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Jneid H, Chikwe J, Arnold SV, Bonow RO, Bradley SM, Chen EP, Diekemper RL, Fugar S, Johnston DR, Kumbhani DJ, Mehran R, Misra A, Patel MR, Sweis RN, Szerlip M. 2024 ACC/AHA Clinical Performance and Quality Measures for Adults With Valvular and Structural Heart Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Performance Measures. J Am Coll Cardiol 2024; 83:1579-1613. [PMID: 38493389 DOI: 10.1016/j.jacc.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
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Jneid H, Chikwe J, Arnold SV, Bonow RO, Bradley SM, Chen EP, Diekemper RL, Fugar S, Johnston DR, Kumbhani DJ, Mehran R, Misra A, Patel MR, Sweis RN, Szerlip M. 2024 ACC/AHA Clinical Performance and Quality Measures for Adults With Valvular and Structural Heart Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Performance Measures. Circ Cardiovasc Qual Outcomes 2024; 17:e000129. [PMID: 38484039 DOI: 10.1161/hcq.0000000000000129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Affiliation(s)
- Hani Jneid
- ACC/AHA Joint Committee on Clinical Data Standards liaison
- Society for Cardiovascular Angiography and Interventions representative
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Oikonomou G, Apostolos A, Drakopoulou M, Simopoulou C, Karmpalioti M, Toskas P, Stathogiannis K, Xanthopoulou M, Ktenopoulos N, Latsios G, Synetos A, Tsioufis C, Toutouzas K. Long-Term Outcomes of Aortic Stenosis Patients with Different Flow/Gradient Patterns Undergoing Transcatheter Aortic Valve Implantation. J Clin Med 2024; 13:1200. [PMID: 38592019 PMCID: PMC10932005 DOI: 10.3390/jcm13051200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/11/2024] [Accepted: 02/16/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Few data exist on the comparative long-term outcomes of severe aortic stenosis (AS) patients with different flow-gradient patterns undergoing transcatheter aortic valve implantation (TAVI). This study sought to evaluate the impact of the pre-TAVI flow-gradient pattern on long-term clinical outcomes after TAVI and assess changes in the left ventricular ejection fraction (LVEF) of different subtypes of AS patients following TAVI. Methods: Consecutive patients with severe AS undergoing TAVI in our institution were screened and prospectively enrolled. Patients were divided into four subgroups according to pre-TAVI flow/gradient pattern: (i) low flow-low gradient (LF-LG): stroke volume indexed (SVi) ≤ 35 mL/m2 and mean gradient (MG) < 40 mmHg); (ii) normal flow-low gradient (NF-LG): SVi > 35 mL/m2 and MG < 40 mmHg; (iii) low flow-high gradient (LF-HG): Svi 35 mL/m2 and MG ≥ 40 mmHg and (iv) normal flow-high gradient (NF-HG): SVi > 35 mL/m2 and MG ≥ 40 mmHg. Transthoracic echocardiography was repeated at 1-year follow-up. Clinical follow-up was obtained at 12 months, and yearly thereafter until 5-year follow-up was complete for all patients. Results: A total of 272 patients with complete echocardiographic and clinical follow-up were included in our analysis. Their mean age was 80 ± 7 years and the majority of patients (N = 138, 50.8%) were women. 62 patients (22.8% of the study population) were distributed in the LF-LG group, 98 patients (36%) were LF-HG patients, 95 patients (34.9%) were NF-HG, and 17 patients (6.3%) were NF-LG. There was a greater prevalence of comorbidities among LF-LG AS patients. One-year all-cause mortality differed significantly between the four subgroups of AS patients (log-rank p: 0.022) and was more prevalent among LF-LG patients (25.8%) compared to LF-HG (11.3%), NF-HG (6.3%) and NF-LG patients (18.8%). At 5-year follow-up, global mortality remained persistently higher among LF-LG patients (64.5%) compared to LF-HG (47.9%), NF-HG (42.9%), and NF-LG patients (58.8%) (log-rank p: 0.029). At multivariable Cox hazard regression analysis, baseline SVi (HR: 0.951, 95% C.I.; 0.918-0.984), the presence of at least moderate tricuspid regurgitation at baseline (HR: 3.091, 95% C.I: 1.645-5.809) and at least moderate paravalvular leak (PVL) post-TAVI (HR: 1.456, 95% C.I.: 1.106-1.792) were significant independent predictors of late global mortality. LF-LG patients and LF-HG patients exhibited a significant increase in LVEF at 1-year follow-up. A lower LVEF (p < 0.001) and a lower Svi (p < 0.001) at baseline were associated with LVEF improvement at 1-year. Conclusions: Patients with LF-LG AS have acceptable 1-year outcomes with significant improvement in LVEF at 1-year follow-up, but exhibit exceedingly high 5-year mortality following TAVI. The presence of low transvalvular flow and at least moderate tricuspid regurgitation at baseline and significant paravalvular leak post-TAVI were associated with poorer long-term outcomes in the entire cohort of AS patients. The presence of a low LVEF or a low SVi predicts LVEF improvement at 1-year.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Konstantinos Toutouzas
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” General Hospital of Athens, 11527 Athens, Greece; (G.O.); (A.A.); (M.D.); (C.S.); (M.K.); (P.T.); (K.S.); (M.X.); (N.K.); (G.L.); (A.S.); (C.T.)
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Zeugin T, Coulter FB, Gülan U, Studart AR, Holzner M. In vitro investigation of the blood flow downstream of a 3D-printed aortic valve. Sci Rep 2024; 14:1572. [PMID: 38238358 PMCID: PMC10796383 DOI: 10.1038/s41598-024-51676-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/08/2024] [Indexed: 01/22/2024] Open
Abstract
The hemodynamics in the aorta as well as the durability of aortic valve prostheses vary greatly between different types of devices. Although placement and sizing of surgical aortic valve prostheses are excellent, the valve geometry of common devices cannot be customized to fit the patient's anatomy perfectly. Similarly, transcatheter aortic valve implantation (TAVI) devices are not customizable and may be orientated unfavorably during implantation. Imperfect fit of an aortic valve prosthesis may result in suboptimal performance and in some cases the need for additional surgery. Leveraging the advent of precision, multi-material 3D-printing, a bioinspired silicone aortic valve was developed. The manufacturing technique makes it fully customizable and significantly cheaper to develop and produce than common prostheses. In this study, we assess the hemodynamic performance of such a 3D-printed aortic valve and compare it to two TAVI devices as well as to a severely stenosed valve. We investigate the blood flow distal to the valve in an anatomically accurate, compliant aorta model via three-dimensional particle tracking velocimetry measurements. Our results demonstrate that the 3D-printed aortic valve induces flow patterns and topology compatible with the TAVI valves and showing similarity to healthy aortic blood flow. Compared to the stenosis, the 3D-printed aortic valve reduces turbulent kinetic energy levels and irreversible energy losses by over 75%, reaching values compatible with healthy subjects and conventional TAVIs. Our study substantiates that the 3D-printed heart valve displays a hemodynamic performance similar to established devices and underscores its potential for driving innovation towards patient specific valve prostheses.
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Affiliation(s)
- Till Zeugin
- Department of Civil, Environmental and Geomatic Engineering, Institute of Environmental Engineering, Swiss Federal Institute of Technology ETH Zürich, Zürich, Switzerland.
- Swiss Federal Institute for Forest, Snow and Landscape Research WSL, Birmensdorf, Switzerland.
| | - Fergal B Coulter
- Complex Materials, Swiss Federal Institute of Technology ETH Zürich, Zürich, Switzerland
| | | | - André R Studart
- Complex Materials, Swiss Federal Institute of Technology ETH Zürich, Zürich, Switzerland
| | - Markus Holzner
- Swiss Federal Institute for Forest, Snow and Landscape Research WSL, Birmensdorf, Switzerland
- Swiss Federal Institute for Water Science and Technology EAWAG, Dübendorf, Switzerland
- Institute of Hydraulic Engineering and River Research (IWA), University of Natural Resources and Life Sciences, Vienna, Austria
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Ludwig S, Schofer N, Abdel-Wahab M, Urena M, Jean G, Renker M, Hamm CW, Thiele H, Iung B, Ooms JF, Wiessman M, Mogensen NSB, Longère B, Perrin N, Ben Ali W, Coisne A, Dahl JS, Van Mieghem NM, Kornowski R, Kim WK, Clavel MA. Transcatheter Aortic Valve Replacement in Patients With Reduced Ejection Fraction and Nonsevere Aortic Stenosis. Circ Cardiovasc Interv 2023; 16:e012768. [PMID: 37192310 DOI: 10.1161/circinterventions.122.012768] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/28/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND The potential benefit of transcatheter aortic valve replacement (TAVR) in patients with nonsevere aortic stenosis (AS) and heart failure is controversial. This study aimed to assess outcomes of patients with nonsevere low-gradient AS (LGAS) and reduced left ventricular ejection fraction undergoing TAVR or medical management. METHODS Patients undergoing TAVR for LGAS and reduced left ventricular ejection fraction (<50%) were included in a multinational registry. True-severe low-gradient AS (TS-LGAS) and pseudo-severe low-gradient AS (PS-LGAS) were classified according to computed tomography-derived aortic valve calcification thresholds. A medical control group with reduced left ventricular ejection fraction and moderate AS or PS-LGAS was used (Medical-Mod). Adjusted outcomes between all groups were compared. Among patients with nonsevere AS (moderate or PS-LGAS), outcomes after TAVR and medical therapy were compared using propensity score-matching. RESULTS A total of 706 LGAS patients undergoing TAVR (TS-LGAS, N=527; PS-LGAS, N=179) and 470 Medical-Mod patients were included. After adjustment, both TAVR groups showed superior survival compared with Medical-Mod patients (all P<0.001), while no difference was found between TS-LGAS and PS-LGAS TAVR patients (P=0.96). After propensity score-matching among patients with nonsevere AS, PS-LGAS TAVR patients showed superior 2-year overall (65.4%) and cardiovascular survival (80.4%) compared with Medical-Mod patients (48.8% and 58.5%, both P≤0.004). In a multivariable analysis including all patients with nonsevere AS, TAVR was an independent predictor of survival (hazard ratio, 0.39 [95% CI, 0.27-0.55]; P<0.0001). CONCLUSIONS Among patients with nonsevere AS and reduced left ventricular ejection fraction, TAVR represents a major predictor of superior survival. These results reinforce the need for randomized-controlled trials comparing TAVR versus medical management in heart failure patients with nonsevere AS. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT04914481.
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Affiliation(s)
- Sebastian Ludwig
- Department of Cardiology, University Heart & Vascular Center Hamburg, Germany (S.L., N.S.)
- German Center for Cardiovascular Research: DZHK, Partner site Hamburg/Kiel/Lübeck, Germany (S.L., N.S.)
- Cardiovascular Research Foundation, NY (S.L., N.S.)
| | - Niklas Schofer
- Department of Cardiology, University Heart & Vascular Center Hamburg, Germany (S.L., N.S.)
- German Center for Cardiovascular Research: DZHK, Partner site Hamburg/Kiel/Lübeck, Germany (S.L., N.S.)
- Cardiovascular Research Foundation, NY (S.L., N.S.)
| | - Mohamed Abdel-Wahab
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, Germany (M.A.-W., H.T.)
| | - Marina Urena
- Department of Cardiology, Bichat-Claude Bernard Hospital, Paris, France (M.U., B.L.)
| | - Guillaume Jean
- Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Québec, Canada (G.J., M.A.C.)
| | - Matthias Renker
- Department for Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R., C.W.H., W.-K.K.)
| | - Christian W Hamm
- Department for Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R., C.W.H., W.-K.K.)
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, Germany (M.A.-W., H.T.)
| | | | - Joris F Ooms
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands (J.F.O., N.M.V.M.)
| | - Maya Wiessman
- Department of Cardiology, Rabin Medical Center, Tel-Aviv University, Israel (M.W., R.K.)
| | - Nils S B Mogensen
- Department of Cardiology, Odense University Hospital, Denmark (N.S.B.M., J.S.D.)
| | - Benjamin Longère
- Department of Cardiology, Bichat-Claude Bernard Hospital, Paris, France (M.U., B.L.)
- Université Lille, Inserm, Centre Hospitalier Universitaire de Lille, France (B.L., A.C.)
| | - Nils Perrin
- Structural Valve Program, Montreal Heart Institute, Canada (N.P., W.B.A.)
| | - Walid Ben Ali
- Structural Valve Program, Montreal Heart Institute, Canada (N.P., W.B.A.)
| | - Augustin Coisne
- Université Lille, Inserm, Centre Hospitalier Universitaire de Lille, France (B.L., A.C.)
| | - Jordi S Dahl
- Department of Cardiology, Odense University Hospital, Denmark (N.S.B.M., J.S.D.)
| | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands (J.F.O., N.M.V.M.)
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Tel-Aviv University, Israel (M.W., R.K.)
| | - Won-Keun Kim
- Department for Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany (M.R., C.W.H., W.-K.K.)
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Québec, Canada (G.J., M.A.C.)
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Patel KP, Vandermolen S, Cooper J, Pugliese F, Ozkor M, Kennon S, Mathur A, Khanji MY, Mullen MJ, Baumbach A, Awad WI. Comparing Outcomes Between Surgical and Transcatheter Aortic Valve Replacement in Classical Low-Flow Low-Gradient Aortic Stenosis. Am J Cardiol 2023; 192:206-211. [PMID: 36842338 DOI: 10.1016/j.amjcard.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/29/2022] [Accepted: 01/13/2023] [Indexed: 02/27/2023]
Abstract
Patients with classic low-flow low-gradient (cLFLG) aortic stenosis (AS) have a poor prognosis but still benefit from aortic valve replacement. There is a paucity of evidence to guide the choice between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). This study compared procedural and midterm outcomes in patients with cLFLG AS between TAVR and SAVR. Patients with cLFLG AS, defined as an aortic valve area ≤1 cm2, mean gradient <40 mm Hg, and left ventricular ejection fraction <50%, were selected from a single center between 2015 and 2020. Inverse probability weighting and regression were used to adjust for differences in baseline characteristics, the nonrandom assignment of treatment modalities, and procedural differences. The primary end point was all-cause mortality. A total of 322 patients (220 TAVR and 102 SAVR) were included. At a follow-up of 4.4 ± 1.5 years, the adjusted hazard ratio (HR) for mortality after inverse probability weighting with SAVR was 0.66, 95% confidence interval (CI) 0.31 to 1.35; p = 0.24. Worse renal function at baseline (per 10 ml/min/m2 increase HR 0.92, 95% CI 0.84 to 1.00, p = 0.04) and multiple valve interventions (HR 5.39, 95% CI 2.62 to 11.12, p <0.001) independently predicted mortality. There was no difference in stroke and permanent pacemaker implantation, but the rates of renal replacement therapy were higher among the SAVR cohort: 13.7% versus 0%; p <0.001. In conclusion, among patients with cLFLG AS, there was no difference in midterm mortality between TAVR and SAVR, supporting the use of either treatment. However, in patients with poor renal function or at risk of renal failure, TAVR may be the preferred option.
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Affiliation(s)
- Kush P Patel
- Barts Heart Center, West Smithfield, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Sebastian Vandermolen
- Barts Heart Center, West Smithfield, London, United Kingdom; National Institute for Heart Research Barts Biomedical Research Center and Center for Advanced Cardiovascular Imaging, William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Jackie Cooper
- Barts Heart Center, West Smithfield, London, United Kingdom; National Institute for Heart Research Barts Biomedical Research Center and Center for Advanced Cardiovascular Imaging, William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Francesca Pugliese
- Barts Heart Center, West Smithfield, London, United Kingdom; National Institute for Heart Research Barts Biomedical Research Center and Center for Advanced Cardiovascular Imaging, William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Mick Ozkor
- Barts Heart Center, West Smithfield, London, United Kingdom
| | - Simon Kennon
- Barts Heart Center, West Smithfield, London, United Kingdom
| | - Anthony Mathur
- Barts Heart Center, West Smithfield, London, United Kingdom; Center for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, United Kingdom
| | - Mohammed Y Khanji
- Barts Heart Center, West Smithfield, London, United Kingdom; National Institute for Heart Research Barts Biomedical Research Center and Center for Advanced Cardiovascular Imaging, William Harvey Research Institute, Queen Mary University of London, United Kingdom
| | - Michael J Mullen
- Barts Heart Center, West Smithfield, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Andreas Baumbach
- Barts Heart Center, West Smithfield, London, United Kingdom; Center for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, United Kingdom
| | - Wael I Awad
- Barts Heart Center, West Smithfield, London, United Kingdom; Center for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, United Kingdom.
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Dong M, Wang L, Tse G, Dai T, Wang L, Xiao Z, Liu T, Ren F. Effectiveness and safety of transcatheter aortic valve replacement in elderly people with severe aortic stenosis with different types of heart failure. BMC Cardiovasc Disord 2023; 23:34. [PMID: 36653770 PMCID: PMC9850637 DOI: 10.1186/s12872-023-03048-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Impaired left ventricular function is an independent predictor of adverse clinical outcomes in patients with aortic stenosis. The aim of this study is to evaluate the short-term changes of echocardiographic parameters, New York Heart Association (NYHA) class and B-type natriuretic peptide (BNP) level and adverse events amongst patients with heart failure (HF) after transcatheter aortic valve replacement (TAVR) procedure. METHODS This was a retrospective cohort study conducted at affiliated Yantai Yuhuangding Hospital of Qingdao University between September 2017 and September 2022. TAVR cases were stratified into three groups [heart failure with reduced ejection fraction (HFrEF), heart failure with mildly reduced ejection fraction (HFmrEF), heart failure with preserved ejection fraction (HFpEF)] by left ventricular ejection fraction (LVEF). Baseline characteristics, changes in echocardiographic parameters (1 week and 1 month), BNP (1 month), and NYHA class (6 months) post-TAVR were compared across the three groups. Meanwhile, we observed the adverse events of the patients after TAVR. RESULTS A total of 96 patients were included, of whom 15 (15.6%) had HFrEF, 15 (15.6%) had HFmrEF, and 66 (68.8%) had HFpEF. Compared to the HFpEF subgroup, patients in the HFrEF subgroup were younger (p < 0.05), and with a higher BNP (p < 0.05). The left ventricular end-diastolic dimension (LVEDD) in HFrEF group decreased significantly after TAVR. HFmrEF and HFrEF patients showed significant improvements in LVEF after TAVR. The pulmonary artery systolic pressure (PASP), aortic valve peak gradient (AVPG) and aortic valve peak gradient (Vmax) decreased significantly 1 month after TAVR in all three groups compared to the baseline (all p < 0.05). BNP significantly reduced in HFrEF group compared to HFpEF patients after TAVR (p < 0.05). The majority of patients experienced an improvement at least one NYHA class in all three groups 6 months post-TAVR. There is no significant increase in the risk of adverse events in the HFrEF group. CONCLUSIONS Patients who underwent TAVR achieved significant improvements in BNP, NYHA class, LVEDD, LVEF, and PASP across the three HF classes, with a more rapid and pronounced improvement in the HFrEF and HFmrEF groups. Complication rates were low in the different HF groups. There is no significant increase in the risk of periprocedural complications in the HFrEF and HFmrEF groups.
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Affiliation(s)
- Mei Dong
- grid.440323.20000 0004 1757 3171Department of Cardiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong China
| | - Lizhen Wang
- grid.440323.20000 0004 1757 3171Department of Cardiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong China
| | - Gary Tse
- grid.412648.d0000 0004 1798 6160Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China ,Kent and Medway Medical School, Canterbury, CT2 7FS UK ,School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Tao Dai
- grid.440323.20000 0004 1757 3171Department of Cardiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong China
| | - Lihong Wang
- grid.440323.20000 0004 1757 3171Department of Ultrasound, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong China
| | - Zhicheng Xiao
- grid.440323.20000 0004 1757 3171Department of Cardiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong China
| | - Tong Liu
- grid.412648.d0000 0004 1798 6160Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Faxin Ren
- grid.440323.20000 0004 1757 3171Department of Cardiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong China
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Lisi M, Pastore MC, Fiorio A, Cameli M, Mandoli GE, Righini FM, Cavigli L, D'Ascenzi F, Focardi M, Rubboli A, Campo G, Mondillo S, Henein MY. Left Atrial Remodeling in Response to Aortic Valve Replacement: Pathophysiology and Myocardial Strain Analysis. Life (Basel) 2022; 12. [PMID: 36556439 DOI: 10.3390/life12122074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/03/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
Severe aortic stenosis (AS) is the most common valve disease in the elderly and is associated with poor prognosis if treated only medically. AS causes chronic pressure overload, concentric left ventricular (LV) hypertrophy, myocardial stiffness, and diastolic dysfunction. This adverse remodeling also affects the left atrium (LA), which dilates and develops myocardial fibrosis, with a reduction in intrinsic function and a consequent high risk of the development of atrial fibrillation. Speckle-tracking echocardiography is able to detect myocardial dysfunction before other conventional parameters, such as LV ejection fraction, and also predict clinical outcomes. This review aims at describing LV and LA remodeling in AS and before and after aortic valve replacement and the usefulness of myocardial strain analysis in this clinical setting.
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Fraccaro C, Tarantini G, Rosato S, Baglio G, Biancari F, Barbanti M, Tamburino C, Bedogni F, Ranucci M, Ussia GP, Seccareccia F, D'Errigo P. Early and mid-term outcome of patients with low-flow-low-gradient aortic stenosis treated with newer-generation transcatheter aortic valves. Front Cardiovasc Med 2022; 9:991729. [PMID: 36277797 PMCID: PMC9583539 DOI: 10.3389/fcvm.2022.991729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Patients with non-paradoxical low-flow-low-gradient (LFLG) aortic stenosis (AS) are at increased surgical risk, and thus, they may particularly benefit from transcatheter aortic valve replacement (TAVR). However, data on this issue are still limited and based on the results with older-generation transcatheter heart valves (THVs). The aim of this study was to investigate early and mid-term outcome of TAVR with newer-generation THVs in the setting of LFLG AS. Data for the present analysis were gathered from the OBSERVANT II dataset, a national Italian observational, prospective, multicenter cohort study that enrolled 2,989 consecutive AS patients who underwent TAVR at 30 Italian centers between December 2016 and September 2018, using newer-generation THVs. Overall, 420 patients with LVEF ≤50% and mean aortic gradient <40 mmHg were included in this analysis. The primary outcomes were 1-year all-cause mortality and a combined endpoint including all-cause mortality and hospital readmission due to congestive heart failure (CHF) at 1 year. A risk-adjusted analysis was performed to compare the outcome of LFLG AS patients treated with TAVR (n = 389) with those who underwent surgical aortic valve replacement (SAVR, n = 401) from the OBSERVANT I study. Patients with LFLG AS undergoing TAVR were old (mean age, 80.8 ± 6.7 years) and with increased operative risk (mean EuroSCORE II, 11.5 ± 10.2%). VARC-3 device success was 83.3% with 7.6% of moderate/severe paravalvular leak. Thirty-day mortality was 3.1%. One-year all-cause mortality was 17.4%, and the composite endpoint was 34.8%. Chronic obstructive pulmonary disease (HR 1.78) and EuroSCORE II (HR 1.02) were independent predictors of 1-year mortality, while diabetes (HR 1.53) and class NYHA IV (HR 2.38) were independent predictors of 1-year mortality or CHF. Compared with LFLG AS treated with SAVR, TAVR patients had a higher rate of major vascular complications and permanent pacemaker, while SAVR patients underwent more frequently to blood transfusion, cardiogenic shock, AKI, and MI. However, 30-day and 1-year outcomes were similar between groups. Patients with non-paradoxical LFLG AS treated by TAVR were older and with higher surgical risk compared with SAVR patients. Notwithstanding, TAVR was safe and effective with a similar outcome to SAVR at both early and mid-term.
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Affiliation(s)
- Chiara Fraccaro
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giuseppe Tarantini
- Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy,*Correspondence: Giuseppe Tarantini
| | - Stefano Rosato
- Centro Nazionale per la Salute Globale, National Center for Global Health, Istituto Superiore di Sanità Italiana, Roma, Italy
| | - Giovanni Baglio
- Italian National Agency for Regional Healthcare Services, Rome, Italy
| | - Fausto Biancari
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy,Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico—San Marco”, University of Catania, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico “G. Rodolico—San Marco”, University of Catania, Catania, Italy
| | - Francesco Bedogni
- Interventional Cardiology Unit, IRCCS Policlinico San Donato, Milan, Italy
| | - Marco Ranucci
- Department of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, Italy
| | - Gian Paolo Ussia
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Fulvia Seccareccia
- Centro Nazionale per la Salute Globale, National Center for Global Health, Istituto Superiore di Sanità Italiana, Roma, Italy
| | - Paola D'Errigo
- Centro Nazionale per la Salute Globale, National Center for Global Health, Istituto Superiore di Sanità Italiana, Roma, Italy
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Manla Y, Khalouf A, Edris A, Hasan K, Hashmani S, El Zouhbi A, Lee-St John T, Dababo N, Tuzcu EM, Al Badarin F. Left ventricular remodelling and changes in functional measurements in patients undergoing transcatheter vs surgical aortic valve replacement: a head-to-head comparison. AsiaIntervention 2022; 8:153-155. [PMID: 36483278 PMCID: PMC9706741 DOI: 10.4244/aij-d-22-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/08/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Yosef Manla
- Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Amani Khalouf
- Emergency Medicine Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Ahmad Edris
- Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Khwaja Hasan
- Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Shahrukh Hashmani
- Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Anas El Zouhbi
- Academic Office, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | | | - Nour Dababo
- Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - E Murat Tuzcu
- Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
- Academic Office, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Firas Al Badarin
- Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
- Academic Office, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
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11
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Tsushima T, Main A, Al-Kindi SG, Dallan LAP, Wheat HL, Baeza CR, Pelletier MP, Arruda MS, Mackall JA, Thal SG, Ohno Y, Lee KH, Siqueira DA, Kaneko T, Harloff MT, Costa G, Barbanti M, Attizzani GF. Risk Stratification of New Persistent Left Bundle Branch Block After Transcatheter Aortic Valve Implantation. Am J Cardiol 2022; 175:80-87. [PMID: 35597627 DOI: 10.1016/j.amjcard.2022.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 11/15/2022]
Abstract
Previous studies reported that new-onset persistent left bundle branch block (NOP-LBBB) was related to worse outcomes after transcatheter aortic valve implantation (TAVI). However, these results can be confounded by the presence of permanent pacemaker (PPM) implantation before and after TAVI. Long-term outcomes and the risk stratification of NOP-LBBB not having PPM implantation before and after TAVI have not been fully investigated. This is an international, multicenter, retrospective study of patients who underwent TAVI from July 31, 2007, to May 8, 2020. A total of 2,240 patients were included, and 17.5% of patients developed NOP-LBBB. NOP-LBBB was associated with cardiac mortality (adjusted hazard ratio [aHR] 1.419, 95% confidence interval [CI] 1.014 to 1.985, p = 0.041) and the composite outcomes of cardiac mortality and/or heart failure readmission (aHR 1.313, 95% CI 1.027 to 1.678, p = 0.030). Patients who developed NOP-LBBB with pre-TAVI left ventricular ejection fraction (LVEF) <40% were significantly associated with cardiac mortality (aHR 2.049, 95% CI 1.039 to 4.041, p = 0.038), heart failure (aHR 3.990, 95% CI 2.362 to 6.741, p <0.001), and the composite outcome (aHR 2.729, 95% CI 1.703 to 4.374, p <0.001). Although NOP-LBBB with pre-TAVI LVEF >40% had a significant decrease in LVEF 6 to 12 months after TAVI (-1.8 ± 9.7% vs +0.6 ± 8.1%, p = 0.003), NOP-LBBB with pre-TAVI LVEF <40% had a significant increase in LVEF 6 to 12 months after TAVI (+9.7 ± 13.6% vs +13.0 ± 11.7%, p = 0.157). In conclusion, patients with NOP-LBBB without pre-TAVI and post-TAVI PPM developed significantly worse long-term outcomes, especially in patients with pre-TAVI LVEF <40%. Further prospective investigation should be undertaken.
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Affiliation(s)
- Takahiro Tsushima
- Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Anthony Main
- Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sadeer G Al-Kindi
- Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Luis Augusto Palma Dallan
- Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Heather L Wheat
- Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Cristian R Baeza
- Department of Surgery, Division of Cardiac Surgery, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Marc P Pelletier
- Department of Surgery, Division of Cardiac Surgery, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Mauricio S Arruda
- Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Judith A Mackall
- Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sergio G Thal
- Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Yohei Ohno
- Department of Cardiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Kyong-Hee Lee
- Department of Cardiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Dimytri A Siqueira
- Department of Cardiology, Instituto Dante Pazzanese de Cardiologia - Fundação Adib Jatene, Sao Paulo, Brazil
| | - Tsuyoshi Kaneko
- Department of Surgery, Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Morgan T Harloff
- Department of Surgery, Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Giuliano Costa
- Division of Cardiology, Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy
| | - Marco Barbanti
- Division of Cardiology, Policlinico "G. Rodolico-San Marco," University of Catania, Catania, Italy
| | - Guilherme F Attizzani
- Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, Ohio.
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Al Balool J, Al Jarallah M, Rajan R, Dashti R, Alasousi N, Kotevski V, Taha Mousa AS, Al Haroun R, Tse G, Zhanna KD, Setiya P, Saber AA, Brady PA. Clinical outcomes of transcatheter aortic valve replacement stratified by left ventricular ejection fraction: A single centre pilot study. Ann Med Surg (Lond) 2022; 77:103712. [PMID: 35638043 PMCID: PMC9142703 DOI: 10.1016/j.amsu.2022.103712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/26/2022] [Accepted: 05/01/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction To define baseline echocardiographic, electrocardiographic (ECG) and computed tomographic (CT) findings of patients with heart failure undergoing transcatheter aortic valve replacement (TAVR) and analyze their overall procedural outcomes. Methods Between 2018 and 2021, patients with severe aortic stenosis (AS) who performed transcatheter aortic valve replacement (TAVR) in Sabah Al Ahmad Cardiac Centre, Al Amiri Hospital were identified. A retrospective review of patients' parameters including pre-, intra-, and post-procedural data was conducted. Patients were grouped in 2 subgroups according to their EF: EF <40% (HFrEF) and EF ≥ 40%. The data included patients’ baseline characteristics, electrocardiographic and echocardiographic details along with pre-procedural CT assessment of aortic valve dimensions. Primary outcomes including post-operative disturbances, pacemaker implantation and in-hospital mortality following TAVR were additionally analyzed. Results A total of 61 patients with severe AS underwent TAVR. The mean age was 73.5 ± 9, and 21 (34%) of the patients were males. The mean ejection fraction (EF) was 55.5 ± 9.7%. Of 61 patients, 12 (20%) were identified as heart failure with reduced EF (<40%). These patients were younger, more often males, and were more likely to have coronary artery disease (75% versus 53.1%). Left ventricular hypertrophy and diastolic dysfunction was documented in 75% and 58.3% of patients with heart failure with reduced ejection fraction (HFrEF) respectively. Post TAVR conduction disturbances, with the commonest being LBBB was observed in 41.7%. Permanent pacemaker was implanted in 3 of patients with HFrEF (25%). There were no significant differences between the two groups with regards to in hospital mortality (p = 0.618). Conclusion Severe AS with EF <40% constitute a remarkable proportion of patients undergoing TAVR. Preliminary results of post-operative conduction disturbances and in hospital mortality in HFrEF patients were concluded to not differ from patients with LVEF ≥40%. This is the first reported outcome study of TAVR in patients with heart failure in Kuwait. Conduction disturbances induced by TAVR was observed in almost half of the patients. Systolic dysfunction was not a predictor of in hospital complications or mortality outcomes.
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Affiliation(s)
- Joud Al Balool
- Department of Medicine, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
- Corresponding author. Department of Medicine, Faculty of Medicine, Kuwait University, China.
| | - Mohammed Al Jarallah
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait
| | - Rajesh Rajan
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait
- Department of Internal Medicine with the Subspecialty of Cardiology and Functional Diagnostics Named after V.S. Moiseev, Institute of Medicine, Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - Raja Dashti
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait
| | - Nader Alasousi
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait
| | - Vladimir Kotevski
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait
| | - Ahmed Said Taha Mousa
- Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait
| | - Retaj Al Haroun
- Department of Medicine, Royal College of Surgeons, Dublin, Ireland
| | - Gary Tse
- Cardiovascular Analytics Group, Hong Kong, China: Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Kobalava D. Zhanna
- Department of Internal Medicine with the Subspecialty of Cardiology and Functional Diagnostics Named after V.S. Moiseev, Institute of Medicine, Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation
| | - Parul Setiya
- Department of Agrometeorology, College of Agriculture, G.B.Pant University of Agriculture & Technology, Pantnagar, Uttarakhand, India
| | - Ahmad Al Saber
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, G1 1XH, UK
| | - Peter A. Brady
- Department of Cardiology, Illinois Masonic Medical Center, Chicago IL, USA
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13
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Moldovan H, Popescu BŞ, Nechifor E, Badea A, Ciomaga I, Nica C, Zaharia O, Gheorghiță D, Broască M, Diaconu C, Parasca C, Chioncel O, Iliescu VA. Rare Cause of Severe Mitral Regurgitation after TAVI: Case Report and Literature Review. Medicina (B Aires) 2022; 58:medicina58040464. [PMID: 35454303 PMCID: PMC9031139 DOI: 10.3390/medicina58040464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 11/29/2022] Open
Abstract
Pre-procedure mitral regurgitation (MR) is a frequent coexistent finding in patients undergoing transcatheter aortic valve replacement (TAVR), and most of them (up to 55%) experience a significant improvement in MR after the procedure. Although seldom described, mitral valve perforation after TAVR is a potentially serious complication that physicians should be aware of, as moderate or severe MR in TAVR recipients is associated with a high early mortality rate. We herein describe the case of a 65-year-old man presenting with worsening heart failure symptoms 5 months after TAVR due to an intraprocedural anterior mitral leaflet perforation and discuss the diagnostic process and therapeutic course of the case. Furthermore, we draw attention to the essential role of echocardiography in the management of TAVR procedures, taking into account its ability in detecting early complications, and emphasize the value of CT as a main determinant to predict long-term MR improvement after TAVR and to assess the potential candidates for double valve repair with percutaneous techniques.
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Affiliation(s)
- Horațiu Moldovan
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.Z.); (C.D.); (O.C.); (V.A.I.)
- Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (B.-Ş.P.); (A.B.); (C.N.); (M.B.)
- Correspondence: (H.M.); (D.G.)
| | - Bogdan-Ştefan Popescu
- Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (B.-Ş.P.); (A.B.); (C.N.); (M.B.)
| | - Elena Nechifor
- Sanador Clinical Hospital, 011038 Bucharest, Romania; (E.N.); (I.C.)
| | - Aida Badea
- Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (B.-Ş.P.); (A.B.); (C.N.); (M.B.)
| | - Irina Ciomaga
- Sanador Clinical Hospital, 011038 Bucharest, Romania; (E.N.); (I.C.)
| | - Claudia Nica
- Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (B.-Ş.P.); (A.B.); (C.N.); (M.B.)
| | - Ondin Zaharia
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.Z.); (C.D.); (O.C.); (V.A.I.)
- ”Prof. Dr. Theodor Burghele” Clinical Hospital, 061344 Bucharest, Romania
| | - Daniela Gheorghiță
- Faculty of Materials Science and Engineering, Politehnica University of Bucharest, 060042 Bucharest, Romania
- Correspondence: (H.M.); (D.G.)
| | - Marian Broască
- Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (B.-Ş.P.); (A.B.); (C.N.); (M.B.)
| | - Camelia Diaconu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.Z.); (C.D.); (O.C.); (V.A.I.)
- Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (B.-Ş.P.); (A.B.); (C.N.); (M.B.)
| | - Cătălina Parasca
- “Prof. Dr. C.C. Iliescu” Institute for Cardiovascular Diseases, 022328 Bucharest, Romania;
| | - Ovidiu Chioncel
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.Z.); (C.D.); (O.C.); (V.A.I.)
- “Prof. Dr. C.C. Iliescu” Institute for Cardiovascular Diseases, 022328 Bucharest, Romania;
| | - Vlad Anton Iliescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.Z.); (C.D.); (O.C.); (V.A.I.)
- “Prof. Dr. C.C. Iliescu” Institute for Cardiovascular Diseases, 022328 Bucharest, Romania;
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14
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Ibrahim M, Spelde AE, Szeto WY, Acker MA, Atluri P, Grimm JC, Cevasco M, Vallabhajosyula P, Bavaria J, Desai ND, Williams ML. Clinical and Echocardiographic Results of Aortic Valve Replacement in the Failing Ventricle: Do Aortic Stenosis and Aortic Regurgitation Differ? Ann Thorac Surg 2022; 113:853-858. [PMID: 33631158 PMCID: PMC9774041 DOI: 10.1016/j.athoracsur.2021.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 01/04/2021] [Accepted: 02/03/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND We hypothesized that long-term clinical and echocardiographic recovery of the impaired ventricle from pressure (aortic stenosis [AS]) and volume (aortic regurgitation [AR]) overload would be different after aortic valve replacement (AVR). METHODS We compared the results of AVR in patients with a preoperative ejection fraction (EF) of 0.35 or less due to AS, AR, or mixed disease. We constructed a mixed-effects model of EF and left ventricular (LV) end-diastolic diameter (LVEDD) to understand ventricular recovery over the short- (in-hospital), intermediate- (3-6 months), and longer- (>24 months) terms. We sought to identify factors associated with clinical and echocardiographic recovery using multivariable analysis. RESULTS Between July 2011 and 2017, 136 patients with a preoperative EF of 0.35 or less and severe AS (n = 83), severe AR (n = 18), or mixed AS and AR (n = 35) underwent AVR. There were 2 (1.5%) early deaths in the AS group. Survival at 1, 2, and 5 years did not differ between groups. Baseline EF did not differ between the groups but improved with markedly different trajectory and time course in the AS, AR, and mixed groups over time. LVEDD regressed in all patient cohorts, following a different pattern for AS and AR. Baseline EF and LVEDD predicted the long-term fate of the LV but did not determine survival. We identify factors associated with long-term survival. CONCLUSIONS The pattern of LV recovery appears to be early in AS and delayed in AR. Baseline clinical factors, rather than echocardiographic status of the LV, appear to determine late survival.
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15
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Gallone G, Bruno F, Trenkwalder T, D'Ascenzo F, Islas F, Leone PP, Nicol P, Pellegrini C, Incaminato E, Jimenez-Quevedo P, Alvarez-Covarrubias HA, Bragato R, Andreis A, Salizzoni S, Rinaldi M, Kastrati A, Conrotto F, Joner M, Stefanini G, Nombela-Franco L, Xhepa E, Escaned J, De Ferrari GM. Prognostic implications of impaired longitudinal left ventricular systolic function assessed by tissue Doppler imaging prior to transcatheter aortic valve implantation for severe aortic stenosis. Int J Cardiovasc Imaging 2022; 38:10.1007/s10554-021-02519-2. [PMID: 35006473 DOI: 10.1007/s10554-021-02519-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/30/2021] [Indexed: 11/05/2022]
Abstract
Change in longitudinal left ventricular (LV) systolic function serves as an early marker of the deleterious effect of aortic stenosis (AS) and other cardiac comorbidities on cardiac function. We explored the prognostic value of tissue Doppler imaging (TDI)-derived longitudinal LV systolic function, defined by the peak systolic average of lateral and septal mitral annular velocities (average S') among symptomatic patients with severe AS undergoing transcatheter aortic valve implantation (TAVI). 297 consecutive patients with severe AS undergoing TAVI at three european centers with available average S' at preprocedural echocardiography were retrospectively included. The primary endpoint was the Kaplan Meier estimate of all-cause mortality. After a median 18 months (IQR 12-18) follow-up, 36 (12.1%) patients had died. Average S' was associated with all-cause mortality (per 1 cm/sec decrease: HR 1.29, 95%CI 1.03-1.60, p = 0.025), the cut-off of 6.5 cm/sec being the most accurate. Patients with average S' < 6.5 cm/sec (55.2%) presented characteristics of more advanced LV remodeling and functional impairment along with higher burden of cardiac comorbidities, and experienced higher all-cause mortality (17.6% vs. 7.5%, p = 0.007), also when adjusted for in-study outcome predictors (adj-HR: 2.69, 95%CI 1.22-5.93, p = 0.014). Results were consistent among patients with preserved ejection fraction, normal-flow AS, high-gradient AS and in those without LV hypertrophy. Longitudinal LV systolic function assessed by average S' is independently associated with long-term all-cause mortality among TAVI patients. An average S' below 6.5 cm/sec best defines clinically meaningful reduced longitudinal systolic function and may aid clinical risk stratification in these patients.
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Affiliation(s)
- Guglielmo Gallone
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy.
| | - Francesco Bruno
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
| | | | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
| | - Fabian Islas
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | | | | | | | - Enrico Incaminato
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
| | - Pilar Jimenez-Quevedo
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | | | - Renato Bragato
- Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy
| | - Alessandro Andreis
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
| | - Stefano Salizzoni
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
| | - Mauro Rinaldi
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
| | | | - Federico Conrotto
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
| | | | - Giulio Stefanini
- Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy
| | - Luis Nombela-Franco
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Erion Xhepa
- Deutsches Herzzentrum München, Munich, Germany
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Gaetano M De Ferrari
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
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16
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Eugène M, Duchnowski P, Prendergast B, Wendler O, Laroche C, Monin JL, Jobic Y, Popescu BA, Bax JJ, Vahanian A, Iung B. Contemporary Management of Severe Symptomatic Aortic Stenosis. J Am Coll Cardiol 2021; 78:2131-2143. [PMID: 34823655 DOI: 10.1016/j.jacc.2021.09.864] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/30/2021] [Accepted: 09/06/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND There were gaps between guidelines and practice when surgery was the only treatment for aortic stenosis (AS). OBJECTIVES This study analyzed the decision to intervene in patients with severe AS in the EORP VHD (EURObservational Research Programme Valvular Heart Disease) II survey. METHODS Among 2,152 patients with severe AS, 1,271 patients with high-gradient AS who were symptomatic fulfilled a Class I recommendation for intervention according to the 2012 European Society of Cardiology guidelines; the primary end point was the decision for intervention. RESULTS A decision not to intervene was taken in 262 patients (20.6%). In multivariate analysis, the decision not to intervene was associated with older age (odds ratio [OR]: 1.34 per 10-year increase; 95% CI: 1.11 to 1.61; P = 0.002), New York Heart Association functional classes I and II versus III (OR: 1.63; 95% CI: 1.16 to 2.30; P = 0.005), higher age-adjusted Charlson comorbidity index (OR: 1.09 per 1-point increase; 95% CI: 1.01 to 1.17; P = 0.03), and a lower transaortic mean gradient (OR: 0.81 per 10-mm Hg decrease; 95% CI: 0.71 to 0.92; P < 0.001). During the study period, 346 patients (40.2%, median age 84 years, median EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 3.1%) underwent transcatheter intervention and 515 (59.8%, median age 69 years, median EuroSCORE II 1.5%) underwent surgery. A decision not to intervene versus intervention was associated with lower 6-month survival (87.4%; 95% CI: 82.0 to 91.3 vs 94.6%; 95% CI: 92.8 to 95.9; P < 0.001). CONCLUSIONS A decision not to intervene was taken in 1 in 5 patients with severe symptomatic AS despite a Class I recommendation for intervention and the decision was particularly associated with older age and combined comorbidities. Transcatheter intervention was extensively used in octogenarians.
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Affiliation(s)
- Marc Eugène
- Cardiology Department, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Piotr Duchnowski
- Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | | | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital, London, United Kingdom
| | - Cécile Laroche
- EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France
| | - Jean-Luc Monin
- Cardiology Department, Institut Mutualiste Montsouris, Paris, France
| | - Yannick Jobic
- Cardiology Department, Hôpital Cavale Blanche, Brest, France
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy Carol Davila-Euroecolab, Emergency Institute for Cardiovascular Diseases Prof Dr C. C. Iliescu, Bucharest, Romania
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Bernard Iung
- Cardiology Department, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France.
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17
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Koutsoukis A, Nahory L, Deguillard C, Juguet W, Nguyen A, Fard D, Folliguet T, Fiore A, Bergoend E, Gallet R, Mouillet G, Derumeaux G, Vincent F, Teiger E, Lim P, Ternacle J. Timing of aortic valve replacement in high-gradient severe aortic stenosis: impact of left ventricular ejection fraction. Acta Cardiol 2021; 76:517-524. [PMID: 33283639 DOI: 10.1080/00015385.2020.1851495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients with high-gradient (HG) severe aortic stenosis (AS) and left ventricular (LV) dysfunction are at high risk of death. The optimal timing for aortic valve replacement (AVR) is not defined by guidelines. The objective was to define the optimal timing to perform isolated AVR in patients with HG-AS and severe LV dysfunction. METHODS We retrospectively included 233 consecutive patients admitted for severe HG-AS (aortic valve area <1cm2 and mean gradient ≥40mmHg). Severe LV dysfunction was defined by LV ejection fraction ≤35% (LVEF). All-cause mortality while waiting for AVR and after the intervention (30 days) was compared in patients with (n = 28) and without (n = 205) LVEF ≤35%. RESULTS Patients with HG-AS and severe LV dysfunction had a higher risk profile than those with LVEF >35%. AVR was performed in 93% (218/233) of patients, 41% by surgery (SAVR) and 53% by transcatheter (TAVR). TAVR was the preferred method to treat HG-AS patients with LVEF ≤35%. All-cause mortality while waiting for AVR was higher in patients with severe LV dysfunction (22% vs. 2.0%, p < 0.001) and occurred within a shorter time (12 [8-26] days vs. 63 [58-152] days, p = 0.010) compared to those with LVEF >35%. All death in HG-AS patients with a severe LV dysfunction occurred within the first month. Postoperative mortality was low (1.3%), irrespective of LVEF. CONCLUSIONS AVR should be performed promptly after Heart Team decision in patients with HG severe AS and LVEF ≤35% because of a very high and premature risk of death while waiting for intervention.
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Affiliation(s)
- Athanasios Koutsoukis
- Cardiology Department, AP-HP Henri Mondor University Hospital, Créteil, France
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
| | - Louis Nahory
- Cardiology Department, AP-HP Henri Mondor University Hospital, Créteil, France
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
| | - Camille Deguillard
- Cardiology Department, AP-HP Henri Mondor University Hospital, Créteil, France
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
| | - William Juguet
- Cardiology Department, AP-HP Henri Mondor University Hospital, Créteil, France
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
| | - Annabelle Nguyen
- Cardiology Department, AP-HP Henri Mondor University Hospital, Créteil, France
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
| | - Damien Fard
- Cardiology Department, AP-HP Henri Mondor University Hospital, Créteil, France
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
| | - Thierry Folliguet
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
- Cardiac Surgery Department, AP-HP Henri Mondor University Hospital, Créteil, France
| | - Antonio Fiore
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
- Cardiac Surgery Department, AP-HP Henri Mondor University Hospital, Créteil, France
| | - Eric Bergoend
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
- Cardiac Surgery Department, AP-HP Henri Mondor University Hospital, Créteil, France
| | - Romain Gallet
- Cardiology Department, AP-HP Henri Mondor University Hospital, Créteil, France
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
| | - Gauthier Mouillet
- Cardiology Department, AP-HP Henri Mondor University Hospital, Créteil, France
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
| | - Genevieve Derumeaux
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
- Physiology Department, AP-HP Henri Mondor University Hospital, Créteil, France
| | - Flavien Vincent
- CHU Lille, Institut Coeur Poumon, Cardiology, Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Lille, France
- Inserm, U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille, France
| | - Emmanuel Teiger
- Cardiology Department, AP-HP Henri Mondor University Hospital, Créteil, France
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
| | - Pascal Lim
- Cardiology Department, AP-HP Henri Mondor University Hospital, Créteil, France
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
| | - Julien Ternacle
- Cardiology Department, AP-HP Henri Mondor University Hospital, Créteil, France
- INSERM U955, Team 8, Paris-Est Creteil University, Créteil, France
- DHU ATVB, Paris-Est Creteil University, Créteil, France
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18
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM 3rd, Thompson A, Toly C, O'Gara PT, Beckman JA, Levine GN, Al-Khatib SM, Armbruster A, Birtcher KK, Ciggaroa J, Deswal A, Dixon DL, Fleisher LA, de Las Fuentes L, Gentile F, Goldberger ZD, Gorenek B, Haynes N, Hernandez AF, Hlatky MA, Joglar JA, Jones WS, Marine JE, Mark D, Palaniappan L, Piano MR, Spatz ES, Tamis-Holland J, Wijeysundera DN, Woo YJ; Writing Committee Members., ACC/AHA Joint Committee Members. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2021; 162:e183-353. [PMID: 33972115 DOI: 10.1016/j.jtcvs.2021.04.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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19
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Shishido K, Yamanaka F, Ochiai T, Moriyama N, Yokoyama H, Yokota S, Noguchi K, Yashima F, Tada N, Naganuma T, Araki M, Shirai S, Ueno H, Mizutani K, Tabata M, Takagi K, Watanabe Y, Yamamoto M, Saito S, Hayashida K. Effect of Sex on Mortality and Left Ventricular Remodeling After Transcatheter Aortic Valve Implantation. Circ J 2021; 85:979-988. [PMID: 33907051 DOI: 10.1253/circj.cj-20-1095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The effect of sex on mortality is controversial; furthermore, sex differences in left ventricular (LV) remodeling after transcatheter aortic valve implantation (TAVI) remain unknown.Methods and Results:This study included 2,588 patients (1,793 [69.3%] female) enrolled in the Optimized CathEter vAlvular iNtervention (OCEAN)-TAVI Japanese multicenter registry between October 2013 and May 2017. We retrospectively analyzed the effect of sex on mortality, and evaluated changes in the LV mass index (LVMI) after TAVI. Female sex was significantly associated with lower all-cause and cardiovascular mortality (log-rank P<0.001 for both). Multivariate analysis showed that female sex was independently associated with lower cumulative long-term mortality (hazard ratio 0.615; 95% confidence interval 0.512-0.738; P<0.001). Regression in the LVMI was observed in both sexes, and there was no significant difference in the percentage LVMI regression from baseline to 1 year after TAVI between women and men. Women had a survival advantage compared with men among patients with LVMI regression at 1 year, but not among patients with no LVMI regression. CONCLUSIONS We found that female sex is associated with better survival outcomes after TAVI in a large Japanese registry. Although LVMI regression was observed in women and men after TAVI, post-procedural LV mass regression may be related to the sex differences in mortality.
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Affiliation(s)
- Koki Shishido
- Department of Cardiology, Shonan Kamakura General Hospital
| | | | - Tomoki Ochiai
- Department of Cardiology, Shonan Kamakura General Hospital
| | | | | | - Shohei Yokota
- Department of Cardiology, Shonan Kamakura General Hospital
| | - Kenichiro Noguchi
- Department of Cardiovascular Surgery, Shonan Kamakura General Hospital
| | | | - Norio Tada
- Department of Cardiology, Sendai Kousei Hospital
| | | | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital
| | | | - Hiroshi Ueno
- Department of Cardiovascular Medicine, Toyama University School of Medicine
| | - Kazuki Mizutani
- Department of Cardiovascular Medicine, Osaka City University School of Medicine
| | - Minoru Tabata
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center
| | | | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Canter.,Department of Cardiology, Nagoya Heart Canter
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital
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20
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e72-e227. [PMID: 33332150 DOI: 10.1161/cir.0000000000000923] [Citation(s) in RCA: 491] [Impact Index Per Article: 163.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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21
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 77:e25-e197. [PMID: 33342586 DOI: 10.1016/j.jacc.2020.11.018] [Citation(s) in RCA: 702] [Impact Index Per Article: 234.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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22
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Lauten A, Rudolph TK, Messika-Zeitoun D, Thambyrajah J, Serra A, Schulz E, Frey N, Maly J, Aiello M, Lloyd G, Bortone AS, Clerici A, Delle-Karth G, Rieber J, Indolfi C, Mancone M, Belle L, Arnold M, Bouma BJ, Lutz M, Deutsch C, Kurucova J, Thoenes M, Bramlage P, Steeds RP. Management of patients with severe aortic stenosis in the TAVI-era: how recent recommendations are translated into clinical practice. Open Heart 2021; 8:openhrt-2020-001485. [PMID: 33431618 PMCID: PMC7802661 DOI: 10.1136/openhrt-2020-001485] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/02/2020] [Accepted: 12/21/2020] [Indexed: 11/25/2022] Open
Abstract
Objective Approximately 3.4% of adults aged >75 years suffer from aortic stenosis (AS). Guideline indications for aortic valve replacement (AVR) distinguish between patients with symptomatic and asymptomatic severe AS. The present analysis aims to assess contemporary practice in the treatment of severe AS across Europe and identify characteristics associated with treatment decisions, namely denial of AVR in symptomatic patients and assignment of asymptomatic patients to AVR. Methods Participants of the prospective, multinational IMPULSE database of patients with severe AS were grouped according to AS symptoms, and stratified into subgroups based on assignment to/denial of AVR. Results Of 1608 symptomatic patients, 23.8% did not undergo AVR and underwent medical treatment. Denial was independently associated with multiple factors, including severe frailty (p=0.024); mitral (p=0.002) or tricuspid (p=0.004) regurgitation grade III/IV, and the presence of renal impairment (p=0.017). Of 392 asymptomatic patients, 86.5% had no prespecified indication for AVR. Regardless, 36.3% were assigned to valve replacement. Those with an indexed aortic valve area (AVA; p=0.045) or left ventricular ejection fraction (LVEF; p<0.001) below the study median; or with a left ventricular end systolic diameter above the study median (p=0.007) were more likely to be assigned to AVR. Conclusions There may be considerable discrepancies between guideline-based recommendations and clinical practice decision-making in the treatment of AS. It appears that guidelines may not fully capture the complete clinical spectrum of patients with AS. Thus, there is a need to find ways to increase their acceptance and the rate of adoption.
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Affiliation(s)
| | - Tanja K Rudolph
- Department of Cardiology, Hear and Diabetes Center Bad Oeynhausen, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | | | | | - Antonio Serra
- Interventional Cardiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalunya, Spain
| | - Eberhard Schulz
- Cardiology Department, AKH Celle, Celle, Niedersachsen, Germany
| | - Norbert Frey
- Department of Cardiology and Angiology, University of Kiel, Kiel, Schleswig-Holstein, Germany
| | - Jiri Maly
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.,Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marco Aiello
- Department of Cardiothoracic Surgery, Foundation IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Guy Lloyd
- St Bartholomew's Hospital, London, UK
| | | | | | | | - Johannes Rieber
- Herzkatheterlabor Nymphenburg and Department of Cardiology, University of Munich, Munich, Bayern, Germany
| | - Ciro Indolfi
- Division of Cardiology and URT CNR of IFC, University Magna Graecia, Catanzaro, Calabria, Italy
| | | | - Loic Belle
- Centre Hospital d'Annecy, Annecy, France
| | - Martin Arnold
- Department of Cardiology, University Hospital Erlangen, Erlangen, Bayern, Germany
| | | | - Matthias Lutz
- Department of Cardiology and Angiology, University of Kiel, Kiel, Schleswig-Holstein, Germany
| | - Cornelia Deutsch
- Institut für Pharmakologie und Präventive Medizin GmbH, Cloppenburg, Germany
| | | | | | - Peter Bramlage
- Institut für Pharmakologie und Präventive Medizin GmbH, Cloppenburg, Germany
| | - Richard Paul Steeds
- Queen Elizabeth Hospital & Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
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23
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Komlev AE, Saidova MA, Imaev TE, Shitov VN, Akchurin RS. Haemodynamic Patterns of Severe Aortic Stenosis. Racionalʹnaâ farmakoterapiâ v kardiologii 2020. [DOI: 10.20996/1819-6446-2020-10-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The authors present up-to-date review of clinical pathophysiology of aortic stenosis (AS) based on differentiation of its haemodynamic patterns, and some actual issues of instrumental diagnostics and classification of AS. The variety of clinical presentations of AS is based on diverse combination of pathological changes of haemodynamics. In Russian cardiology, there is no clear pathophysiological classification of AS despite of its relevance under the progress of surgical and transcatheter treatment of AS. The authors suggest the pilot haemodynamic classification of AS which includes 6 types (0-5) based on different combination of the following variables: left ventricle ejection fraction, stroke volume, mean aortic systolic pressure gradient. Severe AS with low transaortic pressure gradient in patients with depressed systolic function of the left ventricle (so called «low flow-low» gradient phenomenon) is referred to as the most frequent, classical haemodynamic pattern of low-gradient AS. The prevalence of this variant is about 10% among European population of patients with severe AS. The inconsistence between aortic valve area and mean pressure gradient is as common as in 35-40% of patients with AS, however, in 30-50% of these cases, AS is not severe. Severe AS is a surgical disease that should be treated in a surgical way in all patients but those in whom predicted risk overbalances potential benefits of the procedure. The use of integrated clinical and instrumental approach for identification of a true sever AS is the matter of great concern, as both overestimation and underestimation can misguide the clinical decision-making process. Verification of severe AS in patients with classical and paradoxical low flow-low gradient AS with specific indications for surgical treatment regarded is further emphasized in the paper. Since transcatheter aortic valve implantation has become a commonly recognized alternative to surgical aortic valve replacement, its role in the treatment of severe AS with different haemodynamic patterns is also discussed. The authors stress on the necessity of using tailored approach for treatment of AS regarding different clinical and pathophysiological scenarios: high gradient AS with preserved ejection fraction, classical and paradoxical low flow-low gradient AS.
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Affiliation(s)
| | | | - T. E. Imaev
- National Medical Research Center of Cardiology
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24
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Wang Z. Echocardiographic Assessment in Patients With Aortic Stenosis and LV Dysfunction: Is It time to Add Strain? Cardiovasc Revasc Med 2020; 21:986-988. [PMID: 33092726 DOI: 10.1016/j.carrev.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Zuyue Wang
- Baylor Scott & White Legacy Heart Center - Plano Preston Road, 6601 Preston Rd, Plano, TX 75024.
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25
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Panoulas VF, Chandrasekhar J, Busi G, Ruparelia N, Zhang Z, Mehilli J, Sartori S, Lefèvre T, Presbitero P, Capranzano P, Tchetche D, Iadanza A, Sardella G, Van Mieghem NM, Meliga E, Dumonteil N, Fraccaro C, Trabattoni D, Sharma S, Ferrer‐Gracia M, Naber CK, Kievit PC, Snyder C, Sutaria N, Sen S, Malik IS, Morice M, Nihoyannopoulos P, Petronio AS, Mehran R, Chieffo A, Mikhail GW. Prevalence, predictors, and outcomes of patient prosthesis mismatch in women undergoing
TAVI
for severe aortic stenosis: Insights from the
WIN‐TAVI
registry. Catheter Cardiovasc Interv 2020; 97:516-526. [DOI: 10.1002/ccd.29227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/05/2020] [Accepted: 08/08/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Vasileios F. Panoulas
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
- Faculty of Medicine, Cardiovascular Sciences National Heart and Lung Institute, Imperial College London London UK
| | - Jaya Chandrasekhar
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place New York New York Box 1030 USA
| | - Gherardo Busi
- Interventional cardiology unit San Raffaele Scientific Institute Milan Italy
| | - Neil Ruparelia
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
| | - Zhongjie Zhang
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place New York New York Box 1030 USA
| | - Julinda Mehilli
- Department of cardiology Ludwig‐Maximilians‐University of Munich Munich Germany
| | - Samantha Sartori
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place New York New York Box 1030 USA
| | - Thierre Lefèvre
- Institut Cardiovasculaire Paris Sud Hôpital privé Jacques cartier, Ramsay Générale de santé Massy France
| | - Patrizia Presbitero
- Department of Cardiology IRCCS Humanitas Clinical and Research Centre Milan Italy
| | | | | | - Alessandro Iadanza
- Emodinamica Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte Siena Italy
| | - Gennaro Sardella
- Interventional cardiology unit Policlinico “Umberto I Rome Italy
| | - Nicolas M. Van Mieghem
- Department of interventional cardiology Erasmus Medical Center, Thoraxcenter Rotterdam The Netherlands
| | - Emanuele Meliga
- Interventional cardiology unit Mauriziano Hospital Turin Italy
| | | | - Chiara Fraccaro
- Interventional cardiology unit University of Padova Padova Italy
| | - Daniela Trabattoni
- Invasive Cardiology Unit 3 Centro Cardiologico Monzino, IRCCS Milan Italy
| | - Samin Sharma
- Department of cardiology Mount Sinai Hospital New York New York USA
| | - Maria‐Cruz Ferrer‐Gracia
- Department of Cardiology, Interventional Cardiology Unit Hospital Universitario Miguel Servet Zaragoza Spain
| | - Christoph K. Naber
- Department of cardiology Contilia Heart and Vascular Centre, Elisabeth Krankenhaus Essen Germany
| | - Peter C. Kievit
- Department of cardiology Radboud University Nijmegen Medical Center Nijmegan, The Netherlands
| | - Clayton Snyder
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place New York New York Box 1030 USA
| | - Nilesh Sutaria
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
| | - Sayan Sen
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
- Faculty of Medicine, Cardiovascular Sciences National Heart and Lung Institute, Imperial College London London UK
| | - Iqbal S. Malik
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
- Faculty of Medicine, Cardiovascular Sciences National Heart and Lung Institute, Imperial College London London UK
| | - Marie‐Claude Morice
- Department of cardiology Ludwig‐Maximilians‐University of Munich Munich Germany
| | - Petros Nihoyannopoulos
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
- Faculty of Medicine, Cardiovascular Sciences National Heart and Lung Institute, Imperial College London London UK
| | - Anna Sonia Petronio
- Interventional cardiology unit AOUP Cisanello, University Hospital Pisa Italy
| | - Roxana Mehran
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place New York New York Box 1030 USA
| | - Alaide Chieffo
- Interventional cardiology unit San Raffaele Scientific Institute Milan Italy
| | - Ghada W. Mikhail
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
- Faculty of Medicine, Cardiovascular Sciences National Heart and Lung Institute, Imperial College London London UK
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26
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Cao Y, Singh V, Wang A, Zhang L, He T, Su H, Wei R, Duan Y, Jiang K, Wu W, Huang Y, Elmariah S, Qi G, Su X, Zhang Y, Zhang M. Meta-analysis of right ventricular function in patients with aortic stenosis after transfemoral aortic valve replacement or surgical aortic valve replacement. Ther Adv Chronic Dis 2020; 11:2040622320933775. [PMID: 32670537 PMCID: PMC7339069 DOI: 10.1177/2040622320933775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 05/12/2020] [Indexed: 01/08/2023] Open
Abstract
Background: Right ventricular function (RVF) is an independent predictor of prognosis for
patients undergoing aortic valve replacement: transcatheter aortic valve
replacement (TAVR) or surgical aortic valve replacement (SAVR). The effect
of transfemoral aortic valve replacement (TF-TAVR) on RVF is uncertain. We
aimed to perform a meta-analysis of the effect of TF-TAVR on RVF in patients
with aortic stenosis (AS) and compare the effect of TF-TAVR with SAVR. Methods: We searched relevant studies from PubMed, Embase, Cochrane Library databases,
and Web of Science. Furthermore, two reviewers (Wang AQ and Cao YS)
extracted all relevant data, which were then double checked by another two
reviewers (Zhang M and Qi GM). We used the forest plot to present results.
Tricuspid annular plane systolic excursion (TAPSE) was the primary
outcome. Results: This meta-analysis included 11 studies. There were 353 patients who underwent
TF-TAVR, and 358 patients who were subjected to SAVR. There was no
significant difference in TAPSE at 1 week and 6 months as well as right
ventricular ejection fraction (RVEF) at <2 weeks and 6 months after
TF-TAVR. For the SAVR group, TAPSE at 1 week and 3 months as well as
fractional area change (FAC) at 3 months post procedure were significantly
aggravated, while RVEF did not change significantly. Moreover, TAPSE
post-TF-TAVR was significantly improved as compared with post-SAVR. The
△TAPSE, the difference between TAPSE post-procedure and TAPSE prior to
procedure, was also significantly better in the TF-TAVR group than in the
SAVR group. Conclusion: RVF was maintained post TF-TAVR. For SAVR, discrepancy in the measured
parameters exists, as reduced TAPSE indicates compromised longitudinal RVF,
while insignificant changes in RVEF implicate maintained RVF post procedure.
Collectively, our study suggests that the baseline RV dysfunction and the
effect of TF-TAVR versus SAVR on longitudinal RVF may
influence the selection of aortic valve intervention.
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Affiliation(s)
- Yunshan Cao
- Department of Cardiology, Gansu Provincial Hospital, No. 204, Donggang West Road, Chengguan District, Lanzhou, Gansu 730000, China
| | - Vikas Singh
- Division of Cardiovascular Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Aqian Wang
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou, China
| | - Liyan Zhang
- Clinical Medicine School, Gansu University of Chinese Medicine, Lanzhou, China
| | - Tingting He
- Clinical Medicine School, Gansu University of Chinese Medicine, Lanzhou, China
| | - Hongling Su
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou, China
| | - Rong Wei
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou, China
| | - Yichao Duan
- School of Clinical Medicine, Ningxia Medical University, Ningxia, China
| | - Kaiyu Jiang
- Clinical Medicine School, Gansu University of Chinese Medicine, Lanzhou, China
| | - Wenyu Wu
- School of Clinical Medicine, Ningxia Medical University, Ningxia, China
| | - Yan Huang
- Department of Cardiology, Gansu Provincial Hospital, Lanzhou, China
| | - Sammy Elmariah
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School Boston, MA, USA
| | - Guanming Qi
- Pulmonary and Critical Care Division, Tufts Medical Center, Boston, MA, USA
| | - Xin Su
- Clinical Medicine School, Gansu University of Chinese Medicine, Lanzhou, China
| | - Yan Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin International Joint Research and Development Center of Ophthalmology and Vision Science, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, No. 251, Fukang Road, Nankai District, Tianjin, China
| | - Min Zhang
- Department of Pathology, Gansu Provincial Hospital, No.204, Donggang West Road, Chengguan District, Lanzhou, Gansu 730000, China
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Amer MR, Mosleh W, Memon S, Joshi S, Sullivan B, Sharkawi M, Mather JF, Kiernan FJ, McMahon S, Duvall WL, McKay RG. Comparison of Benefit of Transcatheter Aortic Valve Implantation in Patients With Low Gradient Versus High Gradient Aortic Stenosis and Left Ventricular Dysfunction. Am J Cardiol 2020; 125:1543-1549. [PMID: 32273053 DOI: 10.1016/j.amjcard.2020.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 11/30/2022]
Abstract
Patients with low gradient severe aortic stenosis (LG-AS) often exhibit significant limitations in functional status and quality of life. We aimed to evaluate the clinical effect of transcatheter aortic valve implantation (TAVI) on LG-AS patients compared to those with high transvalvular gradients and similar left ventricular dysfunction. Retrospective analysis of records for all patients with a left ventricular ejection fraction <50% who underwent TAVI at our institution was performed. Patients were grouped according to their transvalvular gradient. Data were collected from The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Clinical benefit endpoints included improvements in left ventricular ejection fraction and changes in the Kansas City Cardiomyopathy Questionnaire. Additional outcomes analyzed included 1-year all-cause mortality, stroke rates, rates of rehospitalization, need for a permanent pacemaker, and hospital length of stay. Two hundred three patients met our inclusion criteria. one hundred one LG-AS patients (mean transvalvular gradient <40 mm Hg) were compared to 102 patients with high transvalvular gradients (mean transvalvular gradient >40 mm Hg). LG-AS patients yielded similar improvements in left ventricular ejection fraction (43.5% ± 63.7 vs 37.7% ± 58.7; p = 0.525) and Kansas City Cardiomyopathy Questionnaire scores (423.51% ± 1257.02 vs 266.56% ± 822.81; p = 0.352). There were no differences between the groups with respect to 1-year mortality (16.8% vs 12.7%; p = 0.412), stroke rates, hospital length of stay, need for permanent pacemaker implantation or hospital readmissions. In conclusion, we found that TAVI is associated with comparable improvement in clinical and echocardiographic outcomes in LG-AS patients as compared to those with high gradient severe aortic stenosis.
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Affiliation(s)
- Mostafa R Amer
- Division of Cardiology, University of Connecticut, Farmington, Connecticut
| | - Wassim Mosleh
- Division of Cardiology, University of Connecticut, Farmington, Connecticut
| | - Sarfaraz Memon
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Saurabh Joshi
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Bethany Sullivan
- Division of Cardiology, University of Connecticut, Farmington, Connecticut
| | - Musa Sharkawi
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Jeffrey F Mather
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Francis J Kiernan
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Sean McMahon
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - W Lane Duvall
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut
| | - Raymond G McKay
- Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut.
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Kugelman N, Jaffe R, Aronson D, Sharoni E, Adawi S, Khader N, Shiran A. Outcome of Patients with Low-Gradient Aortic Stenosis Undergoing Transcatheter or Surgical Aortic Valve Replacement. Cardiovascular Revascularization Medicine 2020; 21:257-62. [DOI: 10.1016/j.carrev.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/14/2019] [Accepted: 05/01/2019] [Indexed: 11/19/2022]
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Freitas-Ferraz AB, Lerakis S, Barbosa Ribeiro H, Gilard M, Cavalcante JL, Makkar R, Herrmann HC, Windecker S, Enriquez-Sarano M, Cheema AN, Nombela-Franco L, Amat-Santos I, Muñoz-García AJ, Garcia del Blanco B, Zajarias A, Lisko JC, Hayek S, Babaliaros V, Le Ven F, Gleason TG, Chakravarty T, Szeto WY, Clavel MA, de Agustin A, Serra V, Schindler JT, Dahou A, Annabi MS, Pelletier-Beaumont E, Pibarot P, Rodés-Cabau J. Mitral Regurgitation in Low-Flow, Low-Gradient Aortic Stenosis Patients Undergoing TAVR. JACC Cardiovasc Interv 2020; 13:567-579. [DOI: 10.1016/j.jcin.2019.11.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/11/2019] [Accepted: 11/15/2019] [Indexed: 11/24/2022]
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Popovic B, Molho A, Varlot J, Fay R, Metzdorf PA, Elfarra M, Maureira P, Juillière Y, Huttin O, Camenzind E. Prognostic influence of acute decompensated heart failure in patients planned for transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2020; 96:E542-E551. [DOI: 10.1002/ccd.28813] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/30/2020] [Accepted: 02/14/2020] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Renaud Fay
- Department of Cardiology CHU Nancy France
| | | | - Mazen Elfarra
- Department of Cardiovascular Surgery CHU Nancy France
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Merdler I, Loewenstein I, Hochstadt A, Morgan S, Schwarzbard S, Sadeh B, Peri Y, Shacham Y, Finkelstein A, Steinvil A. Effectiveness and Safety of Transcatheter Aortic Valve Implantation in Patients With Aortic Stenosis and Variable Ejection Fractions (<40%, 40%-49%, and >50%). Am J Cardiol 2020; 125:583-588. [PMID: 31843234 DOI: 10.1016/j.amjcard.2019.10.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 11/18/2022]
Abstract
We evaluated the safety and efficacy of transcatheter aortic valve implantation (TAVI) in aortic stenosis patients with mid-range ejection fraction (ASmrEF) and compared it to aortic stenosis patients with reduced ejection fraction (ASrEF) and preserved ejection fraction (ASpEF). TAVI cases were stratified by baseline ejection fraction (ASrEF, ASmrEF, ASpEF) and compared for characteristics, procedural outcomes, and change in echocardiographic parameters at 1 year and mortality over a 5-year follow-up. The final study population included 708 patients who underwent TAVI. ASmrEF patients presented with improved EF at 1-year after procedure (49.0 ± 9.8 at 1 year vs 43.0 ± 2.5 at baseline, p <0.001) and showed improvements in left ventricular (LV) diameters (LV end-diastolic diameter: 50.4 ± 6.0 at 1 year vs 53.0 ± 5.5 at baseline and LV end-systolic diameter 34.7 ± 7.8 at 1 year vs 39.5 ± 5.9 at baseline, p <0.001 for both). LVEF improved for patients with ASrEF but not in ASpEF patients. LV diameters did not improve for patients in either group. Procedural safety and success rates were similar between all heart failure groups. Survival rates over a 5-year follow-up post-TAVI were not different between patients with ASmrEF, ASrEF, and ASpEF (ASrEF 78.4%, ASmrEF 81.9%, ASpEF 78.3%, p = 0.327). TAVI for patients with ASmrEF is safe and effective and results in marked improvement of LV function and structure.
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Affiliation(s)
- Ilan Merdler
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Itamar Loewenstein
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aviram Hochstadt
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Samuel Morgan
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sivan Schwarzbard
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ben Sadeh
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yogev Peri
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yacov Shacham
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ariel Finkelstein
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arie Steinvil
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Pibarot P, Messika-Zeitoun D, Ben-Yehuda O, Hahn RT, Burwash IG, Van Mieghem NM, Spitzer E, Leon MB, Bax J, Otto CM. Moderate Aortic Stenosis and Heart Failure With Reduced Ejection Fraction: Can Imaging Guide Us to Therapy? JACC Cardiovasc Imaging 2019; 12:172-84. [PMID: 30621989 DOI: 10.1016/j.jcmg.2018.10.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 11/21/2022]
Abstract
Clinical management of patients with only moderate aortic stenosis (AS) but symptoms of heart failure with a reduced left ventricular ejection fraction (HFrEF) is challenging. Current guidelines recommend clinical surveillance with multimodality imaging; aortic valve replacement (AVR) is deferred until the stenosis becomes severe. Given the known benefits of afterload reduction in management of patients with HFrEF, it has been hypothesized that AVR may be beneficial in patients with only moderate AS who present with HFrEF. In this article, we first review the current approach for management of patients with moderate AS and HFrEF based on close clinical and imaging surveillance with AVR delayed until AS is severe. We then discuss the case for transcatheter AVR (TAVR) earlier in the disease course, when AS is moderate, based on stress echocardiographic data. We conclude with a detailed summary of the TAVR UNLOAD (Transcatheter Aortic Valve Replacement to UNload the Left Ventricle in Patients With ADvanced Heart Failure) trial, in which patients with moderate AS and HFrEF are randomized to guideline-directed heart failure therapy alone versus guideline-directed heart failure therapy plus TAVR.
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Ben-assa E, Biner S, Banai S, Arbel Y, Laufer-perl M, Kramarz J, Elmariah S, Inglessis I, Keren G, Finkelstein A, Topilsky Y. Clinical impact of post procedural mitral regurgitation after transcatheter aortic valve replacement. Int J Cardiol 2020; 299:215-21. [DOI: 10.1016/j.ijcard.2019.07.092] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 05/18/2019] [Accepted: 07/30/2019] [Indexed: 11/21/2022]
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Benamer H, Saighi Bouaouina M, Sanguineti F, Neylon A, Garot P, Hovasse T, Unterseeh T, Champagne S, Lefèvre T, Chevalier B. [TAVI in women, very encouraging results]. Ann Cardiol Angeiol (Paris) 2019; 68:429-433. [PMID: 31668338 DOI: 10.1016/j.ancard.2019.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/20/2019] [Indexed: 11/16/2022]
Abstract
The population of elderly patients comprises a high percentage of women. This population is more vulnerable due to the presence of numerous comorbidities and is, therefore, particularly exposed to the risk of aortic valve degeneration, resulting in aortic valve stenosis whose symptoms are predictors of poor short-term outcomes. In the presence of symptomatic aortic stenosis, the recommended therapeutic option in this vulnerable population is the implementation of transcatheter aortic valve implantation, preferably via the femoral route. The outcomes of this procedure are better in women than in men despite a more frequent occurrence of vascular, bleeding and cerebral complications. Several hypotheses have been reported in the literature regarding the reasons for such differences. Among other reasons, it is likely that in female patients, the myocardium adjusts better to the occurrence of aortic stenosis and that recovery after valve treatment is also more optimal. Another explanation is the higher frequency of coronary artery disease in this older population. This has a considerable impact on the outcome even when coronary lesions are treated prior to valve implantation. There is still room for improvement and progress can be achieved by further reducing the size of the equipment used in order to decrease the diameter of the vascular access, and by continuing to simplify TAVI procedures. Less invasive techniques should result in decreased complication rates. In addition, dedicated studies should allow us to further improve our practice in this growing population of vulnerable patients.
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Affiliation(s)
- H Benamer
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; ICV-GVM La Roseraie, 120, avenue de la République, 93300 Aubervilliers, France; Hôpital Foch, Suresnes, France.
| | - M Saighi Bouaouina
- ICV-GVM La Roseraie, 120, avenue de la République, 93300 Aubervilliers, France; Hôpital Foch, Suresnes, France
| | - F Sanguineti
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital Claude-Gallien, 91480 Quincy-sous-Sénart, France
| | - A Neylon
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital Claude-Gallien, 91480 Quincy-sous-Sénart, France
| | - P Garot
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital Claude-Gallien, 91480 Quincy-sous-Sénart, France
| | - T Hovasse
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital Claude-Gallien, 91480 Quincy-sous-Sénart, France
| | - T Unterseeh
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital Claude-Gallien, 91480 Quincy-sous-Sénart, France
| | - S Champagne
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital Claude-Gallien, 91480 Quincy-sous-Sénart, France
| | - T Lefèvre
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital Claude-Gallien, 91480 Quincy-sous-Sénart, France
| | - B Chevalier
- ICPS Jacques-Cartier, Ramsay générale de santé, 6, avenue du Noyer-Lambert, 91300 Massy, France; Hôpital Claude-Gallien, 91480 Quincy-sous-Sénart, France
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Burwash IG, Messika-zeitoun D. Low Gradient Aortic Stenosis: Role of Echocardiography. Curr Cardiovasc Imaging Rep 2019; 12. [DOI: 10.1007/s12410-019-9518-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Soon KH, Kooistra NHM, Voskuil M, Kraaijeveld AO, Stella PR. LV systolic dysfunction stands to gain the most post transcatheter aortic valve implantation (TAVI). AsiaIntervention 2019; 5:142-148. [PMID: 36483532 PMCID: PMC9706768 DOI: 10.4244/aij-d-18-00054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 05/02/2019] [Indexed: 06/17/2023]
Abstract
AIMS We aimed to evaluate the extent of left ventricular (LV) recovery post transcatheter aortic valve implantation (TAVI) and its clinical predictors. METHODS AND RESULTS This was a retrospective study on patients treated with TAVI from August 2008 to September 2017. Patients were sub-classified according to their baseline LV function as normal, mildly impaired, moderately impaired or severely impaired. Echo pre TAVI and early post TAVI were compared to assess LV function change. Predictors of LV function change were sought from univariate and multivariate ordinal logistic regression analyses. There were 662 patients included in this study. Nearly half of them, 323 patients (49%), had abnormal LV systolic dysfunction of various degrees. Of these, 193 (60%) showed LV function improvement post TAVI. Based on their pre-TAVI LV function, 55% of the mild LV dysfunction cohort, 62% of the moderate LV dysfunction cohort and 74% of the severe LV dysfunction cohort had LV function improvement post TAVI. Multivariate logistic regression analysis revealed baseline LV dysfunction as the only significant predictor of LV function improvement post TAVI. CONCLUSIONS The majority of patients with baseline LV dysfunction had LV improvement post TAVI, more so those patients with severe LV dysfunction.
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Affiliation(s)
- Kean H Soon
- Department of Medicine-Western Health and Epworth Clinical School, The University of Melbourne, Melbourne, Australia
| | - Nynke H M Kooistra
- Hart en Longen, Cardiologie, Universitair Medisch Centrum Utrecht, Utrecht, the Netherlands
| | - Michiel Voskuil
- Hart en Longen, Cardiologie, Universitair Medisch Centrum Utrecht, Utrecht, the Netherlands
| | - Adriaan O Kraaijeveld
- Hart en Longen, Cardiologie, Universitair Medisch Centrum Utrecht, Utrecht, the Netherlands
| | - Pieter R Stella
- Hart en Longen, Cardiologie, Universitair Medisch Centrum Utrecht, Utrecht, the Netherlands
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Merdler I, Rozenbaum Z, Finkelstein A, Arbel Y, Banai S, Bazan S, Halkin A, Zhitomirsky S, Horen S, Shacham Y, Steinvil A. Effect of Statin Therapy and Long-Term Mortality Following Transcatheter Aortic Valve Implantation. Am J Cardiol 2019; 123:1978-82. [PMID: 30967288 DOI: 10.1016/j.amjcard.2019.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/07/2019] [Accepted: 03/14/2019] [Indexed: 01/04/2023]
Abstract
Increased inflammatory response after aortic valve replacement is linked to higher postprocedural mortality. The aim of the present analysis was to assess the impact of baseline statin therapy on procedural outcomes and mortality after transcatheter aortic valve implantation (TAVI). We performed a retrospective analysis on patients who underwent TAVI stratified to 3 statin therapy groups: high-intensity statin (HIS), low-medium intensity statins, and no statin. Included were 1,238 patients. Patients treated with HIS were significantly younger, had higher body mass index, lower Society of Thoracic Surgeons score, and higher prevalence of dyslipidemia, hypertension, past stroke, and ischemic heart disease. Procedural outcomes were similar between groups. There were no statistically significant short-term mortality differences at 1 month (2.2% vs 2.1% vs 3.5%, p = 0.50) and 1 year (6.9% vs 9.3% vs 14.2%, p = 0.15), albeit the observed numerical trend. As for long-term mortality (median follow time of 2.5 years, interquartile range 1.3 to 4.2), lower mortality rates were observed in the HIS group (14.5% vs 25.2% vs 36.6%, p = 0.001). Compared with no statin, the HIS group was significantly associated with reduced risk of long-term mortality in multivariate analysis (hazard ratio = 0.59, 95% CI 0.37 to 0.96, p = 0.03). Baseline HIS therapy is associated with reduced rates of long-term morality after TAVI.
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Corso P, Gülan U, Cohrs N, Stark WJ, Duru F, Holzner M. Comprehensive In Vitro Study of the Flow Past Two Transcatheter Aortic Valves: Comparison with a Severe Stenotic Case. Ann Biomed Eng 2019; 47:2241-57. [DOI: 10.1007/s10439-019-02289-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/10/2019] [Indexed: 11/25/2022]
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Gallo G, Presta V, Volpe M, Rubattu S. Molecular and clinical implications of natriuretic peptides in aortic valve stenosis. J Mol Cell Cardiol 2019; 129:266-271. [DOI: 10.1016/j.yjmcc.2019.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/06/2019] [Accepted: 03/11/2019] [Indexed: 11/16/2022]
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Shiino K, Yamada A, Scalia GM, Putrino A, Chamberlain R, Poon K, Walters DL, Chan J. Early Changes of Myocardial Function After Transcatheter Aortic Valve Implantation Using Multilayer Strain Speckle Tracking Echocardiography. Am J Cardiol 2019; 123:956-960. [PMID: 30594290 DOI: 10.1016/j.amjcard.2018.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/05/2018] [Accepted: 12/13/2018] [Indexed: 02/06/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is an effective therapeutic option for severe symptomatic aortic valve stenosis (AS) with intermediate or high surgical risk. The purpose of this study was to examine the effects of TAVI on left ventricular (LV) mechanics using multilayer global longitudinal strain (GLS) by 2D speckle-tracking echocardiography. A total of 119 patients (mean age 83 ± 7.0 years, male 54%) with severe symptomatic AS and normal LV ejection fraction (LVEF) underwent echocardiography at baseline and 1 month after TAVI. Global longitudinal strain was measured from the endocardial layer (GLSendo), mid-ventricular layer (GLSmyo), epicardial layer (GLSepi) and full thickness of myocardium (GLSwhole). There was significant improvement in all 3 layers of GLS after TAVI compared with baseline, but there was no significant change in LVEF. The relative % increment in GLS in each layer strain were 11.2 ± 23.4% (GLSendo), 13.4 ± 33.0% (GLSmyo) and 18.0 ± 46.6% (GLSepi) with significant difference between GLSendo and GLSepi (p < 0.05). In conclusion, multilayer GLS is more sensitive than conventional LVEF to detect early improvement in LV systolic function after TAVI in patients with severe AS. There is a disproportional improvement in different layers with least improvement in the endocardium. Multilayer strain analysis may provide new insights into understanding mechanics of AS.
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Itzhaki Ben Zadok O, Kornowski R, Finkelstein A, Barbash I, Danenberg H, Segev A, Guetta V, Halkin A, Vaknin H, Planer D, Assali A, Barsheshet A, Orvin K. Temporal Trends in Gender-Related Differences and Outcomes in Patients Who Underwent Transcatheter Aortic Valve Implantation (from the Israeli Transcatheter Aortic Valve Implantation Multicenter Registry). Am J Cardiol 2019; 123:108-115. [PMID: 30539744 DOI: 10.1016/j.amjcard.2018.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 09/05/2018] [Accepted: 09/11/2018] [Indexed: 12/20/2022]
Abstract
We evaluated temporal trends in gender-related differences in patients who underwent transcatheter aortic valve implantation (TAVI) for severe symptomatic aortic stenosis from a multicenter TAVI registry during the years 2008 to 2016. Our final cohort included 1,159 males and 1,370 females, with a median follow-up of 2.3 (IQR 1.2, 4.4) years. For temporal trends analysis, the entire population was divided according to period of procedure: 2008 to 2012 and 2013 to 2016. During the 2008 to 2012 period, the rates of in-hospital aortic paravalvular leak, myocardial infarction, pacemaker implantation, and stroke were higher among men than women, but became comparable between the gender during the 2013 to 2016 period. Multivariate analysis demonstrated that female patients who underwent TAVI between the years 2008 and 2012 had a 26% lower risk of death compared with male patients (p = 0.004), but there were no gender-related differences in mortality risk between the years 2013 and 2016 (hazard ratio 1.07, p = 0.6; gender-by-year of procedure, p = 0.027 for interaction). In conclusion, the favorable long-term prognosis described in female patients during the earlier TAVI period seemed to diminish with contemporary TAVI. This might be attributed to current technological advances and improved valve sizing, with a more significant benefit in favor of male patients.
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Affiliation(s)
- Osnat Itzhaki Ben Zadok
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ariel Finkelstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiology, Sourasky Medical Center, Tel Aviv, Israel
| | - Israel Barbash
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Leviev Heart Center, Chaim Sheba Medical Center, Tel HaShomer Hospital, Ramat Gan, Israel
| | - Haim Danenberg
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amit Segev
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Leviev Heart Center, Chaim Sheba Medical Center, Tel HaShomer Hospital, Ramat Gan, Israel
| | - Victor Guetta
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Leviev Heart Center, Chaim Sheba Medical Center, Tel HaShomer Hospital, Ramat Gan, Israel
| | - Amir Halkin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiology, Sourasky Medical Center, Tel Aviv, Israel
| | - Hana Vaknin
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Planer
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Abid Assali
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Barsheshet
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Katia Orvin
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Malhotra A. Prosthesis patient mismatch: myth or reality? Indian J Thorac Cardiovasc Surg 2019; 35:3-5. [PMID: 33060962 PMCID: PMC7525692 DOI: 10.1007/s12055-018-0708-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- Amber Malhotra
- Department of Cardio vascular and Thoracic Surgery, U. N. Mehta Institute of Cardiology and Research Center, Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat 380016 India
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Chieffo A, Buchanan GL, Mehilli J, Capodanno D, Kunadian V, Petronio AS, Mikhail GW, Capranzano P, Gonzal N, Karam N, Manzo-Silberman S, Schüpke S, Byrne RA, Capretti G, Appelman Y, Morice MC, Presbitero P, Radu M, Mauri J. Percutaneous coronary and structural interventions in women: a position statement from the EAPCI Women Committee. EUROINTERVENTION 2018; 14:e1227-e1235. [PMID: 29786536 DOI: 10.4244/eij-d-18-00225] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Several expert documents on sex-based differences in interventional outcomes are now available, however this is the first position paper from the EAPCI Women Committee discussing the potential influence of sex in the percutaneous treatment of coronary and structural heart disease. Despite the misconception that coronary artery disease is a 'man's disease', contemporary data shows a growing incidence in women. However, women are under-represented in randomised coronary clinical trials (~25%). The generalisation of such studies is therefore problematic in decision-making for females undergoing coronary intervention. Differences in pathophysiology between sexes exist, highlighting the need for greater awareness amongst healthcare professionals to enable best evidence-based therapies for women as well as for men. Reassuringly, women represent half of the population included in transcatheter aortic valve implantation clinical trials and may actually benefit more. Growing evidence is also emerging for other interventional atrial procedures which may well be advantageous to women. Awareness of sex disparities is increasing, and we must all work collaboratively within our profession to ensure we provide effective care for all patients with heart disease. The EAPCI Women Committee aim to highlight such issues through this position paper and through visibility within the interventional community.
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Suzuki-Eguchi N, Murata M, Itabashi Y, Shirakawa K, Fukuda M, Endo J, Tsuruta H, Arai T, Hayashida K, Shimizu H, Fukuda K. Prognostic value of pre-procedural left ventricular strain for clinical events after transcatheter aortic valve implantation. PLoS One 2018; 13:e0205190. [PMID: 30308001 PMCID: PMC6181329 DOI: 10.1371/journal.pone.0205190] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 08/28/2018] [Indexed: 12/04/2022] Open
Abstract
Background Transcatheter aortic valve implantation (TAVI) is an alternative therapy for surgically high-risk patients with severe aortic stenosis (AS). Although TAVI improves survival of patients with severe AS, the mechanism of this effect remains to be clarified. We investigated the effects of TAVI on left ventricular (LV) function and identified the predictive parameters for cardiac events after TAVI. Methods and results We studied 128 patients with severe symptomatic AS who underwent TAVI. Echocardiographic assessments were performed before and after TAVI. In addition to the conventional echocardiographic parameters such as LV ejection fraction (LVEF) and LV mass index (LVMI), the LV global longitudinal strain (GLS) and early diastolic peak strain rate (SR_E) using two-dimensional speckle tracking echocardiography were also evaluated. All patients were assessed for clinical events including major adverse cardiac events and stroke according to Valve Academic Research Consortium-2 criteria. GLS, early diastolic peak velocity (eʹ), aortic regurgitation (AR) severity, and SR_E were significantly improved after TAVI. Thirteen patients had an event during the observational period of 591 days (median). Patients with events had higher LVMI, more severe AR, and worse GLS compared to those without events. Furthermore, receiver-operating curve analysis revealed that GLS was the strongest predictor for clinical events (p = 0.009; area under the curve, 0.73). Conclusion Preoperative LV geometric deformation and dysfunction, as a consequence of the cumulative burden of pressure overload, improved after TAVI and could predict cardiac events after TAVI.
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Affiliation(s)
| | - Mitsushige Murata
- Center for Preventive Medicine, Keio University Hospital, Tokyo, Japan
- * E-mail:
| | - Yuji Itabashi
- Department of Laboratory Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Kousuke Shirakawa
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Memori Fukuda
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Jin Endo
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Hikaru Tsuruta
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Takahide Arai
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
| | - Hideyuki Shimizu
- Cardiovascular Surgery, School of Medicine, Keio University, Tokyo, Japan
| | - Keiichi Fukuda
- Department of Cardiology, School of Medicine, Keio University, Tokyo, Japan
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Broyd CJ, Panoulas V, Mattar W, Akhtar M, Shekarchi-Khanghahi E, Ioannou A, Raja SG, Mason M, Rahman-Haley S, Skondras E, Dalby M, Luscher TF, Kabir T. Effect of Aortic Valve Calcium Quantity on Outcome After Balloon Aortic Valvuloplasty for Severe Aortic Stenosis. Am J Cardiol 2018; 122:1036-1041. [PMID: 30086876 DOI: 10.1016/j.amjcard.2018.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/23/2018] [Accepted: 05/30/2018] [Indexed: 11/28/2022]
Abstract
Balloon aortic valvuloplasty has a role in a select group of patients with severe aortic stenosis. Identifying those appropriate patients who will benefit most is key. Given previous evidence demonstrating that histologically the intervention involves a physical disrupting of the cusp's calcium we hypothesized that the quantity of calcium seen at CT will influence outcome. We examined our cohort of patients who had undergone balloon aortic valvuloplasty and CT-quantified aortic valve calcium (AVC) between July 2011 and April 2014. All patients underwent echocardiography pre- and post-procedure and for those patients managed medically, again at 6 months. A potential predictive AVC value for mortality was calculated using Youden's index. A total of 240 aortic valvuloplasties were performed in 206 patients (male = 124). Valvuloplasty caused a significant (pre 0.63 ± 0.21 vs post 0.77 ± 0.27 cm2, p <0.01, n = 240), but temporary (post 0.80 ± 0.27 vs 6 months: 0.64 ± 0.18 cm2, p <0.01, n = 88) increase in valve area. Those patients with a non-severe AVC (<1853.5 AU) had a larger increase in valve area after valvuloplasty compared with those with more calcium (0.10 [95% confidence interval {CI} 0.05 to 0.10] vs 0.15 [95%CI 0.10 to 0.22] cm2, p = 0.049). Multivariate analysis revealed severe AVC (Hazard ratio 2.79, 95% CI 1.18 to 6.63, p = 0.02) along with pulmonary artery pressure post-valvuloplasty (Hazard ratio 1.02, 95% CI 1.00 to 1.03, p = 0.03) to be predictive of survival. In conclusion, in patients with severe aortic stenosis the degree of AVC impacts on the success of valvuloplasty.
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Affiliation(s)
- Christopher J Broyd
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom.
| | - Vasileios Panoulas
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom; Imperial College London
| | - Wala Mattar
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom
| | - Mohammed Akhtar
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom
| | - Eliana Shekarchi-Khanghahi
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom
| | - Adam Ioannou
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom
| | - Shahzad G Raja
- Department of Cardiac Surgery, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom
| | - Mark Mason
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom
| | - Shelley Rahman-Haley
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom
| | - Evangelos Skondras
- Department of Imaging, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom
| | - Miles Dalby
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom; Imperial College London
| | - Thomas F Luscher
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom; Imperial College London
| | - Tito Kabir
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom
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49
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Panoulas VF, Francis DP, Ruparelia N, Malik IS, Chukwuemeka A, Sen S, Anderson J, Nihoyannopoulos P, Sutaria N, Hannan EL, Samadashvili Z, D'Errigo P, Schymik G, Mehran R, Chieffo A, Latib A, Presbitero P, Mehilli J, Petronio AS, Morice MC, Tamburino C, Thyregod HGH, Leon M, Colombo A, Mikhail GW. Female-specific survival advantage from transcatheter aortic valve implantation over surgical aortic valve replacement: Meta-analysis of the gender subgroups of randomised controlled trials including 3758 patients. Int J Cardiol 2018; 250:66-72. [PMID: 29169764 DOI: 10.1016/j.ijcard.2017.05.047] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 03/05/2017] [Accepted: 05/09/2017] [Indexed: 01/09/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) is the first area of interventional cardiology where women are treated as often as men. In this analysis of the gender specific results of randomised controlled trials (RCTs) comparing TAVI with surgical aortic valve replacement (SAVR) we aimed to determine whether gender affects the survival comparison between TAVI and SAVR. We identified all RCTs comparing TAVI versus SAVR for severe AS and reporting 1 and/or 2year survival. Summary odds ratios (ORs) were obtained using a random-effects model. Heterogeneity was assessed using the Q statistic and I2. Four RCTs met the criteria, totalling 3758 patients, 1706 women and 2052 men. Amongst females, TAVI recipients had a significantly lower mortality than SAVR recipients, at 1year (OR 0.68; 95%CI 0.50 to 0.94) and at 2years (OR 0.74; 95%CI 0.58 to 0.95). Amongst males there was no difference in mortality between TAVI and SAVR, at 1year (OR 1.09; 95%CI 0.86 to 1.39) or 2years (OR 1.05; 95%CI 0.85 to 1.3). The difference in treatment effect between genders was significant at both 1year (pinteraction=0.02) and 2years (pinteraction=0.04). In women TAVI has a 26 to 31% lower mortality odds than SAVR. In men, there is no difference in mortality between TAVI and SAVR.
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Affiliation(s)
- Vasileios F Panoulas
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Darrel P Francis
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
| | - Neil Ruparelia
- Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Iqbal S Malik
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Andrew Chukwuemeka
- Cardiothoracic Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Sayan Sen
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Jonathan Anderson
- Cardiothoracic Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust
| | - Petros Nihoyannopoulos
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Nilesh Sutaria
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK
| | - Edward L Hannan
- School of Public Health, University at Albany, State University of New York, Albany, NY, USA
| | - Zaza Samadashvili
- School of Public Health, University at Albany, State University of New York, Albany, NY, USA
| | - Paola D'Errigo
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | - Gerhard Schymik
- Medical Clinic IV, Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Freiburg, Germany
| | - Roxana Mehran
- Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Alaide Chieffo
- Cardiology department, San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Cardiology department, San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Presbitero
- Hemodynamic and Invasive Cardiology Unit, IRCCS Istituto Clinico Humanitas, Milan, Italy
| | - Julinda Mehilli
- Munich University Clinic, Ludwig-Maximilians University, Munich, Germany,; Munich Heart Alliance at Deutsches Zentrum für Herz-Kreislauf-Forschung, Munich, Germany
| | | | - Marie-Claude Morice
- RAMSAY, Génerale de Santé,ICPS, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Italy; ETNA Foundation, Catania, Italy
| | - Hans G H Thyregod
- Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Martin Leon
- Columbia University Medical Center, New York, USA
| | - Antonio Colombo
- Cardiology department, San Raffaele Scientific Institute, Milan, Italy
| | - Ghada W Mikhail
- Cardiovascular Sciences, National Heart and Lung Institute, Imperial College London, London, UK; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK
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Abstract
PURPOSE OF REVIEW Grading of aortic stenosis is essential in aortic stenosis management patients. However, despite clear thresholds provided in the guidelines, up to 30% of patients have discordant grading of aortic stenosis. The management of patients with low gradients/velocity despite tight aortic valve area is challenging. RECENT FINDINGS Recent studies demonstrated that patients with or without low flow may have a severe aortic stenosis despite a low gradient. Moreover, aortic valve replacement has been shown to improve outcome in low-gradient aortic stenosis patients with or without low flow. Finally, measurement of aortic valve calcification by multidetector computed tomography is an important tool to assess aortic stenosis severity in these patients. SUMMARY The presence of a low gradient/velocity despite a tight aortic valve area could be linked to low ejection fraction or low flow with preserved ejection fraction but also with normal flow and normal ejection fraction. In each situation, aortic stenosis could be truly severe or pseudosevere, and the severity of aortic stenosis has to be accurately evaluated for clinical decision-making. Nowadays, two types of interventions are available: surgical and transcatheter aortic valve replacement, whereas conservative management should be considered as a palliative treatment in patients with proven severe aortic stenosis and symptoms or left ventricle dysfunction.
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