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Chiabrando JG, Lombardi M, Seropian IM, Valle Raleigh JM, Vergallo R, Larribau M, Agatiello CR, Trani C, Burzotta F. Chronic systemic glucocorticoid therapy is associated with increased risk of major vascular complications and cardiac tamponade after transcatheter aortic valve implantation: a systematic review and meta-analysis. Minerva Cardiol Angiol 2024; 72:284-291. [PMID: 37822235 DOI: 10.23736/s2724-5683.23.06347-0] [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: 10/13/2023]
Abstract
INTRODUCTION TAVI-related complications, such as conduction disturbances, vascular complications or death may be related to increased inflammatory response. The aim of this study was to elucidate the efficacy and safety of the systemic glucocorticoid therapy regarding the adverse events after TAVI deployment. EVIDENCE ACQUISITION We conducted a systemic search of PubMed, a reference list of relevant articles, and Medline. The main efficacy outcomes of interest were all-cause death, cardiac and non-cardiac death, permanent pacemaker implantation (PPM), new left bundle branch block (LBBB), stroke, and myocardial infarction (MI). Safety endpoints were major vascular complications, major bleeding events, and cardiac tamponade. EVIDENCE SYNTHESIS A total of 7 studies including data from 3439 patients with a median follow-up was 30 days. Systemic glucocorticoid compared to the control group were associated with an increased risk of non-cardiac death (Relative Risk [RR] 5.90 95%CI [2.95; 11.80], P<0.001) major vascular complications (RR 1.78, 95%CI [1.22 - 2.61], P=0.003) and cardiac tamponade (RR 3.42, 95%CI [1.69 - 6.92], P<0.001). However, there were no differences in all-cause death, cardiac death, new LBBB, stroke, MI, or major bleeding events (all P values >0.05). CONCLUSIONS Glucocorticoid therapy before the TAVI procedure was associated with an increase in non-cardiac death, major vascular events and cardiac tamponade. There were no differences in the risk of all-cause death, cardiac death, PPM or LBBB, stroke, or MI.
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Affiliation(s)
- Juan G Chiabrando
- Unit of Interventional Cardiology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina -
- Unit of Interventional Cardiology, Spanish Hospital of Mendoza, Mendoza, Argentina -
| | - Marco Lombardi
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - Ignacio M Seropian
- Unit of Interventional Cardiology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Juan M Valle Raleigh
- Unit of Interventional Cardiology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Rocco Vergallo
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
- Cardiothoracic and Vascular Department (DICATOV), IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Miguel Larribau
- Unit of Interventional Cardiology, Spanish Hospital of Mendoza, Mendoza, Argentina
| | - Carla R Agatiello
- Unit of Interventional Cardiology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Carlo Trani
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
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Stan A, Călburean PA, Drinkal RK, Harpa M, Elkahlout A, Nicolae VC, Tomșa F, Hadadi L, Brînzaniuc K, Suciu H, Mărușteri M. Inflammatory Status Assessment by Machine Learning Techniques to Predict Outcomes in Patients with Symptomatic Aortic Stenosis Treated by Transcatheter Aortic Valve Replacement. Diagnostics (Basel) 2023; 13:2907. [PMID: 37761276 PMCID: PMC10530147 DOI: 10.3390/diagnostics13182907] [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: 06/28/2023] [Revised: 08/17/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Although transcatheter aortic valve replacement (TAVR) significantly improves long-term outcomes of symptomatic severe aortic stenosis (AS) patients, long-term mortality rates are still high. The aim of our study was to identify potential inflammatory biomarkers with predictive capacity for post-TAVR adverse events from a wide panel of routine biomarkers by employing ML techniques. (2) Methods: All patients diagnosed with symptomatic severe AS and treated by TAVR since January 2016 in a tertiary center were included in the present study. Three separate analyses were performed: (a) using only inflammatory biomarkers, (b) using inflammatory biomarkers, age, creatinine, and left ventricular ejection fraction (LVEF), and (c) using all collected parameters. (3) Results: A total of 338 patients were included in the study, of which 56 (16.5%) patients died during follow-up. Inflammatory biomarkers assessed using ML techniques have predictive value for adverse events post-TAVR with an AUC-ROC of 0.743 and an AUC-PR of 0.329; most important variables were CRP, WBC count and Neu/Lym ratio. When adding age, creatinine and LVEF to inflammatory panel, the ML performance increased to an AUC-ROC of 0.860 and an AUC-PR of 0.574; even though LVEF was the most important predictor, inflammatory parameters retained their value. When using the entire dataset (inflammatory parameters and complete patient characteristics), the ML performance was the highest with an AUC-ROC of 0.916 and an AUC-PR of 0.676; in this setting, the CRP and Neu/Lym ratio were also among the most important predictors of events. (4) Conclusions: ML models identified the CRP, Neu/Lym ratio, WBC count and fibrinogen as important variables for adverse events post-TAVR.
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Affiliation(s)
- Alexandru Stan
- Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureş, 540136 Târgu Mureş, Romania; (A.S.); (R.-K.D.)
- University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureş, 540139 Târgu Mureş, Romania
| | - Paul-Adrian Călburean
- Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureş, 540136 Târgu Mureş, Romania; (A.S.); (R.-K.D.)
- University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureş, 540139 Târgu Mureş, Romania
| | - Reka-Katalin Drinkal
- Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureş, 540136 Târgu Mureş, Romania; (A.S.); (R.-K.D.)
- University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureş, 540139 Târgu Mureş, Romania
| | - Marius Harpa
- Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureş, 540136 Târgu Mureş, Romania; (A.S.); (R.-K.D.)
- University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureş, 540139 Târgu Mureş, Romania
| | - Ayman Elkahlout
- Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureş, 540136 Târgu Mureş, Romania; (A.S.); (R.-K.D.)
| | - Viorel Constantin Nicolae
- Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureş, 540136 Târgu Mureş, Romania; (A.S.); (R.-K.D.)
| | - Flavius Tomșa
- Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureş, 540136 Târgu Mureş, Romania; (A.S.); (R.-K.D.)
| | - Laszlo Hadadi
- Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureş, 540136 Târgu Mureş, Romania; (A.S.); (R.-K.D.)
| | - Klara Brînzaniuc
- University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureş, 540139 Târgu Mureş, Romania
| | - Horațiu Suciu
- Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureş, 540136 Târgu Mureş, Romania; (A.S.); (R.-K.D.)
- University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureş, 540139 Târgu Mureş, Romania
| | - Marius Mărușteri
- University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureş, 540139 Târgu Mureş, Romania
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Sluka M, Hutyra M, Nykl R, Ostransky J, Furst T, Petrova P, Precek J, Hudec S, Taborsky M. Risk stratification using growth differentiation factor 15 in patients undergoing transcatheter aortic valve implantation. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2023; 167:263-271. [PMID: 35416185 DOI: 10.5507/bp.2022.017] [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: 01/24/2022] [Accepted: 03/24/2022] [Indexed: 11/23/2022] Open
Abstract
AIMS Growth differentiation factor 15 (GDF15) shows potential predictive value in various cardiac conditions. We investigated relationships between GDF15 and clinical or procedural outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) in order to propose clinically useful predictive risk stratification model. METHODS This prospective single-center registry enrolled 88 consecutive patients with severe symptomatic aortic stenosis treated with TAVI. Clinical parameters were collected and biomarkers including GDF-15 were measured within 24 h before TAVI. All relevant clinical outcomes according to the Valve Academic Research Consortium-2 were collected over the follow-up period. RESULTS The cohort included 52.3% of females. The mean age of study participants was 81 years; the mean Society of Thoracic Surgeons (STS) score and logistic EuroSCORE were 3.6% and 15.4%, respectively. The mortality over the entire follow-up period was 10.2%; no death was observed within the first 30 days following TAVI. Univariate analysis showed significant associations between GDF15 and mortality (P=0.0006), bleeding (P=0.0416) and acute kidney injury (P=0.0399). A standard multivariate logistic regression model showed GDF-15 as the only significant predictor of mortality (P=0.003); the odds ratio corresponding to an increase in GDF15 of 1000 pg/mL was 1.22. However, incremental predictive value was not observed when the STS score was combined with GDF15 in this predictive model. CONCLUSIONS Based on our observations, preprocedural elevated GDF15 levels are associated with increased mortality and demonstrate their additional value in predicting adverse clinical outcomes in a TAVI population.
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Affiliation(s)
- Martin Sluka
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, I. P. Pavlova 6, 779 00, Czech Republic
| | - Martin Hutyra
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, I. P. Pavlova 6, 779 00, Czech Republic
| | - Radomir Nykl
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, I. P. Pavlova 6, 779 00, Czech Republic
| | - Jiri Ostransky
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, I. P. Pavlova 6, 779 00, Czech Republic
| | - Tomas Furst
- Department of Mathematical Analysis and Applications of Mathematics, Faculty of Science, Palacky University Olomouc, Czech Republic
| | - Pavla Petrova
- Department of Clinical Biochemistry, University Hospital Olomouc, I. P. Pavlova 6, 779 00, Czech Republic
| | - Jan Precek
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, I. P. Pavlova 6, 779 00, Czech Republic
| | - Stepan Hudec
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, I. P. Pavlova 6, 779 00, Czech Republic
| | - Milos Taborsky
- Department of Internal Medicine I - Cardiology, University Hospital Olomouc, I. P. Pavlova 6, 779 00, Czech Republic
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Circulating Monocyte Subsets and Transcatheter Aortic Valve Replacement. Int J Mol Sci 2022; 23:ijms23105303. [PMID: 35628113 PMCID: PMC9141814 DOI: 10.3390/ijms23105303] [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: 03/31/2022] [Revised: 05/02/2022] [Accepted: 05/07/2022] [Indexed: 11/17/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR), as an alternative to open heart surgery, has revolutionized the treatment of severe aortic valve stenosis (AVS), the most common valvular disorder in the elderly. AVS is now considered a form of atherosclerosis and, like the latter, partly of inflammatory origin. Patients with high-grade AVS have a highly disturbed blood flow associated with high levels of shear stress. The immediate reopening of the valve during TAVR leads to a sudden restoration of a normal blood flow hemodynamic. Despite its good prognosis for patients, TAVR remains associated with bleeding or thrombotic postprocedural complications, involving mechanisms that are still poorly understood. Many studies report the close link between blood coagulation and inflammation, termed thromboinflammation, including monocytes as a major actor. The TAVR procedure represents a unique opportunity to study the influence of shear stress on human monocytes, key mediators of inflammation and hemostasis processes. The purpose of this study was to conduct a review of the literature to provide a comprehensive overview of the impact of TAVR on monocyte phenotype and subset repartition and the association of these parameters with the clinical outcomes of patients with severe AVS who underwent TAVR.
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5
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Gao F, Shan L, Wang C, Meng X, Chen J, Han L, Zhang Y, Li Z. Predictive Ability of European Heart Surgery Risk Assessment System II (EuroSCORE II) and the Society of Thoracic Surgeons (STS) Score for in-Hospital and Medium-Term Mortality of Patients Undergoing Coronary Artery Bypass Grafting. Int J Gen Med 2021; 14:8509-8519. [PMID: 34824547 PMCID: PMC8610380 DOI: 10.2147/ijgm.s338819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/08/2021] [Indexed: 12/13/2022] Open
Abstract
Objective To evaluate the powers of European Heart Surgery Risk Assessment System II (EuroSCORE II) and the Society of Thoracic Surgeons (STS) score in predicting in-hospital and medium-term mortality of patients undergoing coronary artery bypass grafting (CABG). Methods Totally 1628 Chinese patients were included between January 2000 and January 2018. Their perioperative clinical data were collected and the patients were closely followed up. According to the length of follow-up time, the total cohort was divided into 1-year, 2-year, 3-year, 4-year and 5-year groups. The in-hospital and medium-term risk prediction of EuroSCORE II and STS score were comparatively assessed by calibration, discrimination, decision curve analysis (DCA), net reclassification index (NRI), integrated discrimination improvement (IDI) and Bland-Altman analysis. Results About 36 (2.21%) patients died during hospitalization. Both EuroSCORE II and STS score performed extremely well in predicting in-hospital mortality (area under curve = 0.900 and 0.879, respectively). However, calibration and discrimination analyses showed gradual decrease when these two risk evaluation systems were used to predict mortality during the follow-up period. At the same time, the predictive ability of EuroSCORE II was better than STS score. DCA curves showed that the performances of the two evaluation systems were roughly equal between the threshold probability of 0% to 20%. The percentage of correct reclassification of EuroSCORE II was 21.64% higher than that of STS score in predicting 2-year postoperative mortality. The IDI index showed that the predictive capabilities of these two systems were roughly equivalent. Bland-Altman analysis showed no significant difference between the values of the two systems. Conclusion EuroSCORE II and STS score have excellent predictive powers in predicting in-hospital mortality of patients undergoing CABG. In particular, EuroSCORE II is superior in calibration and discrimination. The prediction efficiency of the two risk evaluation systems is still acceptable for two-year postoperative mortality, but decreases year by year.
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Affiliation(s)
- Fei Gao
- Cardiovascular Department, Huaiyin Hospital of Huai'an City, Huai'an, Jiangsu, People's Republic of China
| | - Lingtong Shan
- Department of Thoracic Surgery, Sheyang County People's Hospital, Yancheng, Jiangsu, People's Republic of China
| | - Chong Wang
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Xiaoqi Meng
- The Second Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Jiapeng Chen
- Xinglin College, Nantong University, Nantong, Jiangsu, People's Republic of China
| | - Lixiang Han
- Department of Cardiovascular Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Yangyang Zhang
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Zhi Li
- Department of Cardiovascular Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
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6
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Affiliation(s)
- Pedro H M C de Melo
- Departamento de Cardiologia Intervencionista - Hospital Sírio Libanês, São Paulo, SP - Brasil
| | - Rodrigo Modolo
- Departamento de Clínica Médica - Divisão de Cardiologia - Faculdade de Ciências Médicas - Universidade Estadual de Campinas (UNICAMP), Campinas, SP - Brasil
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7
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Sousa ALS, Carvalho LAF, Salgado CG, Oliveira RLD, Lima LCCLE, Mattos NDFGD, Fagundes FES, Colafranceschi AS, Mesquita ET. C-reactive Protein as a Prognostic Marker of 1-Year Mortality after Transcatheter Aortic Valve Implantation in Aortic Stenosis. Arq Bras Cardiol 2021; 117:1018-1027. [PMID: 34817012 PMCID: PMC8682084 DOI: 10.36660/abc.20190715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/02/2020] [Indexed: 01/15/2023] Open
Abstract
Fundamento: A proteína C-reativa (PCR) é um biomarcador de inflamação preditor de eventos adversos em procedimentos cardiovasculares. Na avaliação do implante da válvula aórtica transcateter (transcatheter aortic valve implantation, TAVI) em relação ao prognóstico de longo prazo ainda é incipiente. Objetivo: Avaliar a PCR como marcador prognóstico no primeiro ano pós-TAVI na estenose aórtica (EAo). Métodos: A PCR foi avaliada na primeira semana do peroperatório numa coorte de casos retrospectiva com EAo. Correlacionou-se a PCR pré- e pós-TAVI com a mortalidade e foram pesquisados fatores preditores de mortalidade em 1 ano. Realizada regressão de Cox multivariada para identificar os preditores independentes de óbito em 1 ano. Resultados: Estudados 130 pacientes submetidos a TAVI, com mediana de idade de 83 anos, sendo 49% deles do sexo feminino. A PCR pré-TAVI elevada (> 0,5 mg/dL) ocorreu em 34,5% dos casos. O pico de PCR foi 7,0 (5,3-12,1) mg/dL no quarto dia. A mortalidade em 1 ano foi 14,5% (n = 19), sendo maior nos grupos com PCR pré-TAVI elevada (68,8% vs 29,1%; p = 0,004) e pico de PCR ≥ 10,0 mg/dL (64,7% vs 30,8%; p = 0,009). Os fatores preditores independentes de mortalidade foram insuficiência renal aguda (IRA) [razão de risco (RR) = 7,43; intervalo de confiança de 95% (IC95%), 2,1-24,7; p = 0,001], PCR pré-TAVI elevada [RR = 4,15; IC95%, 1,3-12,9; p=0,01] e hemotransfusão volumosa [HR = 4,68; 1,3-16,7; p = 0,02]. Conclusões: A PCR pré-TAVI elevada mostrou-se fator preditor independente de mortalidade no primeiro ano, assim como a ocorrência de IRA e hemotransfusões volumosas.
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Affiliation(s)
- André Luiz Silveira Sousa
- Universidade Federal Fluminense - Hospital Antonio Pedro - Cardiologia, Niterói, RJ - Brasil.,Hospital Pró-Cardíaco - Hemodinâmica, Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | | | - Evandro Tinoco Mesquita
- Universidade Federal Fluminense - Hospital Antonio Pedro - Cardiologia, Niterói, RJ - Brasil
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8
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Vidula MK, Orlenko A, Zhao L, Salvador L, Small AM, Horton E, Cohen JB, Adusumalli S, Denduluri S, Kobayashi T, Hyman M, Fiorilli P, Magro C, Singh B, Pourmussa B, Greczylo C, Basso M, Ebert C, Yarde M, Li Z, Cvijic ME, Wang Z, Walsh A, Maranville J, Kick E, Luettgen J, Adam L, Schafer P, Ramirez-Valle F, Seiffert D, Moore JH, Gordon D, Chirinos JA. Plasma biomarkers associated with adverse outcomes in patients with calcific aortic stenosis. Eur J Heart Fail 2021; 23:2021-2032. [PMID: 34632675 DOI: 10.1002/ejhf.2361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS Enhanced risk stratification of patients with aortic stenosis (AS) is necessary to identify patients at high risk for adverse outcomes, and may allow for better management of patient subgroups at high risk of myocardial damage. The objective of this study was to identify plasma biomarkers and multimarker profiles associated with adverse outcomes in AS. METHODS AND RESULTS We studied 708 patients with calcific AS and measured 49 biomarkers using a Luminex platform. We studied the correlation between biomarkers and the risk of (i) death and (ii) death or heart failure-related hospital admission (DHFA). We also utilized machine-learning methods (a tree-based pipeline optimizer platform) to develop multimarker models associated with the risk of death and DHFA. In this cohort with a median follow-up of 2.8 years, multiple biomarkers were significantly predictive of death in analyses adjusted for clinical confounders, including tumour necrosis factor (TNF)-α [hazard ratio (HR) 1.28, P < 0.0001], TNF receptor 1 (TNFRSF1A; HR 1.38, P < 0.0001), fibroblast growth factor (FGF)-23 (HR 1.22, P < 0.0001), N-terminal pro B-type natriuretic peptide (NT-proBNP) (HR 1.58, P < 0.0001), matrix metalloproteinase-7 (HR 1.24, P = 0.0002), syndecan-1 (HR 1.27, P = 0.0002), suppression of tumorigenicity-2 (ST2) (IL1RL1; HR 1.22, P = 0.0002), interleukin (IL)-8 (CXCL8; HR 1.22, P = 0.0005), pentraxin (PTX)-3 (HR 1.17, P = 0.001), neutrophil gelatinase-associated lipocalin (LCN2; HR 1.18, P < 0.0001), osteoprotegerin (OPG) (TNFRSF11B; HR 1.26, P = 0.0002), and endostatin (COL18A1; HR 1.28, P = 0.0012). Several biomarkers were also significantly predictive of DHFA in adjusted analyses including FGF-23 (HR 1.36, P < 0.0001), TNF-α (HR 1.26, P < 0.0001), TNFR1 (HR 1.34, P < 0.0001), angiopoietin-2 (HR 1.26, P < 0.0001), syndecan-1 (HR 1.23, P = 0.0006), ST2 (HR 1.27, P < 0.0001), IL-8 (HR 1.18, P = 0.0009), PTX-3 (HR 1.18, P = 0.0002), OPG (HR 1.20, P = 0.0013), and NT-proBNP (HR 1.63, P < 0.0001). Machine-learning multimarker models were strongly associated with adverse outcomes (mean 1-year probability of death of 0%, 2%, and 60%; mean 1-year probability of DHFA of 0%, 4%, 97%; P < 0.0001). In these models, IL-6 (a biomarker of inflammation) and FGF-23 (a biomarker of calcification) emerged as the biomarkers of highest importance. CONCLUSIONS Plasma biomarkers are strongly associated with the risk of adverse outcomes in patients with AS. Biomarkers of inflammation and calcification were most strongly related to prognosis.
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Affiliation(s)
- Mahesh K Vidula
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Alena Orlenko
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Lei Zhao
- Bristol Myers Squibb Company, Lawrenceville, NJ, USA
| | - Lisa Salvador
- Bristol Myers Squibb Company, Lawrenceville, NJ, USA
| | - Aeron M Small
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Edward Horton
- Department of Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Jordana B Cohen
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Srinath Adusumalli
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Srinivas Denduluri
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Taisei Kobayashi
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Matthew Hyman
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Paul Fiorilli
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Caroline Magro
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Bibi Singh
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Bianca Pourmussa
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Candy Greczylo
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Michael Basso
- Bristol Myers Squibb Company, Lawrenceville, NJ, USA
| | | | - Melissa Yarde
- Bristol Myers Squibb Company, Lawrenceville, NJ, USA
| | - Zhuyin Li
- Bristol Myers Squibb Company, Lawrenceville, NJ, USA
| | | | - Zhaoqing Wang
- Bristol Myers Squibb Company, Lawrenceville, NJ, USA
| | - Alice Walsh
- Bristol Myers Squibb Company, Lawrenceville, NJ, USA
| | | | - Ellen Kick
- Bristol Myers Squibb Company, Lawrenceville, NJ, USA
| | | | - Leonard Adam
- Bristol Myers Squibb Company, Lawrenceville, NJ, USA
| | - Peter Schafer
- Bristol Myers Squibb Company, Lawrenceville, NJ, USA
| | | | | | - Jason H Moore
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - David Gordon
- Bristol Myers Squibb Company, Lawrenceville, NJ, USA
| | - Julio A Chirinos
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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9
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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.
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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
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10
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White M, Baral R, Ryding A, Tsampasian V, Ravindrarajah T, Garg P, Koskinas KC, Clark A, Vassiliou VS. Biomarkers Associated with Mortality in Aortic Stenosis: A Systematic Review and Meta-Analysis. Med Sci (Basel) 2021; 9:medsci9020029. [PMID: 34067808 PMCID: PMC8163007 DOI: 10.3390/medsci9020029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022] Open
Abstract
The optimal timing of aortic valve replacement (AVR) remains controversial. Several biomarkers reflect the underlying pathophysiological processes in aortic stenosis (AS) and may be of use as mortality predictors. The aim of this systematic review and meta-analysis is to evaluate the blood biomarkers utilised in AS and assess whether they associate with mortality. PubMed and Embase were searched for studies reporting baseline biomarker level and mortality outcomes in patients with AS. A total of 83 studies met the inclusion criteria and were systematically reviewed. Of these, 21 reporting brain natriuretic peptide (BNP), N-terminal pro B-type natriuretic peptide (NT-proBNP), Troponin and Galectin-3 were meta-analysed. Pooled analysis demonstrated that all-cause mortality was significantly associated with elevated baseline levels of BNP (HR 2.59; 95% CI 1.95–3.44; p < 0.00001), NT-proBNP (HR 1.73; 95% CI 1.45–2.06; p = 0.00001), Troponin (HR 1.65; 95% CI 1.31–2.07; p < 0.0001) and Galectin-3 (HR 1.82; 95% CI 1.27–2.61; p < 0.001) compared to lower baseline biomarker levels. Elevated levels of baseline BNP, NT-proBNP, Troponin and Galectin-3 were associated with increased all-cause mortality in a population of patients with AS. Therefore, a change in biomarker level could be considered to refine optimal timing of intervention. The results of this meta-analysis highlight the importance of biomarkers in risk stratification of AS, regardless of symptom status.
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Affiliation(s)
- Madeline White
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7UQ, UK; (M.W.); (R.B.); (A.R.); (T.R.); (P.G.); (A.C.); (V.S.V.)
| | - Ranu Baral
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7UQ, UK; (M.W.); (R.B.); (A.R.); (T.R.); (P.G.); (A.C.); (V.S.V.)
- Norfolk and Norwich University Hospital, Norwich NR4 7UQ, UK
| | - Alisdair Ryding
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7UQ, UK; (M.W.); (R.B.); (A.R.); (T.R.); (P.G.); (A.C.); (V.S.V.)
- Norfolk and Norwich University Hospital, Norwich NR4 7UQ, UK
| | - Vasiliki Tsampasian
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7UQ, UK; (M.W.); (R.B.); (A.R.); (T.R.); (P.G.); (A.C.); (V.S.V.)
- Norfolk and Norwich University Hospital, Norwich NR4 7UQ, UK
- Correspondence:
| | - Thuwarahan Ravindrarajah
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7UQ, UK; (M.W.); (R.B.); (A.R.); (T.R.); (P.G.); (A.C.); (V.S.V.)
| | - Pankaj Garg
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7UQ, UK; (M.W.); (R.B.); (A.R.); (T.R.); (P.G.); (A.C.); (V.S.V.)
- Norfolk and Norwich University Hospital, Norwich NR4 7UQ, UK
| | | | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7UQ, UK; (M.W.); (R.B.); (A.R.); (T.R.); (P.G.); (A.C.); (V.S.V.)
| | - Vassilios S. Vassiliou
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7UQ, UK; (M.W.); (R.B.); (A.R.); (T.R.); (P.G.); (A.C.); (V.S.V.)
- Norfolk and Norwich University Hospital, Norwich NR4 7UQ, UK
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11
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Growth Differentiation Factor 15 in Severe Aortic Valve Stenosis: Relationship with Left Ventricular Remodeling and Frailty. J Clin Med 2020; 9:jcm9092998. [PMID: 32957481 PMCID: PMC7564755 DOI: 10.3390/jcm9092998] [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: 07/05/2020] [Revised: 09/06/2020] [Accepted: 09/15/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Frailty is an important outcome predictor in patients with aortic stenosis who are candidates for transcatheter or surgical aortic valve replacement (AVR). Growth/differentiation factor 15 (GDF15) is a cytokine playing a role in the pathophysiology of ventricular remodeling. We assessed its potential role as an independent soluble biomarker of frailty in these patients. Methods: We studied 62 patients (age, mean 79 years, 95% confidence interval (CI) 77-81; 54.8% female) with severe aortic valve stenosis and candidates for AVR. We systematically assessed pre-intervention GDF15 levels for their relationship with frailty (Katz score) and echocardiographic parameters of left ventricular dysfunction/remodeling. Fifteen hypertensive patients with left ventricular (LV) hypertrophy served as controls. Results: Patients with aortic valve stenosis featured higher GDF15 levels than controls (1773, 95% CI 1574-1971 pg/mL vs. 775, 95% CI 600-950 pg/mL, respectively, p < 0.0001). Subjects in the upper GDF15 tertile were older (p = 0.004), with a more advanced NYHA functional class (p = 0.04) and a higher prevalence of impaired renal function (p = 0.004). Such patients also showed a higher frailty score (p = 0.04) and higher indices of LV dysfunction, including reduced global longitudinal strain (p = 0.01) and a higher left ventricular mass (p = 0.001). GDF15 was significantly related to the Katz score, and predicted (OR 1.05; 95% CI 0.9-1.1; p = 0.03) a low (<5) Katz score, independent of the relationship with LV mass, age, renal function or indices of LV dysfunction. Conclusions: GDF15 is increased in patients with severe aortic stenosis and appears to be a soluble correlate of patients' frailty, independent of indices of left ventricular dysfunction.
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12
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Bignoto TC, Bihan D, Barretto RB, Ramos AI, Moreira DAR, Simonato M, Siqueira DA, Pinto IMF, Santos TSG, Sousa AG, Abizaid A. Predictive role of Selvester
QRS
score in patients undergoing transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2020; 97:E95-E103. [DOI: 10.1002/ccd.28905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/28/2020] [Accepted: 03/31/2020] [Indexed: 01/01/2023]
Affiliation(s)
| | - David Bihan
- Dante Pazzanese Institute of Cardiology São Paulo São Paulo Brazil
| | | | | | | | - Matheus Simonato
- Dante Pazzanese Institute of Cardiology São Paulo São Paulo Brazil
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13
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Takagi H, Kuno T, Hari Y, Nakashima K, Yokoyama Y, Ueyama H, Ando T. Prognostic impact of baseline C‐reactive protein levels on mortality after transcatheter aortic valve implantation. J Card Surg 2020; 35:974-980. [DOI: 10.1111/jocs.14499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular SurgeryShizuoka Medical CenterShizuoka Japan
- Department of Cardiovascular SurgeryKitasato University School of MedicineSagamihara Japan
| | - Toshiki Kuno
- Department of MedicineMount Sinai Beth Israel Medical CenterNew York New York
| | - Yosuke Hari
- Department of Cardiovascular SurgeryShizuoka Medical CenterShizuoka Japan
- Department of Cardiovascular SurgeryKitasato University School of MedicineSagamihara Japan
| | - Kouki Nakashima
- Department of Cardiovascular SurgeryShizuoka Medical CenterShizuoka Japan
- Department of Cardiovascular SurgeryKitasato University School of MedicineSagamihara Japan
| | | | - Hiroki Ueyama
- Department of MedicineMount Sinai Beth Israel Medical CenterNew York New York
| | - Tomo Ando
- Division of Interventional Cardiology, Department of Cardiology, New York‐Presbyterian HospitalColumbia University Medical CenterNew York New York
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14
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Imnadze G, Hofmann S, Billion M, Ferdosi A, Kowalski M, Rajab E, Bramlage K, Bramlage P, Warnecke H, Franz N. Clinical value of the 20% logistic EuroSCORE cut-off for selecting TAVI candidates: a single-centre cohort study analysis. Open Heart 2020; 7:e001194. [PMID: 32153791 PMCID: PMC7046969 DOI: 10.1136/openhrt-2019-001194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/22/2020] [Accepted: 02/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background A logistic European System for Cardiac Operative Risk Evaluation (logEuroSCORE) ≥20% is frequently recognised as a finite criteria for transcatheter aortic valve implantation (TAVI) reimbursement, despite guideline modifications to reflect the appropriacy of TAVI in selected lower-risk patients. The aim was to evaluate the clinical value of this threshold cut-off in TAVI patients and to identify factors associated with mortality in those below this threshold. Methods We analysed data from a single-centre, German, observational, TAVI-patient registry, gathered between 2008 and 2016. Patients were stratified by logEuroSCORE (≥ or <20%) for comparisons. Logistic regression was performed to identify predictors of mortality at 1 year, with this analysis used to generate a calculated (‘real’) risk value for each patient. Results 1679 patients (logEuroSCORE <20%: n=789; logEuroSCORE ≥20%: n=890) were included. LogEuroSCORE <20% patients were significantly younger (80.1 vs 81.6 years; p<0.001) and less comorbid than logEuroSCORE ≥20% patients, with a higher rate of transfemoral TAVI (35.6% vs 26.1%; p<0.001) and predilation (70.0% vs 63.3%; p=0.004). Patients with a logEuroSCORE <20% experienced more vascular complications (3.4% vs 1.5%; p=0.010). One-year survival was 88.3% in the logEuroSCORE <20% and 81.8% in the logEuroSCORE ≥20% group (p=0.005), with the calculated mortality risk falling within 2% of the logEuroSCORE in just 12.9% of patients. In the logEuroSCORE <20% group, only coronary artery disease was significantly predictive of 1-year mortality (OR 2.408; 95% CI 1.361 to 4.262; p=0.003). Conclusions At our institution, patients with a logEuroSCORE <20% selected for TAVI have excellent outcomes. The decision not to reimburse TAVI in such patients may be viewed as inappropriate.
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Affiliation(s)
- Guram Imnadze
- Institut für Gesundheitsforschung und Bildung, Universität Osnabrück, Osnabrück, Germany
| | - Steffen Hofmann
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Michael Billion
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Abbas Ferdosi
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Marek Kowalski
- Department of Cardiology, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Ehab Rajab
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Karin Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Henning Warnecke
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany
- University Witten/ Herdecke, Witten, Germany
| | - Norbert Franz
- Department of Cardiology, Schüchtermann Clinic, Bad Rothenfelde, Germany
- University Witten/ Herdecke, Witten, Germany
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15
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Lindman BR, Dweck MR, Lancellotti P, Généreux P, Piérard LA, O’Gara PT, Bonow RO. Management of Asymptomatic Severe Aortic Stenosis. JACC Cardiovasc Imaging 2020; 13:481-493. [DOI: 10.1016/j.jcmg.2019.01.036] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/02/2019] [Accepted: 01/22/2019] [Indexed: 12/19/2022]
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16
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Lindman BR, Clavel MA, Abu-Alhayja'a R, Côté N, Dagenais F, Novak E, Voisine P, Poulin A, Arsenault BJ, Desmeules P, Dahou A, Taster L, Aldahoun K, Bossé Y, Mathieu P, Pibarot P. Multimarker Approach to Identify Patients With Higher Mortality and Rehospitalization Rate After Surgical Aortic Valve Replacement for Aortic Stenosis. JACC Cardiovasc Interv 2019; 11:2172-2181. [PMID: 30409274 DOI: 10.1016/j.jcin.2018.07.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/15/2018] [Accepted: 07/23/2018] [Indexed: 02/04/2023]
Abstract
OBJECTIVES This study sought to evaluate whether a multimarker approach might identify patients with higher mortality and hospitalization rates after aortic valve replacement (AVR) for aortic stenosis (AS). BACKGROUND The society valve guidelines include accepted triggers for AVR in patients with severe asymptomatic AS, but circulating biomarkers do not have a clear role. METHOD From a prospective registry of patients undergoing cardiac surgery between 2000 and 2012, 665 treated with surgical AVR (441 isolated) were evaluated. Seven biomarkers were measured on blood samples obtained before AVR. Biomarker levels were adjusted to account for the influence of age, sex, body mass index, and renal function; the median was used to determine an elevated value. Endpoints included all-cause mortality and all-cause and cardiovascular hospitalizations. Mean follow-up was 10.7 years and 299 (45%) died. RESULTS Patients with 0 to 1, 2 to 3, 4 to 6, and 7 biomarkers elevated had 5-year mortality of 10%, 12%, 24%, and 33%, respectively, and 10-year mortality of 24%, 35%, 58%, and 71%, respectively (log-rank p < 0.001). The association between an increasing number of elevated biomarkers and increased all-cause mortality was observed among those with minimal symptoms (New York Heart Association functional class I or II) and those with a low N-terminal pro-B-type natriuretic peptide (p < 0.01 for both). Compared with those with 0 to 1 biomarkers elevated, patients with 4 to 6 or 7 biomarkers elevated had an increased hazard of mortality after adjustment for clinical risk scores (p < 0.01) and a 2- to 3-fold higher rate of all-cause and cardiovascular rehospitalization after AVR. Similar findings were obtained when evaluating cardiovascular mortality. Among patients with no or minimal symptoms, 42% had ≥4 biomarkers elevated. CONCLUSIONS Among patients with severe AS treated with surgical AVR, an increasing number of elevated biomarkers of cardiovascular stress was associated with higher all-cause and cardiovascular mortality and a higher rate of repeat hospitalization. A multimarker approach may be useful in the surveillance of asymptomatic patients with severe AS to optimize surgical timing.
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Affiliation(s)
- Brian R Lindman
- Structural Heart and Valve Center, Vanderbilt University School of Medicine, Nashville, Tennessee.
| | | | | | - Nancy Côté
- Quebec Heart and Lung Institute, Quebec City, Canada
| | | | - Eric Novak
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri
| | | | | | | | | | | | - Lionel Taster
- Quebec Heart and Lung Institute, Quebec City, Canada
| | | | - Yohan Bossé
- Quebec Heart and Lung Institute, Quebec City, Canada
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17
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Sexton T, Alkhasova M, de Beer M, Lynch D, Smyth S. Changes in thromboinflammatory profiles across the generations of transcatheter aortic heart valves. J Thromb Thrombolysis 2019; 47:174-178. [PMID: 30484011 DOI: 10.1007/s11239-018-1782-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The transcatheter aortic valve replacement (TAVR) procedure was developed to provide patients with severe aortic stenosis an alternative to the surgical aortic valve replacement. Since the approval of the original SAPIEN the technology has rapidly evolved. While several approaches can be used for valve deployment, as delivery systems have become smaller and more flexible, the transfemoral approach has become the dominant technique for valve deployment. One hundred and forty five patients undergoing TAVR receiving one of four valve types (Sapien, Sapien XT, Sapien3 or CoreValve) via the femoral artery were included in this study. Platelet count, white blood cells count (WBC), Interleukin-6 (IL-6), and Serum Amyloid A (SAA) were determined before and after TAVR. Platelet counts declined after the procedure regardless of the valve type and were dependent upon the baseline platelet count. Use of conscious sedation blunted the decline in platelet count. With the newer generation valves, the rise in WBC post-TAVR was lower than observed with the Sapien, in keeping with less systemic inflammation. Consistent with WBC, IL-6 levels were lower following deployment of the newer generation valves. Elevations in plasma SAA, which occur following myocardial injury, were not reduced with the newer valves. Evolution of the TAVR technology has occurred rapidly over the last 5 years. The newer devices and smaller delivery systems are associated with less systemic inflammation, as reflected in WBC and plasma IL-6 levels. However, the acute phase reactant SAA remains unchanged, possibly reflecting different triggers for SAA following TAVR.
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Affiliation(s)
- Travis Sexton
- Gill Heart and Vascular Institute, University of Kentucky, BBSRB B345, Lexington, KY, 40506, USA
| | - Maria Alkhasova
- Gill Heart and Vascular Institute, University of Kentucky, BBSRB B345, Lexington, KY, 40506, USA
| | - Marcielle de Beer
- Department of Physiology, University of Kentucky, Lexington, KY, USA
| | - Donald Lynch
- Lung and Vascular Institute, University of Cincinnati, Cincinnati, OH, USA
| | - Susan Smyth
- Gill Heart and Vascular Institute, University of Kentucky, BBSRB B345, Lexington, KY, 40506, USA.
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18
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Do U, Ahn JM, Kang DY, Ko E, Kim HJ, Kim JB, Choo SJ, Park DW, Park SJ. Association and Prognostic Implication of C-Reactive Protein with Risk of 1-Year Death or Disabling Stroke After Transcatheter Aortic Valve Replacement. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2019. [DOI: 10.1080/24748706.2019.1610202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Ungjeong Do
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung-Min Ahn
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Do-Yoon Kang
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Euihong Ko
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Duk-Woo Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Jung Park
- Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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19
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Szekely Y, Finkelstein A, Bazan S, Halkin A, Abbas Younis M, Erez J, Keren G, Banai S, Arbel Y. Red blood cell distribution width as a prognostic factor in patients undergoing transcatheter aortic valve implantation. J Cardiol 2019; 74:212-216. [PMID: 31060955 DOI: 10.1016/j.jjcc.2019.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/12/2019] [Accepted: 04/09/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Red blood cell distribution width (RDW), which is routinely reported in complete blood counts, is a measure of the variability in size of circulating erythrocytes. RDW is an independent predictor of prognosis in patients with cardiovascular diseases. We evaluated the short- and long-term prognostic value of RDW in a large cohort of transcatheter aortic valve implantation (TAVI) patients. METHODS The impact of RDW on outcome was determined prospectively in 1029 consecutive patients with severe aortic stenosis (AS) undergoing transfemoral TAVI. The cohort was divided into 2 groups according to RDW above and below 15.5%. Collected data included patient characteristics, medical background, left ventricle ejection fraction (LVEF), frailty score, Society of Thoracic Surgeons (STS) score, periprocedural laboratory results, and long-term (up to 7.5 years) clinical outcomes. RESULTS The mean age (±SD) was 83.1±6.3 years, mean STS score was 4.2±3.1% and mean estimated LVEF was 55.7±8.4%. Mean pre-TAVI RDW levels were 15.3±3.2%. Patients with RDW≤15.5% (n=683) and RDW>15.5% (n=346) had a 1-year mortality rate of 6% and 17%, respectively (p=0.001) and a 5-year mortality rate of 20% and 38%, respectively (p<0.001). Baseline RDW>15.5% was independently associated with all-cause mortality (hazard ratio 1.83, 95% confidence interval 1.44-2.32, p<0.001). CONCLUSIONS Elevated RDW is a strong independent marker and predictor of short- and long-term mortality following TAVI, that might present a relevant future supplement to current preprocedural risk scores. Additional research is needed to clarify the mechanisms responsible for this finding.
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Affiliation(s)
- Yishay Szekely
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Israel.
| | - Ariel Finkelstein
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Israel
| | - Samuel Bazan
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Israel
| | - Amir Halkin
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Israel
| | - Maria Abbas Younis
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Israel
| | - Johnathan Erez
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Israel
| | - Gad Keren
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Israel
| | - Yaron Arbel
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with Sackler School of Medicine, Tel Aviv University, Israel
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Yalta K, Palabiyik O, Gurdogan M, Gurlertop Y. Serum copeptin might improve risk stratification and management of aortic valve stenosis: a review of pathophysiological insights and practical implications. Ther Adv Cardiovasc Dis 2019; 13:1753944719826420. [PMID: 30803406 PMCID: PMC6376527 DOI: 10.1177/1753944719826420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Over recent decades, the prevalence of aortic valve stenosis (AVS) has been constantly increasing possibly owing to the aging of general population. Severe AVS as determined by an aortic valve area (AVA) of <1 cm2 has been regarded as a serious clinical condition potentially associated with a variety of adverse outcomes, including sudden cardiac death (SCD). However, patients with severe AVS (in the absence of overt high-risk features) are usually evaluated and managed exclusively based on symptomatology or imperfect prognostic tools including exercise testing and biomarkers, with a potential risk of mismanagement, suggesting the need for further objective risk stratifiers in this setting. Within this context, copeptin (C-terminal pro-vasopressin), a novel neurohormone widely considered as the surrogate marker of the arginine–vasopressin (AVP) system, may potentially serve as a reliable prognostic and therapeutic guide (e.g. timing of aortic valvular intervention) in patients with severe AVS largely based on its hemodynamic, fibrogenic as well as autonomic implications in these patients. Accordingly, the present paper aims to discuss clinical and pathophysiological implications of copeptin in the setting of AVS along with a summary of biomarkers and other prognostic tools used in this setting.
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Affiliation(s)
- Kenan Yalta
- Trakya University, School of Medicine, Cardiology Department, 22030 Edirne, Turkey
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Takagi H, Hari Y, Kawai N, Kuno T, Ando T. Meta-Analysis of Impact of Baseline N-TerminalPro-Brain Natriuretic Peptide Levels on SurvivalAfter Transcatheter Aortic Valve Implantation for Aortic Stenosis. Am J Cardiol 2019; 123:820-826. [PMID: 30587374 DOI: 10.1016/j.amjcard.2018.11.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 11/18/2018] [Accepted: 11/26/2018] [Indexed: 12/20/2022]
Abstract
We performed a meta-analysis of currently available studies investigating impact of baseline N-terminal pro-brain natriuretic peptide (NT-proBNP) on mortality after transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS). MEDLINE and EMBASE were searched through August 2018 using PubMed and OVID. Studies considered for inclusion met the following criteria: the design was a study researching impact of baseline NT-proBNP levels on survival; the study population was patients underwent TAVI for AS; outcomes included all-cause mortality. For each study, we directly extracted odds ratio (ORs) or hazard ratios (HRs) of mortality (for high vs low baseline NT-proBNP); and generated ORs using mortality rates in both patients with high and low levels of baseline NT-proBNP. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic ORs/HRs in the random-effects model. We identified 16 eligible studies including a total of 3,679 patients who underwent TAVI for AS. Pooled analyses demonstrated that high levels of baseline NT-proBNP were associated with a statistically nonsignificant increase in early (30-day or 2-month) mortality (pooled OR, 1.60; 95% confidence interval, 0.84 to 3.04; p = 0.15) and a statistically significant increase in midterm (6-month to 4-year) mortality (pooled OR/HR, 1.88; 95% confidence interval, 1.54 to 2.28; p < 0.00001). Although funnel-plot asymmetry suggesting publication bias was detected, adjusting for funnel-plot asymmetry indicated an association of high levels of baseline NT-proBNP with a still significant increase in midterm mortality. In conclusion, high levels of baseline NT-proBNP predict increased midterm, not early, mortality after TAVI for AS.
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Nass RD, Motloch LJ, Paar V, Lichtenauer M, Baumann J, Zur B, Hoppe UC, Holdenrieder S, Elger CE, Surges R. Blood markers of cardiac stress after generalized convulsive seizures. Epilepsia 2019; 60:201-210. [PMID: 30645779 DOI: 10.1111/epi.14637] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Generalized convulsive seizures (GCS) are associated with high demands on the cardiovascular system, thereby facilitating cardiac complications. To investigate occurrence, influencing factors, and extent of cardiac stress or injury, the alterations and time course of the latest generation of cardiac blood markers were investigated after documented GCS. METHODS Adult patients with refractory epilepsy who underwent video-electroencephalography (EEG) monitoring along with simultaneous one-lead electrocardiography (ECG) recordings were included. Cardiac biomarkers (cardiac troponin I [cTNI]; high-sensitive troponin T [hsTNT]; N-terminal prohormone of brain natriuretic peptide [NT-proBNP]; copeptin; suppression of tumorigenicity-2 [SST-2]; growth differentiation factor 15, [GDF-15]; soluble urokinase plasminogen activator receptor [suPAR]; and heart-type fatty acid binding protein [HFABP]) and catecholamines were measured at inclusion and at different time points after GCS. Periictal cardiac properties were assessed by analyzing heart rate (HR), HR variability (HRV), and corrected QT intervals(QTc). RESULTS Thirty-six GCS (6 generalized-onset tonic-clonic seizures and 30 focal to bilateral tonic-clonic seizures) were recorded in 30 patients without a history of cardiac or renal disease. Postictal catecholamine levels were elevated more than twofold. A concomitant increase in HR and QTc, as well as a decrease in HRV, was observed. Elevations of cTNI and hsTNT were found in 3 of 30 patients (10%) and 6 of 23 patients (26%), respectively, which were associated with higher dopamine levels. Copeptin was increased considerably after most GCS, whereas SST-2, HFABP, and GDF-15 displayed only subtle variations, and suPAR was unaltered in the postictal period. Cardiac symptoms did not occur in any patient. SIGNIFICANCE The use of more sensitive biomarkers such as hsTNT suggests that signs of cardiac stress occur in about 25% of the patients with GCS without apparent clinical symptoms. SuPAR may indicate clinically relevant troponin elevations. Copeptin could help to diagnose GCS, but specificity needs to be tested.
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Affiliation(s)
- Robert D Nass
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Lukas J Motloch
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Vera Paar
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Jan Baumann
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Berndt Zur
- Institute for Clinical Chemistry and Clinical Pharmacology, University of Bonn Medical Center, Bonn, Germany
| | - Uta C Hoppe
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Stefan Holdenrieder
- Institute for Clinical Chemistry and Clinical Pharmacology, University of Bonn Medical Center, Bonn, Germany.,Institute for Laboratory Medicine, German Heart Center Munich, Technical University, Munich, Germany
| | | | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany.,Section of Epileptology, Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
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Impact of Left Ventricular Diastolic Dysfunction and Biomarkers on Pulmonary Hypertension in Patients with Severe Aortic Stenosis. MEDICINA-LITHUANIA 2018; 54:medicina54040063. [PMID: 30344294 PMCID: PMC6174337 DOI: 10.3390/medicina54040063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/28/2018] [Accepted: 08/30/2018] [Indexed: 12/15/2022]
Abstract
Background: Severe aortic stenosis (AS) complicated by pulmonary hypertension (PH) is associated with poor outcomes after surgical aortic valve replacement (AVR). There is still scarce information about predictors of secondary PH in this group of patients. Objectives: The aim of this study was to investigate the prognostic impact of biomarkers together with conventional Doppler echocardiographic parameters of left ventricular diastolic function on elevated pulmonary systolic pressure (PSP) in severe AS patients before surgical AVR. Methods: Sixty patients with severe isolated AS (aortic valve area <1 cm2) underwent echocardiography, N-terminal pro B-type natriuretic peptide (NT-proBNP) and growth differentiation factor-15 (GDF-15) measurements before AVR. PSP, left ventricular ejection fraction (LV EF), parameters of LV diastolic function (E/E’ ratio, mitral valve deceleration time (MV DT) and left atrial (LA) volume) were evaluated. PH was defined as an estimated PSP ≥ 45 mmHg. Results: Of the 60 patients, 21.7% with severe isolated AS had PH with PSP ≥ 45 mmHg (58.5 ± 11.2 mmHg). LV EF did not differ between groups and was not related to an elevated PSP (50 ± 8 vs. 49 ± 8%, p = 0.58). Parameters of LV diastolic dysfunction (E/E’ ratio > 14 (OR 6.00; 95% CI, 1.41–25.48; p = 0.009), MV DT ≤ 177.5 ms (OR 9.31; 95% CI, 2.06–41.14; p = 0.001), LA volume > 100 mL (OR 9.70; 95% CI, 1.92–49.03; p = 0.002)) and biomarkers (NT-proBNP > 4060 ng/L (OR 12.54; 95% CI, 2.80–55.99; p < 0.001) and GDF-15 > 3393 pg/mL (OR 18.33; 95% CI, 2.39–140.39; p = 0.001)) were significantly associated with elevated PSP in severe AS. Conclusions: Left ventricular diastolic dysfunction and elevated biomarkers levels could predict the development of pulmonary hypertension in patients with severe aortic stenosis. Elevation of biomarkers paired with worsening of LV diastolic dysfunction could help to stratify patients for earlier surgical treatment before the development of pulmonary hypertension.
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Stundl A, Busse L, Leimkühler P, Weber M, Zur B, Mellert F, Grube E, Nickenig G, Werner N, Sinning JM. Combination of high-sensitivity C-reactive protein with logistic EuroSCORE improves risk stratification in patients undergoing TAVI. EUROINTERVENTION 2018; 14:629-636. [DOI: 10.4244/eij-d-18-00059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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25
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Kim JB, Kobayashi Y, Moneghetti KJ, Brenner DA, O'Malley R, Schnittger I, Wu JC, Murtagh G, Beshiri A, Fischbein M, Miller DC, Liang D, Yeung AC, Haddad F, Fearon WF. GDF-15 (Growth Differentiation Factor 15) Is Associated With Lack of Ventricular Recovery and Mortality After Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.005594. [PMID: 29222133 DOI: 10.1161/circinterventions.117.005594] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/23/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Recent data suggest that circulating biomarkers may predict outcome in patients undergoing transcatheter aortic valve replacement (TAVR). We examined the association between inflammatory, myocardial, and renal biomarkers and their role in ventricular recovery and outcome after TAVR. METHODS AND RESULTS A total of 112 subjects undergoing TAVR were included in the prospective registry. Plasma levels of B-type natriuretic peptide, hs-TnI (high-sensitivity troponin I), CRP (C-reactive protein), GDF-15 (growth differentiation factor 15), GAL-3 (galectin-3), and Cys-C (cystatin-C) were assessed before TAVR and in 100 sex-matched healthy controls. Among echocardiographic parameters, we measured global longitudinal strain, indexed left ventricular mass, and indexed left atrial volume. The TAVR group included 59% male, with an average age of 84 years, and 1-year mortality of 18%. Among biomarkers, we found GDF-15 and CRP to be strongly associated with all-cause mortality (P<0.001). Inclusion of GDF-15 and CRP to the Society of Thoracic Surgeons score significantly improved C index (0.65-0.79; P<0.05) and provided a category-free net reclassification improvement of 106% at 2 years (P=0.01). Among survivors, functional recovery in global longitudinal strain (>15% improvement) and indexed left ventricular mass (>20% decrease) at 1 year occurred in 48% and 22%, respectively. On multivariate logistic regression, lower baseline GDF-15 was associated with improved global longitudinal strain at 1 year (hazard ratio=0.29; P<0.001). Furthermore, improvement in global longitudinal strain at 1 month correlated with lower overall mortality (hazard ratio=0.45; P=0.03). CONCLUSIONS Elevated GDF-15 correlates with lack of reverse remodeling and increased mortality after TAVR and improves risk prediction of mortality when added to the Society of Thoracic Surgeons score.
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Affiliation(s)
- Juyong Brian Kim
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.).
| | - Yukari Kobayashi
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - Kegan J Moneghetti
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - Daniel A Brenner
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - Ryan O'Malley
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - Ingela Schnittger
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - Joseph C Wu
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - Gillian Murtagh
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - Agim Beshiri
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - Michael Fischbein
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - D Craig Miller
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - David Liang
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - Alan C Yeung
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - Francois Haddad
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - William F Fearon
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.).
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Oury C, Nchimi A, Lancellotti P, Bergler-Klein J. Can Blood Biomarkers Help Predicting Outcome in Transcatheter Aortic Valve Implantation? Front Cardiovasc Med 2018; 5:31. [PMID: 29644220 PMCID: PMC5882866 DOI: 10.3389/fcvm.2018.00031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/16/2018] [Indexed: 12/14/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has become the method of choice for patients with severe aortic valve stenosis, who are ineligible or at high risk for surgery. In this high risk patient population, early and late mortality and rehospitalization rates after TAVI are still relatively high. In spite of recent improvements in procedural TAVI, and establishment of risk models for poor outcome, determining individual risk remains challenging. In this context, current data from several small studies strongly suggest that blood biomarkers of myocardial injury, cardiac mechanical stretch, inflammation, and hemostasis imbalance might play an important role by providing informations on patient risk at baseline, and postprocedural progression of patient clinical conditions from days up to years post-TAVI. Although the role of biomarkers for predicting survival post-TAVI remains to be validated in large randomized studies, implementing biomarkers in clinical practice might improve risk stratification, thereby further reducing TAVI-associated morbidity and mortality.
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Affiliation(s)
- Cécile Oury
- Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium
| | - Alain Nchimi
- Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium
| | - Patrizio Lancellotti
- Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
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Kleeberger JA, Neuser J, de Gonzalo-Calvo D, Kempf T, Bauersachs J, Thum T, Widder JD. microRNA-206 correlates with left ventricular function after transcatheter aortic valve implantation. Am J Physiol Heart Circ Physiol 2017; 313:H1261-H1266. [PMID: 29030340 DOI: 10.1152/ajpheart.00432.2017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is the method of choice in patients with high risk or contraindications for conventional aortic valve replacement. However, it is not well understood which parameters predict the overall cardiac function postprocedurally. miRNAs are small noncoding RNA molecules that repress gene expression by different mechanisms and can also be detected in the blood. Recent studies have shown that miRNAs detected in the blood may serve as sensitive and specific biomarkers in various diseases; therefore, we examined the levels of different microRNAs in the serum of patients undergoing TAVI. We thereby intended to find potential predictors for cardiac function after TAVI. Serum from patients with aortic valve disease was obtained at five different points: before the TAVI procedure, at days 1 and 3 after the TAVI procedure, and the day of dischargement and after a period of 3 mo. We next performed quantitative real-time PCRs to examine the samples for changes in the level of miRNAs previously described as cardiac enriched. Our results show that the level of miR-206 in the serum of patients after TAVI correlated negatively with the left ventricular ejection fraction of individual patients. We found left ventricular function to be better in patients with lower levels of miR-206 after implantation of the new valve. A decrease in the serum level of miR-206 may be linked to changes in cardiac function of patients after TAVI. Further studies are necessary to test the miRNA for its potential value as a prognostic marker. NEW & NOTEWORTHY This study is the first to investigate novel miRNA-based biomarkers within the context of transcatheter aortic valve implantation. miRNA-206 proved to correlate inversely with the postprocedural left ventricular ejection fraction of patients.
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Affiliation(s)
- J A Kleeberger
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School , Hannover , Germany
| | - J Neuser
- Department of Cardiology and Angiology, Hannover Medical School , Hannover , Germany
| | - D de Gonzalo-Calvo
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School , Hannover , Germany.,Group of Lipids and Cardiovascular Pathology Biomedical Research Insititute Sant Pau , Barcelona , Spain.,CIBERCV, Institute of Health Carlos III , Madrid , Spain
| | - T Kempf
- Department of Cardiology and Angiology, Hannover Medical School , Hannover , Germany
| | - J Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School , Hannover , Germany.,REBIRTH Cluster of Excellence, Hannover Medical School , Hannover , Germany
| | - T Thum
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School , Hannover , Germany.,REBIRTH Cluster of Excellence, Hannover Medical School , Hannover , Germany.,Integrated Research and Treatment Centre Transplantation, Hannover Medical School , Hannover , Germany.,Imperial College of Medicine, National Heart and Lung Institute , London , United Kingdom
| | - J D Widder
- Department of Cardiology and Angiology, Hannover Medical School , Hannover , Germany
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Stundl A, Lünstedt NS, Courtz F, Freitag-Wolf S, Frey N, Holdenrieder S, Zur B, Grube E, Nickenig G, Werner N, Frank D, Sinning JM. Soluble ST2 for Risk Stratification and the Prediction of Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation. Am J Cardiol 2017; 120:986-993. [PMID: 28739033 DOI: 10.1016/j.amjcard.2017.06.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/23/2017] [Accepted: 06/07/2017] [Indexed: 11/19/2022]
Abstract
This study aimed to assess the prognostic value of soluble ST2 (sST2) for risk stratification in patients undergoing transcatheter aortic valve implantation (TAVI). In 461 patients undergoing TAVI, sST2 was determined at baseline and categorized into quartiles. An optimum cutoff of 29 ng/ml was calculated. Primary end point was 1-year all-cause mortality. Results were validated in an independent cohort. Patients with sST2 >29 ng/ml had an increased 30-day (9.7% vs 4.6%, p = 0.043) and 1-year mortality (38.1% vs 21.8%, p = 0.001). In accordance, patients with N-terminal pro-brain natriuretic peptide (NT-proBNP) >8145 pg/ml revealed a comparable 30-day mortality (7.9% vs 4.7%, p = 0.189) and 1-year mortality (39.5% vs 21.0%, p <0.001). In univariate regression analysis, sST2 and NT-proBNP were associated with increased mortality risk. In multivariate regression analysis, independent predictors of mortality were logistic EuroSCORE, chronic renal failure, left ventricular ejection fraction, and sST2. In receiver operating characteristic curve analysis, sST2 did not provide incremental prognostic information beyond that obtained from surgical risk scores such as the STS-PROM or NT-proBNP. Similar findings could be achieved in an independent validation cohort. In conclusion, sST2 is independently associated with adverse outcome after TAVI but was not superior to NT-proBNP or surgical risk scores for the prediction of postprocedural outcomes.
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Affiliation(s)
- Anja Stundl
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Nina-Sophie Lünstedt
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Florian Courtz
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Sandra Freitag-Wolf
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Norbert Frey
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | | | - Berndt Zur
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Eberhard Grube
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Nikos Werner
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Derk Frank
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Jan-Malte Sinning
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.
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Intermediate CD14++CD16+ monocytes decline after transcatheter aortic valve replacement and correlate with functional capacity and left ventricular systolic function. PLoS One 2017; 12:e0183670. [PMID: 28829829 PMCID: PMC5568735 DOI: 10.1371/journal.pone.0183670] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/10/2017] [Indexed: 12/28/2022] Open
Abstract
Background Transcatheter aortic valve replacement (TAVR) is the method of choice for patients with severe aortic valve stenosis, who are ineligible or at high risk for surgery. Though TAVR leads to a significant reduction in mortality, a notable amount of patients are re-hospitalized early after TAVR. Parameters or biomarkers predicting outcome are therefore needed to identify patients who benefit most. Specific monocyte subsets have been associated with cardiovascular diseases and were shown to possess prognostic value. Methods Peripheral blood was drawn before and after transfemoral TAVR with the self-expanding CoreValve, Boston Lotus or the balloon-expanding Edwards Sapien prosthesis. Classical (CD14++CD16−), intermediate (CD14++CD16+) and non-classical (CD14+CD16++) monocyte subsets were determined by flow cytometry. Transthoracic echocardiography was performed before, early after as well as 3 months after the TAVR procedure. Results No significant differences in the absolute monocyte counts were found after TAVR. A significant decline in the intermediate monocyte population was though observed early after TAVR (pre 4.01±0.38%, post 2.803±0.34%, p≤0.05). Creatinine levels stayed stable after TAVR procedure and intermediate monocytes were associated with worse renal function. Monocyte decline was not related to changes in CRP-, noradrenaline, cortisol or aldosterone-levels. The amount of intermediate monocytes correlated with worse cardiac function and predicted the possibility to reach an improvement in NYHA functional class at 3 months after TAVR. Conclusions A significant decline of intermediate monocytes occurs shortly after TAVR. High levels of intermediate monocytes were associated with worse cardiac function and predicted poor functional capacity, hinting at a possible prognostic value.
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Redfors B, Furer A, Lindman BR, Burkhoff D, Marquis-Gravel G, Francese DP, Ben-Yehuda O, Pibarot P, Gillam LD, Leon MB, Généreux P. Biomarkers in Aortic Stenosis: A Systematic Review. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2017. [DOI: 10.1080/24748706.2017.1329959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Björn Redfors
- Cardiovascular Research Foundation, New York, NY, USA
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ariel Furer
- Cardiovascular Research Foundation, New York, NY, USA
| | | | - Daniel Burkhoff
- Cardiovascular Research Foundation, New York, NY, USA
- NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | | | | | - Ori Ben-Yehuda
- Cardiovascular Research Foundation, New York, NY, USA
- NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | - Philippe Pibarot
- Pulmonary Hypertension and Vascular Biology Research Group, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec, Québec, Canada
| | - Linda D. Gillam
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
| | - Martin B. Leon
- Cardiovascular Research Foundation, New York, NY, USA
- NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
| | - Philippe Généreux
- Cardiovascular Research Foundation, New York, NY, USA
- Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA
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Falcão-Pires I, Leite-Moreira AF. Biomarkers of aortic valve stenosis: Should we rely on a single one? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2016.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Zhou H, Della PR, Roberts P, Goh L, Dhaliwal SS. Utility of models to predict 28-day or 30-day unplanned hospital readmissions: an updated systematic review. BMJ Open 2016; 6:e011060. [PMID: 27354072 PMCID: PMC4932323 DOI: 10.1136/bmjopen-2016-011060] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To update previous systematic review of predictive models for 28-day or 30-day unplanned hospital readmissions. DESIGN Systematic review. SETTING/DATA SOURCE CINAHL, Embase, MEDLINE from 2011 to 2015. PARTICIPANTS All studies of 28-day and 30-day readmission predictive model. OUTCOME MEASURES Characteristics of the included studies, performance of the identified predictive models and key predictive variables included in the models. RESULTS Of 7310 records, a total of 60 studies with 73 unique predictive models met the inclusion criteria. The utilisation outcome of the models included all-cause readmissions, cardiovascular disease including pneumonia, medical conditions, surgical conditions and mental health condition-related readmissions. Overall, a wide-range C-statistic was reported in 56/60 studies (0.21-0.88). 11 of 13 predictive models for medical condition-related readmissions were found to have consistent moderate discrimination ability (C-statistic ≥0.7). Only two models were designed for the potentially preventable/avoidable readmissions and had C-statistic >0.8. The variables 'comorbidities', 'length of stay' and 'previous admissions' were frequently cited across 73 models. The variables 'laboratory tests' and 'medication' had more weight in the models for cardiovascular disease and medical condition-related readmissions. CONCLUSIONS The predictive models which focused on general medical condition-related unplanned hospital readmissions reported moderate discriminative ability. Two models for potentially preventable/avoidable readmissions showed high discriminative ability. This updated systematic review, however, found inconsistent performance across the included unique 73 risk predictive models. It is critical to define clearly the utilisation outcomes and the type of accessible data source before the selection of the predictive model. Rigorous validation of the predictive models with moderate-to-high discriminative ability is essential, especially for the two models for the potentially preventable/avoidable readmissions. Given the limited available evidence, the development of a predictive model specifically for paediatric 28-day all-cause, unplanned hospital readmissions is a high priority.
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Affiliation(s)
- Huaqiong Zhou
- Clinical Nurse, General Surgical Ward, Princess Margaret Hospital for Children, Perth, Western Australia, Australia School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Phillip R Della
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Pamela Roberts
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Louise Goh
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Satvinder S Dhaliwal
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
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Halkin A, Steinvil A, Witberg G, Barsheshet A, Barkagan M, Assali A, Segev A, Fefer P, Guetta V, Barbash IM, Kornowski R, Finkelstein A. Mortality prediction following transcatheter aortic valve replacement: A quantitative comparison of risk scores derived from populations treated with either surgical or percutaneous aortic valve replacement. The Israeli TAVR Registry Risk Model Accuracy Assessment (IRRMA) study. Int J Cardiol 2016; 215:227-31. [PMID: 27128536 DOI: 10.1016/j.ijcard.2016.04.038] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/02/2016] [Accepted: 04/10/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Accurate risk stratification is pivotal for appropriate selection of patients with severe symptomatic aortic stenosis for either surgical or transcatheter aortic valve replacement (TAVR). We sought to determine whether recent risk prediction models developed specifically in TAVR patients enhance prognostication in comparison with previous surgical scores used in clinical practice (EuroScore I, EuroScore II, STS). METHODS The Israeli TAVR Registry Risk Model Accuracy Assessment (IRRMA) study utilized a multicenter prospective TAVR database (n=1327) to perform a quantitative comparison between previous risk scores developed in either surgical or TAVR populations, with the present registry serving as an independent external validation set. RESULTS In the IRRMA population, 4 variables (NYHA functional class IV, chronic obstructive pulmonary disease, systolic pulmonary artery pressure ≥60mmHg, vascular access other than by the femoral route) identified by cross-validation and leave-one-out analyses provided the most discriminative model (C-statistic=0.63) for predicting 30-day mortality. Previous scores developed in surgical (EuroScores I and II, STS), TAVR (FRANCE-2, OBSERVANT), or mixed (German AV score) populations were applied to the IRRMA cohort. Resultant C-statistics ranged between 0.52-0.71 (for the German AV and FRANCE-2 scores, respectively) and did not differ significantly (p=0.07 for the comparison between the lowest and highest C-statistics). The observed C-statistic for 5 of these 6 scores was lower than originally reported when applied to the IRRMA population. CONCLUSION Available TAVR risk scores showed limited accuracy when applied to an independent validation set and did not enhance prognostication in comparison to previous surgical scores.
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Affiliation(s)
- Amir Halkin
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Arie Steinvil
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Witberg
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Barsheshet
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Barkagan
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abid Assali
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Segev
- Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Paul Fefer
- Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victor Guetta
- Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel M Barbash
- Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Finkelstein
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abdelghani M, Serruys PW. Transcatheter Aortic Valve Implantation in Lower-Risk Patients With Aortic Stenosis. Circ Cardiovasc Interv 2016; 9:e002944. [DOI: 10.1161/circinterventions.115.002944] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/04/2016] [Indexed: 01/01/2023]
Abstract
Transcatheter aortic valve implantation underwent progressive improvements until it became the default therapy for inoperable patients, and a recommended therapy in high-risk operable patients with symptomatic severe aortic stenosis. In the lower-risk patient strata, a currently costly therapy that still has important complications with questionable durability is competing with the established effective and still-improving surgical replacement. This report tries to weigh the clinical evidence, the recent technical improvements, the durability, and the cost-effectiveness claims supporting the adoption of transcatheter aortic valve implantation in intermediate-low risk patients. The importance of appropriate patients’ risk stratification and a more comprehensive approach to estimate that risk are also emphasized in the present report.
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Affiliation(s)
- Mohammad Abdelghani
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (M.A.); and International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom (P.W.S.)
| | - Patrick W. Serruys
- From the Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands (M.A.); and International Centre for Circulatory Health, NHLI, Imperial College London, United Kingdom (P.W.S.)
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Mrak M, Ambrožič J, Mušič Š, Terseglav S, Kontestabile B, Lakič N, Bunc M. Transcatheter aortic valve implantation in a cancer patient denied for surgical aortic valve replacement—a case report. Wien Klin Wochenschr 2016; 128:516-20. [DOI: 10.1007/s00508-016-0990-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/29/2016] [Indexed: 01/06/2023]
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Effects of elastic band resistance training and nutritional supplementation on muscle quality and circulating muscle growth and degradation factors of institutionalized elderly women: the Vienna Active Ageing Study (VAAS). Eur J Appl Physiol 2016; 116:885-97. [PMID: 26931422 PMCID: PMC4834098 DOI: 10.1007/s00421-016-3344-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 02/11/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE Regular resistance exercise training and a balanced diet may counteract the age-related muscular decline on a molecular level. The aim of this study was to investigate the influence of elastic band resistance training and nutritional supplementation on circulating muscle growth and degradation factors, physical performance and muscle quality (MQ) of institutionalized elderly. METHODS Within the Vienna Active Ageing Study, 91 women aged 83.6 (65.0-92.2) years were randomly assigned to one of the three intervention groups (RT, resistance training; RTS, resistance training plus nutritional supplementation; CT, cognitive training). Circulating levels of myostatin, activin A, follistatin, IGF-1 and GDF-15, as well as MQ and functional parameters were tested at baseline as well as after 3 and 6 months of intervention. RESULTS MQ of lower extremities significantly increased in the RT group (+14 %) and RTS group (+12 %) after 6 months. Performance improved in the RT and RTS groups for chair stand test (RT: +18 %; RTS: +15 %). Follistatin increased only in the RT group (+18 %) in the latter phase of the intervention, accompanied by a decrease in the activin A-to-follistatin ratio (-7 %). IGF-1, myostatin and GDF-15 levels were not affected by the intervention. CONCLUSION Our data confirm that strength training improves physical performance and MQ even in very old institutionalized women. This amelioration appears to be mediated by blocking muscle degradation pathways via follistatin rather than inducing muscle growth through the IGF-1 pathway. As plasma levels of biomarkers reflect an overall status of various organ systems, future studies of tissue levels are suggested.
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