Health and Ageing, University College London London, UK
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing, University College London London, UK
| | - James C Moon
- Institute of Cardiovascular Sciences, University College London London, UK.,Barts Heart Centre, St Bartholomew's Hospital London, UK
| | - Michael J Mullen
- Institute of Cardiovascular Sciences, University College London London, UK.,Barts Heart Centre, St Bartholomew's Hospital London, UK
| |
Collapse
|
41
|
Lux A, Veenstra LF, Kats S, Dohmen W, Maessen JG, van 't Hof AWJ, Maesen B. Urgent transcatheter aortic valve implantation in an all-comer population: a single-centre experience. BMC Cardiovasc Disord 2021; 21:550. [PMID: 34798815 PMCID: PMC8603591 DOI: 10.1186/s12872-021-02347-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/30/2021] [Indexed: 01/04/2023] Open
Abstract
Background When compared with older reports of untreated symptomatic aortic valve stenosis (AoS), urgent transcatheter aortic valve implantation (u-TAVI) seems to improve mortality rates. We performed a single centre, retrospective cohort analysis to characterize our u-TAVI population and to identify potential predictors of worse outcomes. Methods We performed a retrospective analysis of 631 consecutive TAVI patients between 2013 and 2018. Of these patients, 53 were categorized as u-TAVI. Data was collected from the local electronic database. Results Urgent patients had more often a severely decreased left ventricular ejection fraction (LVEF < 30%) and increased creatinine levels (115.5 [88–147] vs 94.5 [78–116] mmol/l; p = 0.001). Urgent patients were hospitalised for 18 [10–28] days before and discharged 6 [4–9] days after the implantation. The incidence of peri-procedural complications and apical implantations was comparable among the study groups. Urgent patients had higher in-hospital (11.3% vs 3.1%; p = 0.011) and 1-year mortality rates (28.2% vs 8.5%, p < 0.001). An increased risk of one-year mortality was associated with urgency (HR 3.5; p < 0.001), apical access (HR 1.9; p = 0.016) and cerebrovascular complications (HR 4.3; p = 0.002). Within the urgent group, the length of pre-hospital admission was the only significant predictor of 1-year mortality (HR 1.037/day; p = 0.003). Conclusions Compared to elective procedures, u-TAVI led to increased mortality and comparable complication rates. This detrimental effect is most likely related to the length of pre-procedural hospitalisation of urgent patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02347-1.
Collapse
Affiliation(s)
- Arpad Lux
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands. .,Department of Cardiology, Zuyderland Medical Centrum, Heerlen, The Netherlands.
| | - Leo F Veenstra
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Suzanne Kats
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Wim Dohmen
- Business Information Management, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.,Cardiovascular Reasearch Institute Maastricht University, Maastricht, The Netherlands
| | - Arnoud W J van 't Hof
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands.,Cardiovascular Reasearch Institute Maastricht University, Maastricht, The Netherlands.,Department of Cardiology, Zuyderland Medical Centrum, Heerlen, The Netherlands
| | - Bart Maesen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands.,Cardiovascular Reasearch Institute Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
42
|
Sturm RC, Harrison J, Tandar A. Frailty and TAVR-Is this the hard-to-define glass ceiling? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 34:61-62. [PMID: 34810114 DOI: 10.1016/j.carrev.2021.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Robert C Sturm
- Division Cardiovascular Medicine, University of Utah School of Medicine, United States of America
| | - Jonathan Harrison
- Division Cardiovascular Medicine, University of Utah School of Medicine, United States of America
| | - Anwar Tandar
- Division Cardiovascular Medicine, University of Utah School of Medicine, United States of America.
| |
Collapse
|
43
|
Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg 2021; 60:727-800. [PMID: 34453161 DOI: 10.1093/ejcts/ezab389] [Citation(s) in RCA: 356] [Impact Index Per Article: 89.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
|
44
|
Terrosu P, Boccanelli A, Sabino G, Alboni P, Baldasseroni S, Bo M, Desideri G, Marchionni N, Palazzo G, Rozzini R, Ungar A, Vetta F, Zito G. Severe aortic stenosis and transcatheter aortic valve replacement in elderly patients: utility vs futility. Minerva Med 2021; 113:640-646. [PMID: 34542953 DOI: 10.23736/s0026-4806.21.07777-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Recently, transcatheter aortic valve replacement (TAVR) has emerged as established standard treatment for symptomatic severe aortic stenosis, providing an effective, less-invasive alternative to open cardiac surgery for inoperable or high-risk older patients. EVIDENCE ACQUISITION In order to assess the anticipated benefit of aortic replacement, considerable interest now lies in better identifying factors likely to predict outcome. In the elderly population frailty and medical comorbidities have been shown to significantly predict mortality, functional recovery and quality of life after transcatheter aortic valve replacement. Scientific literature focused on the three items will be discussed. EVIDENCE SYNTHESIS High likelihood of futility is described in patients with severe chronic lung, kidney, liver disease and/or frailty. The addition of frailty components to conventional risk prediction has been shown to result in improved discrimination for death and disability following the procedure and identifies those individuals least likely to derive benefit. Several dedicated risk score have been proposed to provide new insights into predicted "futile" outcome. However, assessment of frailty according to a limited number of variables is not sufficient, while a multi-dimensional geriatric assessment significantly improves risk prediction. CONCLUSIONS A multidisciplinary heart team that includes geriatricians can allow the customization of therapeutic interventions in elderly patients to optimise care and avoid futility.
Collapse
Affiliation(s)
| | | | - Giuseppe Sabino
- UOC di Cardiologia, AOU-Ospedale SS. Annunziata, Sassari, Italy
| | - Paolo Alboni
- SICGe - Società Italiana di Cardiologia Geriatrica, Firenze, Italy
| | | | - Mario Bo
- SICGe - Società Italiana di Cardiologia Geriatrica, Firenze, Italy
| | | | | | - Giuseppe Palazzo
- SICGe - Società Italiana di Cardiologia Geriatrica, Firenze, Italy
| | - Renzo Rozzini
- SICGe - Società Italiana di Cardiologia Geriatrica, Firenze, Italy
| | - Andrea Ungar
- SICGe - Società Italiana di Cardiologia Geriatrica, Firenze, Italy
| | - Francesco Vetta
- SICGe - Società Italiana di Cardiologia Geriatrica, Firenze, Italy
| | - Giovanni Zito
- SICGe - Società Italiana di Cardiologia Geriatrica, Firenze, Italy
| |
Collapse
|
45
|
Quality-of-Life Outcomes After Transcatheter Aortic Valve Implantation in a "Real World" Population: Insights From a Prospective Canadian Database. CJC Open 2021; 3:1033-1042. [PMID: 34505043 PMCID: PMC8413231 DOI: 10.1016/j.cjco.2021.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/12/2021] [Indexed: 11/27/2022] Open
Abstract
Background Documentation of quality of life (QOL) of patients after transcatheter aortic valve implantation (TAVI) is a Canadian Cardiovascular Society quality indicator. National results have not been reported to date. Methods We conducted an observational cohort study including all TAVI patients, irrespective of surgical risk, treated between January 2016 and June 2019 as documented in the British Columbia TAVI Registry. QOL was measured at baseline, 30 days, and 1 year, using the Kansas City Cardiomyopathy Questionnaire overall score (KCCQ-OS). We used linear regression modelling to examine factors associated with 30-day changes in QOL, logistic regression modelling to identify predictors of sustaining a poor outcome, and Cox regression modelling to ascertain risk estimates of the effect of QOL on 1-year mortality. Results The cohort included 1706 patients (742 women [43.5%]); median age 83 years (interquartile range [IQR]: 77, 86). Median (IQR) baseline KCCQ-OS was 45 (28.2, 67), indicating severe impairment. Patients alive at 1 year (91.3%) reported a mean improvement of 24.1 (95% confidence interval [CI], 22.7-25.6) points in the KCCQ-OS at 30 days, which was sustained at 1 year (25.3; 95% CI, 23.8, 26.8). Older age, lower baseline health status, lower aortic valve gradient, lower hemoglobin, atrial fibrillation, and non-transfemoral access were associated with worse 30-day QOL. At 1 year, 65% of patients had a favorable outcome; additional risk factors for 1-year mortality (8.7%) were male sex, New York Heart Association Class IV, severe pulmonary and renal disease, diabetes, and in-patient status. Conclusions TAVI is associated with significant early improvement in QOL, which is sustained at 1 year. The inclusion of QOL can support treatment decisions and patient-centred evaluation.
Collapse
|
46
|
Ghezzi ES, Psaltis PJ, Loetscher T, Davis D, Montarello J, Lau JK, Delacroix S, Bourke A, McLoughlin J, Keage M, Keage HAD. Identifying New Factors Associated With Cognitive Decline and Delirium After Transcatheter Aortic Valve Implantation: A Study Protocol. Front Cardiovasc Med 2021; 8:657057. [PMID: 34458327 PMCID: PMC8385234 DOI: 10.3389/fcvm.2021.657057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/14/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has become the standard-of-care for treatment of severe symptomatic aortic stenosis and is also being increasingly recommended for low-risk patients. While TAVI boasts positive post-procedural outcomes, it is also associated with cognitive complications, namely delirium and cognitive decline. There is a pressing need for accurate risk tools which can identify TAVI patients at risk of delirium and cognitive decline, as risk scores designed for general cardiovascular surgery fall short. The present effect-finding exploratory study will assess the utility of various measures in the context of aging and frailty in predicting who will and who will not develop delirium or cognitive impairment following TAVI. The measures we propose include gait, visual symptoms, voice, swallowing, mood and sleep. Methods: This is an observational prospective cohort study focused on identifying pre-procedural risk factors for the development of delirium and cognitive decline following TAVI. Potential risk factors will be measured prior to TAVI. Primary outcomes will be post-procedure cognitive decline and delirium. Secondary outcomes include activities of daily living, quality of life, and mortality. Delirium presence will be measured on each of the first 2 days following TAVI. All other outcomes will be assessed at 3-, 6-, and 12-months post-operatively. A series of logistic regressions will be run to investigate the relationship between potential predictors and outcomes (presence vs. absence of either delirium or cognitive decline). Discussion: This study will assess the strengths of associations between a range of measures drawn from frailty and aging literature in terms of association with cognitive decline and delirium following TAVI. Identified measures can be used in future development of TAVI risk prediction models, which are essential for the accurate identification of cognitive at-risk patients and successful application of pre-procedural interventions. Clinical Trial Registration: This trial is registered with the Australian New Zealand Clinical Trials Registry. [https://bit.ly/2PAotP5], [ACTRN12618001114235].
Collapse
Affiliation(s)
- Erica S Ghezzi
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, Adelaide, SA, Australia
| | - Peter J Psaltis
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Adelaide University Medical School, University of Adelaide, Adelaide, SA, Australia.,Department of Cardiology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Tobias Loetscher
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, Adelaide, SA, Australia
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing Unit at UCL, London, United Kingdom
| | - Joseph Montarello
- Department of Cardiology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Jerrett K Lau
- Department of Cardiology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Sinny Delacroix
- Department of Cardiology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Alice Bourke
- Department of Geriatric and Rehabilitation Medicine, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - James McLoughlin
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Megan Keage
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, VIC, Australia.,Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, VIC, Australia
| | - Hannah A D Keage
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, Adelaide, SA, Australia
| |
Collapse
|
47
|
Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2021; 43:561-632. [PMID: 34453165 DOI: 10.1093/eurheartj/ehab395] [Citation(s) in RCA: 3068] [Impact Index Per Article: 767.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
48
|
Prognostic Importance of Health Status Versus Functional Status in Heart Failure and Secondary Mitral Regurgitation. JACC-HEART FAILURE 2021; 9:684-692. [PMID: 34391740 DOI: 10.1016/j.jchf.2021.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/19/2021] [Accepted: 04/27/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study sought to understand the extent to which health status and exercise capacity are independently associated with long-term outcomes in patients with heart failure (HF) and secondary mitral regurgitation (MR). BACKGROUND Secondary MR in patients with HF leads to impaired health status (Kansas City Cardiomyopathy Questionnaire Overall Summary Score [KCCQ-OS]) and exercise capacity (6-minute walk distance [6MWD]), both of which improve after transcatheter mitral valve repair (TMVr). METHODS The study used data from the COAPT trial (N = 604) to examine the association of baseline KCCQ-OS and 6MWD with 2-year mortality and HF hospitalization, adjusting for treatment arm and patient factors. We also examined the association of change in KCCQ-OS and 6MWD from baseline to 1 month with risk of outcomes from 1 month to 2 years. Interactions of KCCQ-OS and 6MWD with treatment assignment were explored. RESULTS Mean baseline KCCQ-OS was 53 ± 23 points, and 6MWD was 240 ± 125 meters. In models including both measures, greater baseline 6MWD (but not KCCQ-OS) was associated with reduced 2-year mortality (HR per 125 meters: 0.75, 95% CI: 0.61-0.92). When stratified by treatment group, both baseline KCCQ-OS and 6MWD were independently associated with HF hospitalization in patients treated with medical therapy, whereas only KCCQ-OS was associated with HF hospitalization in patients treated with TMVr. In separate analyses, 1-month improvements in KCCQ-OS and 6MWD were each associated with lower subsequent risk of mortality and HF hospitalization, independent of treatment group. CONCLUSIONS Among patients with HF and severe secondary MR, assessment of both health status and exercise capacity provide complementary prognostic information for patients with HF and severe secondary MR-both before and after TMVr. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Trial]; NCT01626079).
Collapse
|
49
|
Goldwater DS, Leng M, Karlamangla A, Seeman T, Elashoff D, Wanagat JM, Reuben DB, Lindman BR, Cole S. Baseline pro-inflammatory gene expression in whole blood is related to adverse long-term outcomes after transcatheter aortic valve replacement: a case control study. BMC Cardiovasc Disord 2021; 21:368. [PMID: 34340660 PMCID: PMC8327421 DOI: 10.1186/s12872-021-02186-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/28/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Age-associated inflammation and immune system dysfunction have been implicated as mechanisms that increase risk for adverse long-term procedural outcomes in older adults. The purpose of this study was to investigate relationships between baseline inflammatory and innate antiviral gene expression and outcomes after transcatheter aortic valve replacement (TAVR) in older adults with severe aortic stenosis. METHODS We performed a retrospective case-control study comparing pre-procedural pro-inflammatory and Type 1 interferon (IFN) gene expression in 48 controls with favorable outcomes (alive 1 year after TAVR with improved quality of life [QoL]) versus 48 individuals with unfavorable outcomes (dead by 1 year or alive at 1 year but with reduced QoL). Gene expression was evaluated in whole blood via (1) pre-defined composite scores of 19 inflammation-associated genes and 34 Type I IFN response genes, and (2) pro-inflammatory and antiviral transcription factor activity inferred from promotor based bioinformatics analyses of genes showing > 25% difference in average expression levels across groups. All analyses were adjusted for age, gender, body mass index, diabetes, immunosuppression, cardiovascular disease (CVD), and frailty. RESULTS Relative to controls, those with unfavorable outcomes demonstrated higher expression of the pro-inflammatory gene composite prior to TAVR (p < 0.01) and bioinformatic indicators of elevated Nuclear Factor kB (p < 0.001) and Activator Protein 1 (p < 0.001) transcription factor activity, but no significant differences in Type I IFN-related gene expression. CONCLUSIONS These results demonstrate that a pro-inflammatory state prior to TAVR, independent of CVD severity and frailty status, is associated with worse long-term procedural outcomes.
Collapse
Affiliation(s)
- Deena S Goldwater
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA. .,Division of Geriatrics, Department of Medicine, University of California, Los Angeles, CA, USA.
| | - Mei Leng
- Department of Biostatistics, University of California, Los Angeles, CA, USA
| | - Arun Karlamangla
- Division of Geriatrics, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Teresa Seeman
- Division of Geriatrics, Department of Medicine, University of California, Los Angeles, CA, USA
| | - David Elashoff
- Department of Biostatistics, University of California, Los Angeles, CA, USA
| | - Jonathan M Wanagat
- Division of Geriatrics, Department of Medicine, University of California, Los Angeles, CA, USA.,Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - David B Reuben
- Division of Geriatrics, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Brian R Lindman
- Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Steve Cole
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| |
Collapse
|
50
|
Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C, O'Gara PT, Beckman JA, Levine GN, Al-Khatib SM, Armbruster A, Birtcher KK, Ciggaroa J, Deswal A, Dixon DL, Fleisher LA, de las Fuentes L, Gentile F, Goldberger ZD, Gorenek B, Haynes N, Hernandez AF, Hlatky MA, Joglar JA, Jones WS, Marine JE, Mark D, Palaniappan L, Piano MR, Spatz ES, Tamis-Holland J, Wijeysundera DN, Woo YJ. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2021; 162:e183-e353. [PMID: 33972115 DOI: 10.1016/j.jtcvs.2021.04.002] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|