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Kim M, Kang DY, Ahn JM, Kim JB, Yeung AC, Nishi T, Fearon WF, Cantey EP, Flaherty JD, Davidson CJ, Malaisrie SC, Kim HJ, Lee J, Park J, Kim H, Cho S, Choi Y, Park SJ, Park DW. Sex-Specific Disparities in Clinical Outcomes After Transcatheter Aortic Valve Replacement Among Different Racial Populations. JACC Asia 2024; 4:292-302. [PMID: 38660112 PMCID: PMC11035955 DOI: 10.1016/j.jacasi.2023.11.016] [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] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 04/26/2024]
Abstract
Background Sex-related disparities in clinical outcomes following transcatheter aortic valve replacement (TAVR) and the impact of sex on clinical outcomes after TAVR among different racial groups are undetermined. Objectives This study assessed whether sex-specific differences in baseline clinical and anatomical characteristics affect clinical outcomes after TAVR and investigated the impact of sex on clinical outcomes among different racial groups. Methods The TP-TAVR (Trans-Pacific TAVR) registry is a multinational cohort study of patients with severe aortic stenosis who underwent TAVR at 2 major centers in the United States and 1 major center in South Korea. The primary outcome was a composite of death from any cause, stroke, or rehospitalization after 1 year. Results The incidence of the primary composite outcome was not significantly different between sexes (27.9% in men vs 28% in women; adjusted HR: 0.97; 95% CI: 0.79-1.20). This pattern was consistent in Asian (23.5% vs 23.3%; adjusted HR: 0.99; 95% CI: 0.69-1.41) and non-Asian (30.8% vs 31.6%; adjusted HR: 0.95; 95% CI: 0.72-1.24) cohorts, without a significant interaction between sex and racial group (P for interaction = 0.74). The adjusted risk for all-cause mortality was similar between sexes, regardless of racial group. However, the adjusted risk of stroke was significantly lower in male patients than in female patients, which was more prominent in the non-Asian cohort. Conclusions Despite significantly different baseline and procedural characteristics, there were no sex-specific differences in the adjusted 1-year rates of primary composite outcomes and all-cause mortality, regardless of different racial groups. (Transpacific TAVR registry [TP-TAVR]; NCT03826264).
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Affiliation(s)
- Mijin Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Juyong Brian Kim
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Alan C. Yeung
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Takeshi Nishi
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - William F. Fearon
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Eric P. Cantey
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - James D. Flaherty
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - Charles J. Davidson
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - S. Christopher Malaisrie
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - Hwa Jung Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jinho Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jinsun Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hoyun Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Suji Cho
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yeonwoo Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Dowling C, Haeffele C, Yeung AC, Sharma RP. Emergency Transcatheter Repair for Anterior Leaflet Tear Following Percutaneous Balloon Mitral Valvuloplasty. JACC Case Rep 2023; 23:101980. [PMID: 37954949 PMCID: PMC10635879 DOI: 10.1016/j.jaccas.2023.101980] [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: 03/19/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 11/14/2023]
Abstract
We present the case of a 66-year-old woman who developed severe mitral regurgitation from rupture of the anterior mitral valve leaflet following percutaneous balloon mitral valvuloplasty. Emergency transcatheter mitral valve repair was used to reduce the severity of mitral regurgitation and facilitate definitive surgical treatment. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Cameron Dowling
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Christiane Haeffele
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Alan C. Yeung
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Rahul P. Sharma
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
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Zimmermann FM, Ding VY, Pijls NHJ, Piroth Z, van Straten AHM, Szekely L, Davidavicius G, Kalinauskas G, Mansour S, Kharbanda R, Östlund-Papadogeorgos N, Aminian A, Oldroyd KG, Al-Attar N, Jagic N, Dambrink JHE, Kala P, Angeras O, MacCarthy P, Wendler O, Casselman F, Witt N, Mavromatis K, Miner SES, Sarma J, Engstrøm T, Christiansen EH, Tonino PAL, Reardon MJ, Otsuki H, Kobayashi Y, Hlatky MA, Mahaffey KW, Desai M, Woo YJ, Yeung AC, De Bruyne B, Fearon WF. Fractional Flow Reserve-Guided PCI or Coronary Bypass Surgery for 3-Vessel Coronary Artery Disease: 3-Year Follow-Up of the FAME 3 Trial. Circulation 2023; 148:950-958. [PMID: 37602376 DOI: 10.1161/circulationaha.123.065770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Previous studies comparing percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG) in patients with multivessel coronary disease not involving the left main have shown significantly lower rates of death, myocardial infarction (MI), or stroke after CABG. These studies did not routinely use current-generation drug-eluting stents or fractional flow reserve (FFR) to guide PCI. METHODS FAME 3 (Fractional Flow Reserve versus Angiography for Multivessel Evaluation) is an investigator-initiated, multicenter, international, randomized trial involving patients with 3-vessel coronary artery disease (not involving the left main coronary artery) in 48 centers worldwide. Patients were randomly assigned to receive FFR-guided PCI using zotarolimus drug-eluting stents or CABG. The prespecified key secondary end point of the trial reported here is the 3-year incidence of the composite of death, MI, or stroke. RESULTS A total of 1500 patients were randomized to FFR-guided PCI or CABG. Follow-up was achieved in >96% of patients in both groups. There was no difference in the incidence of the composite of death, MI, or stroke after FFR-guided PCI compared with CABG (12.0% versus 9.2%; hazard ratio [HR], 1.3 [95% CI, 0.98-1.83]; P=0.07). The rates of death (4.1% versus 3.9%; HR, 1.0 [95% CI, 0.6-1.7]; P=0.88) and stroke (1.6% versus 2.0%; HR, 0.8 [95% CI, 0.4-1.7]; P=0.56) were not different. MI occurred more frequently after PCI (7.0% versus 4.2%; HR, 1.7 [95% CI, 1.1-2.7]; P=0.02). CONCLUSIONS At 3-year follow-up, there was no difference in the incidence of the composite of death, MI, or stroke after FFR-guided PCI with current-generation drug-eluting stents compared with CABG. There was a higher incidence of MI after PCI compared with CABG, with no difference in death or stroke. These results provide contemporary data to allow improved shared decision-making between physicians and patients with 3-vessel coronary artery disease. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02100722.
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Affiliation(s)
- Frederik M Zimmermann
- Catharina Hospital, Eindhoven, the Netherlands (F.M.Z., N.H.J.P., A.H.M.v.S., P.A.L.T.)
| | - Victoria Y Ding
- Quantitative Sciences Unit (V.Y.D., M.D.), Stanford University, CA
| | - Nico H J Pijls
- Catharina Hospital, Eindhoven, the Netherlands (F.M.Z., N.H.J.P., A.H.M.v.S., P.A.L.T.)
| | - Zsolt Piroth
- Gottsegen National Cardiovascular Center, Hungary (Z.P., L.S.)
| | | | - Laszlo Szekely
- Gottsegen National Cardiovascular Center, Hungary (Z.P., L.S.)
| | - Giedrius Davidavicius
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, Lithuania (G.D., G.K.)
- Vilnius University Hospital Santaros Klinikos, Lithuania (G.D., G.K.)
| | - Gintaras Kalinauskas
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, Lithuania (G.D., G.K.)
- Vilnius University Hospital Santaros Klinikos, Lithuania (G.D., G.K.)
| | - Samer Mansour
- Centre Hospitalier de l'Université de Montréal, Canada (S.M.)
| | | | | | - Adel Aminian
- Centre Hospitalier Universitaire de Charleroi, Belgium (A.A.)
| | - Keith G Oldroyd
- Golden Jubilee National Hospital, Glasgow, UK (K.G.O., N.A.-A.)
| | - Nawwar Al-Attar
- Golden Jubilee National Hospital, Glasgow, UK (K.G.O., N.A.-A.)
| | - Nikola Jagic
- Clinical Hospital Centre Zemun, University of Belgrade, Serbia (N.J.)
| | | | - Petr Kala
- Medical Faculty of Masaryk University and University Hospital Brno, Czech Republic (P.K.)
| | | | | | | | | | - Nils Witt
- Södersjukhuset Hospital, Stockholm, Sweden (N.W.)
- Karolinska Institutet, Solna, Sweden (N.W.)
| | - Kreton Mavromatis
- Atlanta VA Healthcare System, Decatur, GA (K.M.)
- Emory University School of Medicine, Atlanta, GA (K.M.)
| | | | | | | | | | - Pim A L Tonino
- Catharina Hospital, Eindhoven, the Netherlands (F.M.Z., N.H.J.P., A.H.M.v.S., P.A.L.T.)
| | | | - Hisao Otsuki
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (H.O., A.C.Y., W.F.F.), Stanford University, CA
| | - Yuhei Kobayashi
- New York Presbyterian Brooklyn Methodist and Weill Cornell Medical College (Y.K.)
| | - Mark A Hlatky
- Departments of Health Policy and Medicine (M.A.H.), Stanford University, CA
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, CA (K.W.M.)
| | - Manisha Desai
- Quantitative Sciences Unit (V.Y.D., M.D.), Stanford University, CA
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery (Y.J.W.), Stanford University, CA
| | - Alan C Yeung
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (H.O., A.C.Y., W.F.F.), Stanford University, CA
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, Belgium (F.C., B.D.)
- Lausanne University Centre Hospital, Switzerland (B.D.)
| | - William F Fearon
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (H.O., A.C.Y., W.F.F.), Stanford University, CA
- VA Palo Alto Health Care System, CA (W.F.F.)
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Kobayashi Y, Takahashi T, Zimmermann FM, Otsuki H, El Farissi M, Oldroyd KG, Wendler O, Reardon MJ, Woo YJ, Yeung AC, De Bruyne B, Pijls NHJ, Fearon WF. Outcomes Based on Angiographic vs Functional Significance of Complex 3-Vessel Coronary Disease: FAME 3 Trial. JACC Cardiovasc Interv 2023; 16:2112-2119. [PMID: 37704297 DOI: 10.1016/j.jcin.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND The functional SYNTAX score (FSS), which incorporates functional information as assessed by fractional flow reserve (FFR), is a better predictor of outcome after percutaneous coronary intervention (PCI) in patients with less complex coronary artery disease (CAD). OBJECTIVES This study sought to test the prognostic value of the FSS in patients with complex CAD eligible for coronary artery bypass grafting (CABG). METHODS The FAME 3 (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation 3) trial compared FFR-guided PCI with CABG in patients with angiographic 3-vessel CAD. In this prespecified substudy, the angiographic core laboratory calculated the SYNTAX score (SS) and then the FSS by eliminating lesions that were not significant based on FFR. Outcomes in the PCI patients based on the FSS and the SS were compared to each other and to the patients treated with CABG. RESULTS The FSS reclassified more than one-quarter of patients from an SS >22 to an FSS ≤22. In the 50% of PCI patients who had an FSS ≤22, the primary endpoint occurred at a similar rate to patients treated with CABG (P = 0.77). The primary endpoint in patients without functionally significant 3-vessel CAD was similar to the CABG group (P = 0.97). The rate of myocardial infarction and revascularization among all deferred lesions was 0.5% and 3.2%, respectively. CONCLUSIONS By measuring the FSS, one can identify 50% of patients who have a similar outcome at 1 year with PCI compared with CABG. Lesions deferred from PCI based on FFR have a low event rate.
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Affiliation(s)
- Yuhei Kobayashi
- New York-Presbyterian Brooklyn Methodist Hospital, Weill Cornell Medical College, Brooklyn, New York, USA.
| | - Tatsunori Takahashi
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Hisao Otsuki
- Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, California, USA
| | | | | | | | | | - Y Joseph Woo
- Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, California, USA
| | - Alan C Yeung
- Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, California, USA
| | | | | | - William F Fearon
- Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, California, USA; VA Palo Alto Medical Systems, Palo Alto, California, USA.
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Kim H, Kang DY, Ahn JM, Kim JB, Yeung AC, Nishi T, Fearon WF, Cantey EP, Flaherty JD, Davidson CJ, Malaisrie SC, Kim N, Kim M, Lee J, Park J, Choi Y, Park SJ, Park DW. Race-Specific Impact of Conventional Surgical Risk Score on 1-Year Mortality After Transcatheter Aortic Valve Replacement. JACC Asia 2023; 3:376-387. [PMID: 37323869 PMCID: PMC10261892 DOI: 10.1016/j.jacasi.2022.11.007] [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] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/31/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
Background Interracial differences in the distribution and prognostic value of conventional Society of Thoracic Surgeons (STS) score on long-term mortality after transcatheter aortic valve replacement (TAVR) are uncertain. Objectives This study aims to compare the impact of STS scores on clinical outcomes at 1-year after TAVR between Asian and non-Asian populations. Methods We used the Trans-Pacific TAVR (TP-TAVR) registry, a multinational multicenter, observational registry involving patients undergoing TAVR at 2 major centers in the United States and 1 major center in Korea. Patients were classified into 3 groups (low, intermediate, and high-risk) according to the STS score and compared between STS risk groups and race. The primary outcome was all-cause mortality at 1-year. Results Among 1,412 patients, 581 were Asian and 831 were non-Asian. The distribution of the STS risk score group was different between Asian and non-Asian groups (62.5% low-, 29.8% intermediate-, and 7.7% high-risk in Asian vs 40.6% low-, 39.1% intermediate-, and 20.3% high-risk in non-Asian). In the Asian population, the all-cause mortality at 1-year was substantially higher in the high-risk STS group than in the low- and intermediate-risk groups (3.6% low-risk, 8.7% intermediate-risk, and 24.4% high-risk; log-rank P < 0.001), which was primarily driven by noncardiac mortality. In the non-Asian group, there was a proportional increase in all-cause mortality at 1-year according to the STS risk category (5.3% low-risk, 12.6% intermediate-risk, and 17.8% high-risk; log-rank P < 0.001). Conclusions In this multiracial registry of patients with severe aortic stenosis who underwent TAVR, we identified a differential proportion and prognostic impact of STS score on 1-year mortality between Asian and non-Asian patients (TP-TAVR [Transpacific TAVR Registry]; NCT03826264).
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Affiliation(s)
- Hoyun Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Juyong Brian Kim
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Alan C. Yeung
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Takeshi Nishi
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - William F. Fearon
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Eric P. Cantey
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - James D. Flaherty
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - Charles J. Davidson
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - S. Christopher Malaisrie
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - Nayoung Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Mijin Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jinho Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jinsun Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yeonwoo Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Tanaka S, Okada K, Kitahara H, Luikart H, Yock PG, Yeung AC, Schnittger I, Tremmel JA, Fitzgerald PJ, Khush KK, Fearon WF, Honda Y. Impact of myocardial bridging on coronary artery plaque formation and long-term mortality after heart transplantation. Int J Cardiol 2023; 379:24-32. [PMID: 36893856 PMCID: PMC10085846 DOI: 10.1016/j.ijcard.2023.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 10/12/2022] [Revised: 02/25/2023] [Accepted: 03/05/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES This study aimed to explore the impact of myocardial bridging (MB) on early development of cardiac allograft vasculopathy and long-term graft survival after heart transplantation. BACKGROUND MB has been reported to be associated with acceleration of proximal plaque development and endothelial dysfunction in native coronary atherosclerosis. However, its clinical significance in heart transplantation remains unclear. METHODS In 103 heart-transplant recipients, serial (baseline and 1-year post-transplant) volumetric intravascular ultrasound (IVUS) analyses were performed in the first 50 mm of the left anterior descending (LAD) artery. Standard IVUS indices were evaluated in 3 equally divided LAD segments (proximal, middle, and distal segments). MB was defined by IVUS as an echolucent muscular band lying on top of the artery. The primary endpoint was death or re-transplantation, assessed for up to 12.2 years (median follow-up: 4.7 years). RESULTS IVUS identified MB in 62% of the study population. At baseline, MB patients had smaller intimal volume in the distal LAD than non-MB patients (p = 0.002). During the first year, vessel volume decreased diffusely irrespective of the presence of MB. Intimal growth diffusely distributed in non-MB patients, whereas MB patients demonstrated significantly augmented intimal formation in the proximal LAD. Kaplan-Meier analysis revealed significantly lower event-free survival in patients with versus without MB (log-rank p = 0.02). In multivariate analysis, the presence of MB was independently associated with late adverse events [hazard ratio 5.1 (1.6-22.2)]. CONCLUSION MB appears to relate to accelerated proximal intimal growth and reduced long-term survival in heart-transplant recipients.
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Affiliation(s)
- Shigemitsu Tanaka
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Kozo Okada
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Hideki Kitahara
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Helen Luikart
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Paul G Yock
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Ingela Schnittger
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Peter J Fitzgerald
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Kiran K Khush
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
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7
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Dowling C, Gooley R, McCormick L, Sharma RP, Yeung AC, Fearon WF, Dargan J, Khan F, Firoozi S, Brecker SJ. Ongoing experience with patient-specific computer simulation of transcatheter aortic valve replacement in bicuspid aortic valve. Cardiovasc Revasc Med 2023; 51:31-37. [PMID: 36740551 DOI: 10.1016/j.carrev.2023.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/07/2022] [Revised: 12/23/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is increasingly being used to treat younger, lower-risk patients with bicuspid aortic valve (BAV). Patient-specific computer simulation may identify patients at risk for developing paravalvular regurgitation (PVR) and major conduction disturbance. Only limited prospective experience of this technology exist. We wished to describe our ongoing experience with patient-specific computer simulation. METHODS Patients who were referred for consideration of TAVR with a self-expanding transcatheter heart valve (THV) and had BAV identified on pre-procedural cardiac computed tomography imaging underwent patient-specific computer simulation. The computer simulations were reviewed by the Heart Team and used to guide surgical or transcatheter treatment approaches and to aid in THV sizing and positioning. Clinical outcomes were recorded. RESULTS Between May 2019 and May 2021, 16 patients with BAV were referred for consideration of TAVR with a self-expanding THV. Sievers Type 1 morphology was present in 15 patients and Type 0 in the remaining patient. Two patients were predicted to develop moderate-to-severe PVR with a TAVR procedure and these patients underwent successful surgical aortic valve replacement. In the remaining 14 patients, computer simulation was used to optimize THV sizing and positioning to minimise PVR and conduction disturbance. One patient with a low valve implantation depth developed moderate PVR and this complication was correctly predicted by the computer simulations. No patient required insertion of a new permanent pacemaker. CONCLUSION Patient-specific computer simulation may be used to guide the most appropriate treatment modality for patients with BAV. The usage of computer simulation to guide THV sizing and positioning was associated with favourable clinical outcomes.
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Affiliation(s)
- Cameron Dowling
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.
| | - Robert Gooley
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Liam McCormick
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Rahul P Sharma
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - James Dargan
- Cardiology Clinical Academic Group, St. George's University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Faisal Khan
- Cardiology Clinical Academic Group, St. George's University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sami Firoozi
- Cardiology Clinical Academic Group, St. George's University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Stephen J Brecker
- Cardiology Clinical Academic Group, St. George's University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
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Piroth Z, Otsuki H, Zimmermann FM, Ferenci T, Keulards DCJ, Yeung AC, Pijls NHJ, De Bruyne B, Fearon WF. Prognostic Value of Measuring Fractional Flow Reserve After Percutaneous Coronary Intervention in Patients With Complex Coronary Artery Disease: Insights From the FAME 3 Trial. Circ Cardiovasc Interv 2022; 15:884-891. [PMID: 36121706 DOI: 10.1161/circinterventions.122.012542] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Indexed: 01/10/2023]
Abstract
BACKGROUND We evaluate the prognostic value of measuring fractional flow reserve (FFR) after percutaneous coronary intervention (post-PCI FFR) and intravascular imaging in patients undergoing PCI for 3-vessel coronary artery disease in the FAME 3 trial (Fractional Flow Reserve versus Angiography for Multivessel Evaluation). METHODS The FAME 3 trial is a multicenter, international, randomized study comparing FFR-guided PCI with coronary artery bypass grafting in patients with multivessel coronary artery disease. PCI was not noninferior with respect to the primary end point of death, myocardial infarction, stroke, or repeat revascularization at 1 year. Post-PCI FFR data were acquired on a patient and vessel-related basis. Intravascular imaging guidance was tracked. The primary end point is a comparison of target vessel failure (TVF) defined as a composite of cardiac death, target vessel myocardial infarction, and target vessel revascularization at 1 year based on post-PCI FFR values. Cox regression with robust SEs was used for analysis. RESULTS Of the 757 patients randomized to PCI, 461 (61%) had post-PCI FFR measurement and 11.1% had intravascular imaging performed. The median post-PCI FFR was 0.89 [IQR' 0.85-0.94]. On a vessel-level, post-PCI FFR was found to be a significant predictor of TVF univariately (hazard ratio=0.67 [95% CI' 0.48-0.93] for 0.1 unit increase, P=0.0165). On a patient-level, the single lowest post-PCI FFR value was also found to be a significant predictor of TVF univariately (hazard ratio=0.65 [95% CI' 0.48-0.89] for 0.1 unit increase, P=0.0074). Post-PCI FFR was an independent predictor of TVF in multivariable analysis adjusted for key clinical parameters. Outcomes were similar between patients who had intravascular imaging guidance and those who did not. CONCLUSIONS Post-PCI FFR measurement was a significant predictor of TVF on a vessel and patient level and an independent predictor of outcomes in a population with complex 3-vessel coronary artery disease eligible for coronary artery bypass grafting. The limited use of intravascular imaging did not affect outcomes. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02100722.
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Affiliation(s)
- Zsolt Piroth
- Gottsegen National Cardiovascular Center, Budapest' Hungary (Z.P.)
| | - Hisao Otsuki
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, CA (H.O., A.C.Y., W.F.F.)
| | | | - Tamás Ferenci
- Physiological Controls Research Center, Obuda University and Department of Statistics, Corvinus University of Budapest, Hungary (T.F.)
| | | | - Alan C Yeung
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, CA (H.O., A.C.Y., W.F.F.)
| | - Nico H J Pijls
- Physiological Controls Research Center, Obuda University and Department of Statistics, Corvinus University of Budapest, Hungary (T.F.)
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, Aalst, Belgium and Lausanne University Centre Hospital, Switzerland (B.D.B.)
| | - William F Fearon
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, CA (H.O., A.C.Y., W.F.F.).,Stanford University School of Medicine, Stanford Cardiovascular Institute, and VA Palo Alto Health Care System, CA (W.F.F.)
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Fearon WF, Zimmermann FM, De Bruyne B, Piroth Z, van Straten AHM, Szekely L, Davidavičius G, Kalinauskas G, Mansour S, Kharbanda R, Östlund-Papadogeorgos N, Aminian A, Oldroyd KG, Al-Attar N, Jagic N, Dambrink JHE, Kala P, Angerås O, MacCarthy P, Wendler O, Casselman F, Witt N, Mavromatis K, Miner SES, Sarma J, Engstrøm T, Christiansen EH, Tonino PAL, Reardon MJ, Lu D, Ding VY, Kobayashi Y, Hlatky MA, Mahaffey KW, Desai M, Woo YJ, Yeung AC, Pijls NHJ. Fractional Flow Reserve-Guided PCI as Compared with Coronary Bypass Surgery. N Engl J Med 2022; 386:128-137. [PMID: 34735046 DOI: 10.1056/nejmoa2112299] [Citation(s) in RCA: 141] [Impact Index Per Article: 70.5] [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] [Indexed: 01/10/2023]
Abstract
BACKGROUND Patients with three-vessel coronary artery disease have been found to have better outcomes with coronary-artery bypass grafting (CABG) than with percutaneous coronary intervention (PCI), but studies in which PCI is guided by measurement of fractional flow reserve (FFR) have been lacking. METHODS In this multicenter, international, noninferiority trial, patients with three-vessel coronary artery disease were randomly assigned to undergo CABG or FFR-guided PCI with current-generation zotarolimus-eluting stents. The primary end point was the occurrence within 1 year of a major adverse cardiac or cerebrovascular event, defined as death from any cause, myocardial infarction, stroke, or repeat revascularization. Noninferiority of FFR-guided PCI to CABG was prespecified as an upper boundary of less than 1.65 for the 95% confidence interval of the hazard ratio. Secondary end points included a composite of death, myocardial infarction, or stroke; safety was also assessed. RESULTS A total of 1500 patients underwent randomization at 48 centers. Patients assigned to undergo PCI received a mean (±SD) of 3.7±1.9 stents, and those assigned to undergo CABG received 3.4±1.0 distal anastomoses. The 1-year incidence of the composite primary end point was 10.6% among patients randomly assigned to undergo FFR-guided PCI and 6.9% among those assigned to undergo CABG (hazard ratio, 1.5; 95% confidence interval [CI], 1.1 to 2.2), findings that were not consistent with noninferiority of FFR-guided PCI (P = 0.35 for noninferiority). The incidence of death, myocardial infarction, or stroke was 7.3% in the FFR-guided PCI group and 5.2% in the CABG group (hazard ratio, 1.4; 95% CI, 0.9 to 2.1). The incidences of major bleeding, arrhythmia, and acute kidney injury were higher in the CABG group than in the FFR-guided PCI group. CONCLUSIONS In patients with three-vessel coronary artery disease, FFR-guided PCI was not found to be noninferior to CABG with respect to the incidence of a composite of death, myocardial infarction, stroke, or repeat revascularization at 1 year. (Funded by Medtronic and Abbott Vascular; FAME 3 ClinicalTrials.gov number, NCT02100722.).
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Affiliation(s)
- William F Fearon
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Frederik M Zimmermann
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Bernard De Bruyne
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Zsolt Piroth
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Albert H M van Straten
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Laszlo Szekely
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Giedrius Davidavičius
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Gintaras Kalinauskas
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Samer Mansour
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Rajesh Kharbanda
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Nikolaos Östlund-Papadogeorgos
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Adel Aminian
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Keith G Oldroyd
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Nawwar Al-Attar
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Nikola Jagic
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Jan-Henk E Dambrink
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Petr Kala
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Oskar Angerås
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Philip MacCarthy
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Olaf Wendler
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Filip Casselman
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Nils Witt
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Kreton Mavromatis
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Steven E S Miner
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Jaydeep Sarma
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Thomas Engstrøm
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Evald H Christiansen
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Pim A L Tonino
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Michael J Reardon
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Di Lu
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Victoria Y Ding
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Yuhei Kobayashi
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Mark A Hlatky
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Kenneth W Mahaffey
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Manisha Desai
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Y Joseph Woo
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Alan C Yeung
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
| | - Nico H J Pijls
- From the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute (W.F.F., M.A.H., A.C.Y.), the Quantitative Sciences Unit (D.L., V.Y.D., M.D.), and the Departments of Health Policy (M.A.H.) and Cardiothoracic Surgery (Y.J.W.), Stanford University, and the Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine (K.W.M.), Stanford, and the VA Palo Alto Health Care System, Palo Alto (W.F.F.) - all in California; Catharina Hospital, Eindhoven (F.M.Z., A.H.M.S., P.A.L.T., N.H.J.P.), and Isala Hospital, Zwolle (J.-H.E.D.) - both in the Netherlands; Cardiovascular Center Aalst, Aalst (B.D.B., F.C.), and Centre Hospitalier Universitaire de Charleroi, Charleroi (A.A.) - both in Belgium; Lausanne University Center Hospital, Lausanne, Switzerland (B.D.B.); Gottsegen National Cardiovascular Center, Budapest, Hungary (Z.P., L.S.); the Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Vilnius University, and Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (G.D., G.K.); Centre Hospitalier de l'Université de Montréal, Montreal (S.M.), and Southlake Regional Health Centre, Newmarket, ON (S.E.S.M.) - both in Canada; Oxford University Hospitals NHS Foundation Trust, Oxford (R.K.), Golden Jubilee National Hospital, Glasgow (K.G.O., N.A.-A.), and Wythenshawe Hospital, Manchester (J.S.) - all in the United Kingdom; Danderyd University Hospital (N.Ö.-P.) and Karolinska Institutet (N.Ö.-P., N.W.), Solna, and Sahlgrenska University Hospital, Gothenburg (O.A.) - all in Sweden; Clinical Hospital Centre Zemun, University of Belgrade, Belgrade, Serbia (N.J.); Medical Faculty of Masaryk University and University Hospital Brno, Brno, Czech Republic (P.K.); Kings College Hospital, London (P.M., O.W.); the Atlanta VA Healthcare System, Decatur, GA (K.M.); Rigshospitalet, Copenhagen (T.E.), and Aarhus University Hospital, Aarhus (E.H.C.) - both in Denmark; Houston Methodist Hospital, Houston (M.J.R.); and Montefiore Medical Center, New York (Y.K.)
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Park H, Ahn JM, Kang DY, Kim JB, Yeung AC, Nishi T, Fearon WF, Cantey EP, Flaherty JD, Davidson CJ, Malaisrie SC, Kim S, Yun SC, Ko E, Lee SA, Kim DH, Kim HJ, Kim JB, Choo SJ, Park DW, Park SJ. Racial Differences in the Incidence and Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2021; 14:2670-2681. [PMID: 34838464 DOI: 10.1016/j.jcin.2021.08.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/26/2021] [Revised: 08/04/2021] [Accepted: 08/17/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to compare the incidence and prognostic significance of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) according to racial groups. BACKGROUND PPM after TAVR may be of more concern in Asian populations considering their relatively small annular and valve sizes compared with Western populations. METHODS TP-TAVR (Transpacific TAVR Registry) was an international multicenter cohort study of patients with severe aortic stenosis who underwent TAVR in the United States and South Korea from January 2015 to November 2019. PPM was defined as moderate (0.65-0.85 cm2/m2) or severe (<0.65 cm2/m2) at the indexed effective orifice area. The primary outcome was a composite of death, stroke, or rehospitalization at 1 year. RESULTS Among 1,101 eligible patients (533 Asian and 569 non-Asian), the incidence of PPM was significantly lower in the Asian population (33.6%; moderate, 26.5%; severe, 7.1%) than in the non-Asian population (54.5%; moderate, 29.8%; severe, 24.7%). The 1-year rate of the primary outcome was similar between the PPM and non-PPM groups (27.5% vs 28.1%; P = 0.69); this pattern was consistent between Asian (25.4% vs 25.2%; P = 0.31) and non-Asian (28.7% vs 32.1%; P = 0.97) patients. After multivariable adjustment, the risk for the primary outcome did not significantly differ between the PPM and non-PPM groups in the overall population (HR: 0.95; 95% CI: 0.74-1.21), in Asian patients (HR: 1.07; 95% CI: 0.74-1.55), and in non-Asian patients (HR: 0.86; 95% CI: 0.63-1.19). CONCLUSIONS In this study of patients with severe aortic stenosis who underwent TAVR, the incidence of PPM was significantly lower in Asian patients than in non-Asian patients. The 1-year risk for the primary composite outcome was similar between the PPM and non-PPM groups regardless of racial group. (Transpacific TAVR Registry [TP-TAVR]; NCT03826264).
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Affiliation(s)
- Hanbit Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Juyong Brian Kim
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Alan C Yeung
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Takeshi Nishi
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - William F Fearon
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Eric Page Cantey
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - James D Flaherty
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - Charles J Davidson
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - S Christopher Malaisrie
- Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - Sehee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Cheol Yun
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Euihong Ko
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Ah Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ho Jin Kim
- Division of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joon Bum Kim
- Division of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Suk Jung Choo
- Division of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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11
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Turner VL, Jubran A, Kim JB, Maret E, Moneghetti KJ, Haddad F, Amsallem M, Codari M, Hinostroza V, Mastrodicasa D, Sailer AM, Kobayashi Y, Nishi T, Yeung AC, Watkins AC, Lee AM, Miller DC, Fischbein MP, Fearon WF, Willemink MJ, Fleischmann D. CTA pulmonary artery enlargement in patients with severe aortic stenosis: Prognostic impact after TAVR. J Cardiovasc Comput Tomogr 2021; 15:431-440. [PMID: 33795188 PMCID: PMC10017114 DOI: 10.1016/j.jcct.2021.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/09/2021] [Accepted: 03/13/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Identifying high-risk patients who will not derive substantial survival benefit from TAVR remains challenging. Pulmonary hypertension is a known predictor of poor outcome in patients undergoing TAVR and correlates strongly with pulmonary artery (PA) enlargement on CTA. We sought to evaluate whether PA enlargement, measured on pre-procedural computed tomography angiography (CTA), is associated with 1-year mortality in patients undergoing TAVR. METHODS We retrospectively included 402 patients undergoing TAVR between July 2012 and March 2016. Clinical parameters, including Society of Thoracic Surgeons (STS) score and right ventricular systolic pressure (RVSP) estimated by transthoracic echocardiography were reviewed. PA dimensions were measured on pre-procedural CTAs. Association between PA enlargement and 1-year mortality was analyzed. Kaplan-Meier and Cox proportional hazards regression analyses were performed. RESULTS The median follow-up time was 433 (interquartiles 339-797) days. A total of 56/402 (14%) patients died within 1 year after TAVR. Main PA area (area-MPA) was independently associated with 1-year mortality (hazard ratio per standard deviation equal to 2.04 [95%-confidence interval (CI) 1.48-2.76], p < 0.001). Area under the curve (95%-CI) of the clinical multivariable model including STS-score and RVSP increased slightly from 0.67 (0.59-0.75) to 0.72 (0.72-0.89), p = 0.346 by adding area-MPA. Although the AUC increased, differences were not significant (p = 0.346). Kaplan-Meier analysis showed that mortality was significantly higher in patients with a pre-procedural non-indexed area-MPA of ≥7.40 cm2 compared to patients with a smaller area-MPA (mortality 23% vs. 9%; p < 0.001). CONCLUSIONS Enlargement of MPA on pre-procedural CTA is independently associated with 1-year mortality after TAVR.
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Affiliation(s)
- Valery L Turner
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Ayman Jubran
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Juyong Brian Kim
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
| | - Eva Maret
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institute, Stockholm.
| | - Kegan J Moneghetti
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
| | - Myriam Amsallem
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
| | - Marina Codari
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Virginia Hinostroza
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Domenico Mastrodicasa
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
| | - Anna M Sailer
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Yukari Kobayashi
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
| | - Takeshi Nishi
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
| | - Amelia C Watkins
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA.
| | - Anson M Lee
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA.
| | - D Craig Miller
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA.
| | - Michael P Fischbein
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA.
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
| | - Martin J Willemink
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Dominik Fleischmann
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
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Edwards KS, Chow EKH, Dao C, Hossepian D, Johnson AG, Desai M, Shah S, Lee A, Yeung AC, Fischbein M, Fearon WF. Impact of cognitive behavioral therapy on depression symptoms after transcatheter aortic valve replacement: A randomized controlled trial. Int J Cardiol 2020; 321:61-68. [PMID: 32800909 DOI: 10.1016/j.ijcard.2020.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/05/2019] [Revised: 07/04/2020] [Accepted: 08/07/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Depression is a significant concern after cardiac surgery and has not been studied in patients undergoing transcatheter aortic valve replacement (TAVR). We sought to examine the prevalence of pre-procedure depression and anxiety symptoms and explore whether brief bedside cognitive behavioral therapy (CBT) could prevent post-TAVR psychological distress. METHODS We prospectively recruited consecutive TAVR patients and randomized them to receive brief CBT or treatment as usual (TAU) during their hospitalization. Multi-level regression techniques were used to evaluate changes by treatment arm in depression, anxiety, and quality of life from baseline to 1 month post-TAVR adjusted for sex, race, DM, CHF, MMSE, and STS score. RESULTS One hundred and forty six participants were randomized. The mean age was 82 years, and 43% were female. Self-reported depression and anxiety scores meeting cutoffs for clinical level distress were 24.6% and 23.2% respectively. Both TAU and CBT groups had comparable improvements in depressive symptoms at 1-month (31% reduction for TAU and 35% reduction for CBT, p = .83). Similarly, both TAU and CBT groups had comparable improvements in anxiety symptoms at 1-month (8% reduction for TAU and 11% reduction for CBT, p = .1). Quality of life scores also improved and were not significantly different between the two groups. CONCLUSIONS Pre-procedure depression and anxiety may be common among patients undergoing TAVR. However, TAVR patients show spontaneous improvement in depression and anxiety scores at 1-month follow up, regardless of brief CBT. Further research is needed to determine whether more tailored CBT interventions may improve psychological and medical outcomes.
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Affiliation(s)
| | - Eric K H Chow
- Quantitative Sciences Unit, Stanford University, United States of America
| | - Catherine Dao
- Department of Medicine, Stanford University, United States of America
| | - Derik Hossepian
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, United States of America
| | - Audrey G Johnson
- PGSP-Stanford Psy.D. Consortium, Palo Alto University, United States of America
| | - Manisha Desai
- Quantitative Sciences Unit, Stanford University, United States of America
| | - Sonia Shah
- Department of Medicine, Stanford University, United States of America
| | - Anson Lee
- Department of Cardiothoracic Surgery, Stanford University, United States of America
| | - Alan C Yeung
- Department of Medicine, Stanford University, United States of America
| | - Michael Fischbein
- Department of Cardiothoracic Surgery, Stanford University, United States of America
| | - William F Fearon
- Department of Medicine, Stanford University, United States of America
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Kashiyama K, Okada K, Matsushita K, Hibi K, Hollak MB, Yock P, Yeung AC, Fitzgerald PJ, Honda Y. TCT CONNECT-284 Intravascular Ultrasound Radiofrequency Signal Analysis for Simultaneous Assessment of Functional Significance and Structural Abnormality of Intermediate Coronary Artery Lesions. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.301] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pargaonkar VS, Lee JH, Chow EKH, Nishi T, Ball RL, Kobayashi Y, Kimura T, Lee DP, Stefanick ML, Fearon WF, Yeung AC, Tremmel JA. Dose-Response Relationship Between Intracoronary Acetylcholine and Minimal Lumen Diameter in Coronary Endothelial Function Testing of Women and Men With Angina and No Obstructive Coronary Artery Disease. Circ Cardiovasc Interv 2020; 13:e008587. [PMID: 32279562 DOI: 10.1161/circinterventions.119.008587] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intracoronary acetylcholine (Ach) provocation testing is the gold standard for assessing coronary endothelial function. However, dosing regimens of Ach are quite varied in the literature, and there are limited data evaluating the optimal dose. We evaluated the dose-response relationship between Ach and minimal lumen diameter (MLD) by sex and studied whether incremental intracoronary Ach doses given during endothelial function testing improve its diagnostic utility. METHODS We evaluated 65 men and 212 women with angina and no obstructive coronary artery disease who underwent endothelial function testing using the highest tolerable dose of intracoronary Ach, up to 200 μg. Epicardial endothelial dysfunction was defined as a decrease in MLD >20% after intracoronary Ach by quantitative coronary angiography. We used a linear mixed effects model to evaluate the dose-response relationship. Deming regression analysis was done to compare the %MLD constriction after incremental doses of intracoronary Ach. RESULTS The mean age was 53.5 years. Endothelial dysfunction was present in 186 (68.1%). Among men with endothelial dysfunction, there was a significant decrease in MLD/10 µg of Ach at doses above 50 μg and 100 µg, while this decrease in MLD was not observed in women (P<0.001). The %MLD constriction at 20 μg versus 50 μg and 50 μg versus 100 μg were not equivalent while the %MLD constriction at 100 μg versus 200 μg were equivalent. CONCLUSIONS Women and men appear to have different responses to Ach during endothelial function testing. In addition to having a greater response to intracoronary Ach at all doses, men also demonstrate an Ach-MLD dose-response relationship with doses up to 200 μg, while women have minimal change in MLD with doses above 50 µg. An incremental dosing regimen during endothelial function testing appears to improve the diagnostic utility of the test and should be adjusted based on the sex of the patient.
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Affiliation(s)
- Vedant S Pargaonkar
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute (V.S.P., T.N., Y.K., T.K., D.P.L., W.F.F., A.C.Y., J.A.T.), Stanford School of Medicine, CA
| | - Justin H Lee
- Quantitative Sciences Unit, Department of Medicine (J.H.L., E.K.H.C., R.L.B.), Stanford School of Medicine, CA
| | - Eric K H Chow
- Quantitative Sciences Unit, Department of Medicine (J.H.L., E.K.H.C., R.L.B.), Stanford School of Medicine, CA
| | - Takeshi Nishi
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute (V.S.P., T.N., Y.K., T.K., D.P.L., W.F.F., A.C.Y., J.A.T.), Stanford School of Medicine, CA
| | - Robyn L Ball
- Quantitative Sciences Unit, Department of Medicine (J.H.L., E.K.H.C., R.L.B.), Stanford School of Medicine, CA
| | - Yuhei Kobayashi
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute (V.S.P., T.N., Y.K., T.K., D.P.L., W.F.F., A.C.Y., J.A.T.), Stanford School of Medicine, CA
| | - Takumi Kimura
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute (V.S.P., T.N., Y.K., T.K., D.P.L., W.F.F., A.C.Y., J.A.T.), Stanford School of Medicine, CA.,Department of Cardiology, Iwate Medical University, Morioka, Japan (T.K.)
| | - David P Lee
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute (V.S.P., T.N., Y.K., T.K., D.P.L., W.F.F., A.C.Y., J.A.T.), Stanford School of Medicine, CA
| | - Marcia L Stefanick
- Stanford Prevention Research Center (M.L.S.), Stanford School of Medicine, CA
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute (V.S.P., T.N., Y.K., T.K., D.P.L., W.F.F., A.C.Y., J.A.T.), Stanford School of Medicine, CA
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute (V.S.P., T.N., Y.K., T.K., D.P.L., W.F.F., A.C.Y., J.A.T.), Stanford School of Medicine, CA
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute (V.S.P., T.N., Y.K., T.K., D.P.L., W.F.F., A.C.Y., J.A.T.), Stanford School of Medicine, CA
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Arashi H, Sato T, Kobashigawa J, Luikart H, Kobayashi Y, Okada K, Sinha S, Honda Y, Yeung AC, Khush K, Fearon WF. Long-term clinical outcomes with use of an angiotensin-converting enzyme inhibitor early after heart transplantation. Am Heart J 2020; 222:30-37. [PMID: 32007823 DOI: 10.1016/j.ahj.2020.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/04/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The safety and efficacy of angiotensin converting enzyme inhibition (ACEI) after heart transplantation (HT) is unknown. This study examined long-term clinical outcomes after ACEI in HT recipients. METHODS The ACEI after HT study was a prospective, randomized trial that tested the efficacy of ACEI with ramipril after HT. In this study, long-term clinical outcomes were assessed in 91 patients randomized to either ramipril or placebo (median, 5.8 years). The primary endpoint was a composite of death, retransplantation, hospitalization for rejection or heart failure, and coronary revascularization. RESULTS The primary endpoint occurred in 10 of 45 patients (22.2%) in the ramipril group and in 14 of 46 patients (30.4%) in the placebo group (Hazard ratio (HR), 0.68; 95% CI, 0.29-1.51; P = .34). When the analysis was restricted to comparing patients who remained on a renin-angiotensin system inhibitor beyond 1 year with those who did not, there was a trend to improved outcomes (HR, 0.54; 95% CI, 0.22-1.28, P = .16). There was no significant difference in creatinine, blood urea nitrogen, and potassium at 3 years after randomization. The cumulative incidence of the primary endpoint was significantly higher in patients in whom the index of microcirculatory resistance increased from baseline to 1 year compared with those in whom it did not (39.1 vs 17.4%, HR: 3.36; 95% CI, 1.07-12.7; P = .037). CONCLUSION The use of ramipril after HT safely lowers blood pressure and is associated with favorable long-term clinical outcomes. Clinical Trial Registration-URL: https://www.clinicaltrials.gov. Unique identifier: NCT01078363.
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Willemink MJ, Maret E, Moneghetti KJ, Kim JB, Haddad F, Kobayashi Y, Nishi T, Nieman K, Cauwenberghs N, Kuznetsova T, Higashigaito K, Sailer AM, Yeung AC, Lee AM, Miller DC, Fischbein M, Fearon WF, Fleischmann D. Incremental Value of Aortomitral Continuity Calcification for Risk Assessment after Transcatheter Aortic Valve Replacement. Radiol Cardiothorac Imaging 2019; 1:e190067. [PMID: 33778530 DOI: 10.1148/ryct.2019190067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 08/10/2019] [Accepted: 09/05/2019] [Indexed: 11/11/2022]
Abstract
Purpose To investigate the association of aortomitral continuity calcification (AMCC) with all-cause mortality, postprocedural paravalvular leak (PVL), and prolonged hospital stay in patients undergoing transcatheter aortic valve replacement (TAVR). Materials and Methods The authors retrospectively evaluated 329 patients who underwent TAVR between March 2013 and March 2016. AMCC, aortic valve calcification (AVC), and coronary artery calcification (CAC) were quantified by using preprocedural CT. Pre-procedural Society of Thoracic Surgeons (STS) score was recorded. Associations between baseline AMCC, AVC, and CAC and 1-year mortality, PVL, and hospital stay longer than 7 days were analyzed. Results The median follow-up was 415 days (interquartiles, 344-727 days). After 1 year, 46 of the 329 patients (14%) died and 52 (16%) were hospitalized for more than 7 days. Of the 326 patients who underwent postprocedural echocardiography, 147 (45%) had postprocedural PVL. The CAC score (hazard ratio: 1.11 per 500 points) and AMCC mass (hazard ratio: 1.13 per 500 mg) were associated with 1-year mortality. AVC mass (odds ratio: 1.93 per 100 mg) was associated with postprocedural PVL. Only the STS score was associated with prolonged hospital stay (odds ratio: 1.19 per point). Conclusion AMCC is associated with mortality within 1 year after TAVR and substantially improves individual risk classification when added to a model consisting of STS score and AVC mass only.Supplemental material is available for this article.© RSNA, 2019See also the commentary by Brown and Leipsic in this issue.
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Affiliation(s)
- Martin J Willemink
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Eva Maret
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Kegan J Moneghetti
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Juyong Brian Kim
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Francois Haddad
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Yukari Kobayashi
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Takeshi Nishi
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Koen Nieman
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Nicholas Cauwenberghs
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Tatiana Kuznetsova
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Kai Higashigaito
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Anna M Sailer
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Alan C Yeung
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Anson M Lee
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - D Craig Miller
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Michael Fischbein
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - William F Fearon
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
| | - Dominik Fleischmann
- Department of Radiology (M.J.W., E.M., K.H., A.M.S., D.F.), Stanford Cardiovascular Institute (M.J.W., E.M., K.J.M., J.B.K., F.H., Y.K., T.N., K.N., K.H., A.M.S., A.C.Y., A.M.L., D.C.M., M.F., W.F.F., D.F.), Division of Cardiovascular Medicine (J.B.K., F.H., Y.K., T.N., K.N., A.C.Y., W.F.F.), and Department of Cardiothoracic Surgery (A.M.L., D.C.M., M.F.), Stanford University School of Medicine, 300 Pasteur Dr, S-072, Stanford, CA 94305-5105; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (E.M.); and Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (N.C., T.K.)
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Okada K, Nishi T, Tanaka S, Luikart H, Yock PG, Yeung AC, Hibi K, Kimura K, Schnittger I, Khush K, Fearon W, Honda Y. TCT-345 Impact of Myocardial Bridging on Long-Term Outcomes After Heart Transplantation: Risk Stratification With IVUS-Determined Anatomical Properties. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.427] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Okada K, Honda Y, Luikart H, Yock PG, Fitzgerald PJ, Yeung AC, Valantine HA, Khush KK, Fearon WF. Early invasive assessment of the coronary microcirculation predicts subsequent acute rejection after heart transplantation. Int J Cardiol 2019; 290:27-32. [DOI: 10.1016/j.ijcard.2019.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/12/2019] [Accepted: 04/05/2019] [Indexed: 10/27/2022]
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19
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Zimmermann FM, De Bruyne B, Pijls NH, Desai M, Oldroyd KG, Reardon MJ, Wendler O, Woo J, Yeung AC, Fearon WF. A protocol update of the Fractional Flow Reserve versus Angiography for Multivessel Evaluation (FAME) 3 trial: A comparison of fractional flow reserve-guided percutaneous coronary intervention and coronary artery bypass graft surgery in patients with multivessel coronary artery disease. Am Heart J 2019; 214:156-157. [PMID: 31207442 DOI: 10.1016/j.ahj.2019.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 04/22/2019] [Indexed: 11/27/2022]
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20
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Parikh RV, Pargaonkar V, Ball RL, Kobayashi Y, Kimura T, Yeung AC, Cooke JP, Tremmel JA. Asymmetric dimethylarginine predicts impaired epicardial coronary vasomotion in patients with angina in the absence of obstructive coronary artery disease. Int J Cardiol 2019; 299:7-11. [PMID: 31416658 DOI: 10.1016/j.ijcard.2019.07.062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 08/29/2018] [Revised: 06/17/2019] [Accepted: 07/17/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Impaired epicardial coronary vasomotion is a potential mechanism of angina and a predictor of adverse cardiovascular outcomes in patients without angiographic evidence of obstructive coronary artery disease (CAD). We sought to evaluate the association of asymmetric dimethylarginine (ADMA)-a marker of nitric oxide-mediated vascular dysfunction-with epicardial coronary vasomotor dysfunction in this select population. METHODS Invasive testing for epicardial vasomotor dysfunction was performed using intracoronary acetylcholine in the left anterior descending coronary artery. Impaired vasomotor response was defined as a luminal constriction of >20% on quantitative coronary angiography. Plasma ADMA levels were measured using high performance liquid chromatography. A robust multivariate linear mixed-effect model approach and Akaike information criterion were used to determine predictors of vasomotor dysfunction. RESULTS In 191 patients with angina in the absence of obstructive CAD, abnormal epicardial vasomotion was observed in 137 (71.7%) patients. Median ADMA rose as the extent of impairment progressed: none (0.48 [0.44-0.59] μM), any (0.51 [0.46-0.60] μM, p = 0.12), focal (0.54 [0.49,0.61] μM, p = 0.17), and diffuse (0.55 [0.49,0.63] μM, p = 0.02). In unadjusted analysis, ADMA was highly predictive of vasomotor dysfunction (χ2=15.1, p = 0.002). Notably, ADMA remained a significant predictor even after adjusting for other factors in the best fit model (χ2=10.0, p = 0.02). CONCLUSIONS ADMA is an independent predictor of epicardial coronary vasomotor dysfunction in patients with angina in the absence of obstructive CAD. These data support a very early mechanistic role of ADMA in the continuum of atherosclerotic heart disease.
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Affiliation(s)
- Rushi V Parikh
- Division of Cardiology, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Vedant Pargaonkar
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Robyn L Ball
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Stanford University, Palo Alto, CA, United States of America
| | - Yuhei Kobayashi
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Takumi Kimura
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - John P Cooke
- Department of Cardiovascular Sciences, Texas Methodist Research Institute, Houston, TX, United States of America
| | - Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States of America.
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21
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Kirtane AJ, Yeung AC, Ball M, Carr J, O'Shaughnessy C, Mauri L, Liu M, Leon MB. Long‐term (5‐year) clinical evaluation of the Resolute zotarolimus‐eluting coronary stent: The RESOLUTE US clinical trial. Catheter Cardiovasc Interv 2019; 95:1067-1073. [DOI: 10.1002/ccd.28392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 04/23/2019] [Revised: 06/26/2019] [Accepted: 06/27/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Ajay J. Kirtane
- NewYork‐Presbyterian Hospital/Columbia University Medical Center New York New York
- Clinical Trials CenterCardiovascular Research Foundation New York New York
| | - Alan C. Yeung
- Stanford University School of Medicine Stanford California
| | | | - Jeffrey Carr
- Tyler Cardiac and Endovascular Center and East Texas Medical Center Tyler Texas
| | | | - Laura Mauri
- Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts
| | | | - Martin B. Leon
- NewYork‐Presbyterian Hospital/Columbia University Medical Center New York New York
- Clinical Trials CenterCardiovascular Research Foundation New York New York
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22
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McConnell MV, Shcherbina A, Pavlovic A, Homburger JR, Goldfeder RL, Waggot D, Cho MK, Rosenberger ME, Haskell WL, Myers J, Champagne MA, Mignot E, Landray M, Tarassenko L, Harrington RA, Yeung AC, Ashley EA. Feasibility of Obtaining Measures of Lifestyle From a Smartphone App: The MyHeart Counts Cardiovascular Health Study. JAMA Cardiol 2019; 2:67-76. [PMID: 27973671 DOI: 10.1001/jamacardio.2016.4395] [Citation(s) in RCA: 147] [Impact Index Per Article: 29.4] [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: 11/14/2022]
Abstract
Importance Studies have established the importance of physical activity and fitness, yet limited data exist on the associations between objective, real-world physical activity patterns, fitness, sleep, and cardiovascular health. Objectives To assess the feasibility of obtaining measures of physical activity, fitness, and sleep from smartphones and to gain insights into activity patterns associated with life satisfaction and self-reported disease. Design, Setting, and Participants The MyHeart Counts smartphone app was made available in March 2015, and prospective participants downloaded the free app between March and October 2015. In this smartphone-based study of cardiovascular health, participants recorded physical activity, filled out health questionnaires, and completed a 6-minute walk test. The app was available to download within the United States. Main Outcomes and Measures The feasibility of consent and data collection entirely on a smartphone, the use of machine learning to cluster participants, and the associations between activity patterns, life satisfaction, and self-reported disease. Results From the launch to the time of the data freeze for this study (March to October 2015), the number of individuals (self-selected) who consented to participate was 48 968, representing all 50 states and the District of Columbia. Their median age was 36 years (interquartile range, 27-50 years), and 82.2% (30 338 male, 6556 female, 10 other, and 3115 unknown) were male. In total, 40 017 (81.7% of those who consented) uploaded data. Among those who consented, 20 345 individuals (41.5%) completed 4 of the 7 days of motion data collection, and 4552 individuals (9.3%) completed all 7 days. Among those who consented, 40 017 (81.7%) filled out some portion of the questionnaires, and 4990 (10.2%) completed the 6-minute walk test, made available only at the end of 7 days. The Heart Age Questionnaire, also available after 7 days, required entering lipid values and age 40 to 79 years (among 17 245 individuals, 43.1% of participants). Consequently, 1334 (2.7%) of those who consented completed all fields needed to compute heart age and a 10-year risk score. Physical activity was detected for a mean (SD) of 14.5% (8.0%) of individuals' total recorded time. Physical activity patterns were identified by cluster analysis. A pattern of lower overall activity but more frequent transitions between active and inactive states was associated with equivalent self-reported cardiovascular disease as a pattern of higher overall activity with fewer transitions. Individuals' perception of their activity and risk bore little relation to sensor-estimated activity or calculated cardiovascular risk. Conclusions and Relevance A smartphone-based study of cardiovascular health is feasible, and improvements in participant diversity and engagement will maximize yield from consented participants. Large-scale, real-world assessment of physical activity, fitness, and sleep using mobile devices may be a useful addition to future population health studies.
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Affiliation(s)
- Michael V McConnell
- Department of Medicine, Stanford University, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California3Verily Life Sciences LLC, South San Francisco, California
| | - Anna Shcherbina
- Department of Medicine, Stanford University, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California
| | - Aleksandra Pavlovic
- Department of Medicine, Stanford University, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California
| | | | - Rachel L Goldfeder
- Department of Medicine, Stanford University, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California
| | - Daryl Waggot
- Department of Medicine, Stanford University, Stanford, California5Stanford Center for Cardiovascular Innovation, Stanford University, Stanford, California
| | - Mildred K Cho
- Department of Medicine, Stanford University, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California6Stanford Center for Biomedical Ethics, Stanford University, Stanford, California
| | - Mary E Rosenberger
- Stanford Prevention Research Center, Stanford University, Stanford, California
| | - William L Haskell
- Stanford Prevention Research Center, Stanford University, Stanford, California
| | - Jonathan Myers
- Department of Medicine, Stanford University, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California
| | - Mary Ann Champagne
- Department of Medicine, Stanford University, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California
| | - Emmanuel Mignot
- Stanford Sleep Center, Stanford University, Palo Alto, California
| | - Martin Landray
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, England
| | | | - Robert A Harrington
- Department of Medicine, Stanford University, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California
| | - Alan C Yeung
- Department of Medicine, Stanford University, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California5Stanford Center for Cardiovascular Innovation, Stanford University, Stanford, California
| | - Euan A Ashley
- Department of Medicine, Stanford University, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California4Department of Genetics, Stanford University, Stanford, California
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23
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Hershman SG, Bot BM, Shcherbina A, Doerr M, Moayedi Y, Pavlovic A, Waggott D, Cho MK, Rosenberger ME, Haskell WL, Myers J, Champagne MA, Mignot E, Salvi D, Landray M, Tarassenko L, Harrington RA, Yeung AC, McConnell MV, Ashley EA. Physical activity, sleep and cardiovascular health data for 50,000 individuals from the MyHeart Counts Study. Sci Data 2019; 6:24. [PMID: 30975992 PMCID: PMC6472350 DOI: 10.1038/s41597-019-0016-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/04/2019] [Indexed: 01/21/2023] Open
Abstract
Studies have established the importance of physical activity and fitness for long-term cardiovascular health, yet limited data exist on the association between objective, real-world large-scale physical activity patterns, fitness, sleep, and cardiovascular health primarily due to difficulties in collecting such datasets. We present data from the MyHeart Counts Cardiovascular Health Study, wherein participants contributed data via an iPhone application built using Apple's ResearchKit framework and consented to make this data available freely for further research applications. In this smartphone-based study of cardiovascular health, participants recorded daily physical activity, completed health questionnaires, and performed a 6-minute walk fitness test. Data from English-speaking participants aged 18 years or older with a US-registered iPhone who agreed to share their data broadly and who enrolled between the study's launch and the time of the data freeze for this data release (March 10 2015-October 28 2015) are now available for further research. It is anticipated that releasing this large-scale collection of real-world physical activity, fitness, sleep, and cardiovascular health data will enable the research community to work collaboratively towards improving our understanding of the relationship between cardiovascular indicators, lifestyle, and overall health, as well as inform mobile health research best practices.
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Affiliation(s)
- Steven G Hershman
- Department of Medicine, Stanford University, Stanford, California, USA. .,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA.
| | | | - Anna Shcherbina
- Department of Medicine, Stanford University, Stanford, California, USA
| | | | - Yasbanoo Moayedi
- Department of Medicine, Stanford University, Stanford, California, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA.,Ted Rogers Centre of Excellence for Heart Function, Toronto, Ontario, Canada
| | - Aleksandra Pavlovic
- Department of Medicine, Stanford University, Stanford, California, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Daryl Waggott
- Department of Medicine, Stanford University, Stanford, California, USA.,Stanford Center for Cardiovascular Innovation, Stanford University, Stanford, California, USA
| | - Mildred K Cho
- Department of Medicine, Stanford University, Stanford, California, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA.,Stanford Center for Biomedical Ethics, Stanford University, Stanford, California, USA
| | - Mary E Rosenberger
- Stanford Center on Longevity, Stanford University, Stanford, California, USA
| | - William L Haskell
- Stanford Prevention Research Center, Stanford University, Stanford, California, USA
| | - Jonathan Myers
- Department of Medicine, Stanford University, Stanford, California, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA.,VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Mary Ann Champagne
- Department of Medicine, Stanford University, Stanford, California, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Emmanuel Mignot
- Stanford Sleep Center, Stanford University, Palo Alto, California, USA
| | - Dario Salvi
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Martin Landray
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Robert A Harrington
- Department of Medicine, Stanford University, Stanford, California, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Alan C Yeung
- Department of Medicine, Stanford University, Stanford, California, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA.,Stanford Center for Cardiovascular Innovation, Stanford University, Stanford, California, USA
| | - Michael V McConnell
- Department of Medicine, Stanford University, Stanford, California, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA.,Verily Life Sciences LLC, South San Francisco, California, USA
| | - Euan A Ashley
- Department of Medicine, Stanford University, Stanford, California, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA.,Department of Genetics, Stanford University, Stanford, California, USA
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24
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Yeung AC. New CENTERA Transcatheter Aortic Valve: Best of the Balloon-Expandable and Self-Expanding Valve Worlds? JACC Cardiovasc Interv 2019; 12:681-683. [PMID: 30947943 DOI: 10.1016/j.jcin.2019.02.024] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 02/19/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Alan C Yeung
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California.
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25
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Kim JB, Kobayashi Y, Kuznetsova T, Moneghetti KJ, Brenner DA, O'Malley R, Dao C, Wu JC, Fischbein M, Craig Miller D, Yeung AC, Liang D, Haddad F, Fearon WF. Cytokines profile of reverse cardiac remodeling following transcatheter aortic valve replacement. Int J Cardiol 2019; 270:83-88. [PMID: 30219541 DOI: 10.1016/j.ijcard.2018.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 08/22/2017] [Revised: 04/12/2018] [Accepted: 05/08/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Previous studies have suggested that cytokines and growth factors may predict ventricular recovery following aortic valve replacement (AVR). The primary objective of this study was to identify cytokines that predict ventricular recovery following transcatheter AVR (TAVR). METHODS We prospectively enrolled 121 consecutive patients who underwent TAVR. Standard echocardiographic assessment at baseline, 1-month and 1-year after TAVR included left ventricular (LV) mass index (LVMI) and global longitudinal strain (GLS). Blood samples were obtained at the time of the procedure to measure cytokines using a 63-plex Luminex platform. Partial least squares-discriminant analysis was performed to identify cytokines associated with ventricular remodeling and function at baseline as well as 1 year after TAVR. RESULTS The mean age was 84 ± 9 years, with a majority of male subjects (59%), a mean LVMI of 120.4 ± 45.1 g/m2 and LVGLS of -13.0 ± 3.2%. On average, LV mass decreased by 8.1% and GLS improved by 20.3% at 1 year following TAVR. Among cytokines assayed, elevated hepatocyte growth factor (HGF) emerged as a common factor significantly associated with worse baseline LVMI and GLS as well as reduced ventricular recovery (p < 0.005). Other factors associated with ventricular recovery included a select group of vascular growth factors, inflammatory mediators and tumor necrosis factors, including VEGF-D, ICAM-1, TNFβ, and IL1β. CONCLUSION We identified a network of cytokines, including HGF, that are significantly correlated with baseline LVMI and GLS, and ventricular recovery following TAVR.
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Affiliation(s)
- Juyong Brian Kim
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States; Stanford Cardiovascular Institute, Stanford, CA, United States.
| | - Yukari Kobayashi
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States; Stanford Cardiovascular Institute, Stanford, CA, United States
| | - Tatiana Kuznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Kegan J Moneghetti
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States; Stanford Cardiovascular Institute, Stanford, CA, United States
| | - Daniel A Brenner
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Ryan O'Malley
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Catherine Dao
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Joseph C Wu
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States; Stanford Cardiovascular Institute, Stanford, CA, United States
| | - Michael Fischbein
- Stanford Cardiovascular Institute, Stanford, CA, United States; Department of Cardiovascular Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - D Craig Miller
- Stanford Cardiovascular Institute, Stanford, CA, United States; Department of Cardiovascular Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States; Stanford Cardiovascular Institute, Stanford, CA, United States
| | - David Liang
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States; Stanford Cardiovascular Institute, Stanford, CA, United States
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States; Stanford Cardiovascular Institute, Stanford, CA, United States
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, United States; Stanford Cardiovascular Institute, Stanford, CA, United States.
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26
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Lee JH, Okada K, Khush K, Kobayashi Y, Sinha S, Luikart H, Valantine H, Yeung AC, Honda Y, Fearon WF. Coronary Endothelial Dysfunction and the Index of Microcirculatory Resistance as a Marker of Subsequent Development of Cardiac Allograft Vasculopathy. Circulation 2018; 135:1093-1095. [PMID: 28289008 DOI: 10.1161/circulationaha.116.025268] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jang Hoon Lee
- From Stanford University Medical Center, CA (J.H.L., K.O., K.K., Y.K., H.L. H.V., A.C.Y., Y.H., W.F.F.); Kyunpook National University Hospital, Daegu, Republic of Korea (J.H.L.); and Menlo Medical Clinic, Menlo Park, CA (S.S.)
| | - Kozo Okada
- From Stanford University Medical Center, CA (J.H.L., K.O., K.K., Y.K., H.L. H.V., A.C.Y., Y.H., W.F.F.); Kyunpook National University Hospital, Daegu, Republic of Korea (J.H.L.); and Menlo Medical Clinic, Menlo Park, CA (S.S.)
| | - Kiran Khush
- From Stanford University Medical Center, CA (J.H.L., K.O., K.K., Y.K., H.L. H.V., A.C.Y., Y.H., W.F.F.); Kyunpook National University Hospital, Daegu, Republic of Korea (J.H.L.); and Menlo Medical Clinic, Menlo Park, CA (S.S.)
| | - Yuhei Kobayashi
- From Stanford University Medical Center, CA (J.H.L., K.O., K.K., Y.K., H.L. H.V., A.C.Y., Y.H., W.F.F.); Kyunpook National University Hospital, Daegu, Republic of Korea (J.H.L.); and Menlo Medical Clinic, Menlo Park, CA (S.S.)
| | - Seema Sinha
- From Stanford University Medical Center, CA (J.H.L., K.O., K.K., Y.K., H.L. H.V., A.C.Y., Y.H., W.F.F.); Kyunpook National University Hospital, Daegu, Republic of Korea (J.H.L.); and Menlo Medical Clinic, Menlo Park, CA (S.S.)
| | - Helen Luikart
- From Stanford University Medical Center, CA (J.H.L., K.O., K.K., Y.K., H.L. H.V., A.C.Y., Y.H., W.F.F.); Kyunpook National University Hospital, Daegu, Republic of Korea (J.H.L.); and Menlo Medical Clinic, Menlo Park, CA (S.S.)
| | - Hannah Valantine
- From Stanford University Medical Center, CA (J.H.L., K.O., K.K., Y.K., H.L. H.V., A.C.Y., Y.H., W.F.F.); Kyunpook National University Hospital, Daegu, Republic of Korea (J.H.L.); and Menlo Medical Clinic, Menlo Park, CA (S.S.)
| | - Alan C Yeung
- From Stanford University Medical Center, CA (J.H.L., K.O., K.K., Y.K., H.L. H.V., A.C.Y., Y.H., W.F.F.); Kyunpook National University Hospital, Daegu, Republic of Korea (J.H.L.); and Menlo Medical Clinic, Menlo Park, CA (S.S.)
| | - Yasuhiro Honda
- From Stanford University Medical Center, CA (J.H.L., K.O., K.K., Y.K., H.L. H.V., A.C.Y., Y.H., W.F.F.); Kyunpook National University Hospital, Daegu, Republic of Korea (J.H.L.); and Menlo Medical Clinic, Menlo Park, CA (S.S.)
| | - William F Fearon
- From Stanford University Medical Center, CA (J.H.L., K.O., K.K., Y.K., H.L. H.V., A.C.Y., Y.H., W.F.F.); Kyunpook National University Hospital, Daegu, Republic of Korea (J.H.L.); and Menlo Medical Clinic, Menlo Park, CA (S.S.).
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27
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Parikh RV, Khush K, Pargaonkar VS, Luikart H, Grimm D, Yu M, Okada K, Honda Y, Yeung AC, Valantine H, Fearon WF. Association of Endothelin-1 With Accelerated Cardiac Allograft Vasculopathy and Late Mortality Following Heart Transplantation. J Card Fail 2018; 25:97-104. [PMID: 30543947 DOI: 10.1016/j.cardfail.2018.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 08/27/2018] [Revised: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Endothelin-1 (ET-1) has been implicated in the development of post-heart transplantation (HT) cardiac allograft vasculopathy (CAV), but has not been well studied in humans. METHODS AND RESULTS In 90 HT patients, plasma ET-1 was measured within 8 weeks after HT (baseline) via a competitive enzyme-linked immunosorbent assay. Three-dimensional volumetric intravascular ultrasound of the left anterior descending artery was performed at baseline and at 1 year. Accelerated CAV (lumen volume loss) was defined with the 75th percentile as a cutoff. Patients were followed beyond the first year after HT for late death or retransplantation. A receiver operating characteristic (ROC) curve demonstrated that a baseline ET-1 concentration of 1.75 pg/mL provided the best accuracy for diagnosis of accelerated CAV at 1 year (area under the ROC curve 0.69, 95% confidence interval [CI] 0.57-0.82; P = .007). In multivariate logistic regression, a higher baseline ET-1 concentration was independently associated with accelerated CAV (odds ratio [OR] 2.13, 95% CI 1.15-3.94; P = .01); this relationship persisted when ET-1 was dichotomized at 1.75 pg/mL (OR 4.88, 95% CI 1.69-14.10; P = .003). Eighteen deaths occurred during a median follow-up period of 3.99 (interquartile range 2.51-9.95) years. Treated as a continuous variable, baseline ET-1 was not associated with late mortality in multivariate Cox regression (hazard ratio [HR] 1.22, 95% CI 0.72-2.05; P = .44). However, ET-1 >1.75 pg/mL conferred a significantly lower cumulative event-free survival on Kaplan-Meier analysis (P = .047) and was independently associated with late mortality (HR 2.94, 95% CI 1.12-7.72; P = .02). CONCLUSIONS Elevated ET-1 early after HT is an independent predictor of accelerated CAV and late mortality, suggesting that ET-1 has durable prognostic value in the HT arena.
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Affiliation(s)
- Rushi V Parikh
- Division of Cardiology, University of California, Los Angeles, Los Angeles, California
| | - Kiran Khush
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | | | - Helen Luikart
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - David Grimm
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Michelle Yu
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Kozo Okada
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Hannah Valantine
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA.
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Parikh RV, Khush K, Luikart H, Sakarovitch C, Lee J, Desai M, Valantine H, Yeung AC, Fearon WF. Usefulness of Asymmetric Dimethylarginine to Predict Outcomes After Heart Transplantation. Am J Cardiol 2018; 122:1707-1711. [PMID: 30220417 DOI: 10.1016/j.amjcard.2018.07.048] [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: 03/14/2018] [Revised: 07/21/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
Abstract
Asymmetric dimethylarginine (ADMA) is a key mediator of vascular homeostasis and an independent predictor of the development of accelerated cardiac allograft vasculopathy after heart transplantation. However, its association with clinical outcomes in heart transplant recipients has not been described. Plasma levels of ADMA were assayed within 8 weeks following transplantation (baseline) using a competitive enzyme-linked immunosorbent assay. The primary end point was the composite of nonfatal myocardial infarction, percutaneous coronary intervention, retransplantation, or death at 5-year follow-up. Kaplan-Meier curves were generated to assess the association between baseline ADMA levels (stratified at 0.70 µM, a previously established cutoff) and cumulative event-free survival. Multivariate Cox regression was performed to adjust for other candidate predictors. In 69 heart transplant recipients at Stanford, the primary end point occurred in 11 patients (16%)-4 percutaneous coronary intervention, 1 retransplant, and 6 deaths-during 5-years follow-up. Patients with baseline ADMA ≥0.70 µM had lower cumulative 5-year event-free survival (77% vs 93%, p = 0.059). In multivariate Cox analysis, baseline ADMA was the only significant predictor of the primary end point (hazard ratio 1.33, 95% confidence interval 1.03 to 1.72 per 0.1 µM; p = 0.031). This association remained significant even after restricting the end point to death or retransplantation (hazard ratio 1.48, 95% confidence interval 1.12 to 1.97 per 0.1 µM; p = 0.006). In conclusion, elevated baseline plasma levels of ADMA independently predicted 5-year clinical outcomes after heart transplantation, suggesting that ADMA has potential prognostic value in the heart transplant arena.
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Chacko Y, Zhang X, Jaluba K, Lee A, Miller DC, Yeung AC, Kim B, Fearon W. TCT-610 Outcomes of Transcatheter Aortic Valve Replacement compared to Surgical Aortic Valve Replacement in patients with prior Chest Radiation. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1809] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kim JB, Kobayashi Y, Moneghetti KJ, Brenner DA, O'Malley R, Schnittger I, Wu JC, Murtagh G, Beshiri A, Fischbein M, Miller DC, Liang D, Yeung AC, Haddad F, Fearon WF. GDF-15 (Growth Differentiation Factor 15) Is Associated With Lack of Ventricular Recovery and Mortality After Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.005594. [PMID: 29222133 DOI: 10.1161/circinterventions.117.005594] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [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: 06/26/2017] [Accepted: 10/23/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Recent data suggest that circulating biomarkers may predict outcome in patients undergoing transcatheter aortic valve replacement (TAVR). We examined the association between inflammatory, myocardial, and renal biomarkers and their role in ventricular recovery and outcome after TAVR. METHODS AND RESULTS A total of 112 subjects undergoing TAVR were included in the prospective registry. Plasma levels of B-type natriuretic peptide, hs-TnI (high-sensitivity troponin I), CRP (C-reactive protein), GDF-15 (growth differentiation factor 15), GAL-3 (galectin-3), and Cys-C (cystatin-C) were assessed before TAVR and in 100 sex-matched healthy controls. Among echocardiographic parameters, we measured global longitudinal strain, indexed left ventricular mass, and indexed left atrial volume. The TAVR group included 59% male, with an average age of 84 years, and 1-year mortality of 18%. Among biomarkers, we found GDF-15 and CRP to be strongly associated with all-cause mortality (P<0.001). Inclusion of GDF-15 and CRP to the Society of Thoracic Surgeons score significantly improved C index (0.65-0.79; P<0.05) and provided a category-free net reclassification improvement of 106% at 2 years (P=0.01). Among survivors, functional recovery in global longitudinal strain (>15% improvement) and indexed left ventricular mass (>20% decrease) at 1 year occurred in 48% and 22%, respectively. On multivariate logistic regression, lower baseline GDF-15 was associated with improved global longitudinal strain at 1 year (hazard ratio=0.29; P<0.001). Furthermore, improvement in global longitudinal strain at 1 month correlated with lower overall mortality (hazard ratio=0.45; P=0.03). CONCLUSIONS Elevated GDF-15 correlates with lack of reverse remodeling and increased mortality after TAVR and improves risk prediction of mortality when added to the Society of Thoracic Surgeons score.
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Affiliation(s)
- Juyong Brian Kim
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.).
| | - Yukari Kobayashi
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - Kegan J Moneghetti
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - Daniel A Brenner
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - Ryan O'Malley
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - Ingela Schnittger
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - Joseph C Wu
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - Gillian Murtagh
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - Agim Beshiri
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - Michael Fischbein
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - D Craig Miller
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - David Liang
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - Alan C Yeung
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - Francois Haddad
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.)
| | - William F Fearon
- From the Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., D.L., A.C.Y., F.H., W.F.F.); Stanford Cardiovascular Institute, CA (J.B.K., Y.K., K.J.M., D.A.B., R.O., I.S., J.C.W., M.F., D.C.M., D.L., A.C.Y., F.H., W.F.F.); Department of Medicine, St Vincent's Hospital, University of Melbourne, Australia (K.J.M.); Medical and Scientific Affairs, Abbott Diagnostics, Lake Forest, IL (G.M., A.B.); and Department of Cardiothoracic Surgery, Stanford University School of Medicine, CA (M.F., D.C.M.).
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Kitahara H, Okada K, Kimura T, Yock PG, Lansky AJ, Popma JJ, Yeung AC, Fitzgerald PJ, Honda Y. Impact of Stent Size Selection on Acute and Long-Term Outcomes After Drug-Eluting Stent Implantation in De Novo Coronary Lesions. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004795. [DOI: 10.1161/circinterventions.116.004795] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 11/23/2016] [Accepted: 08/22/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Hideki Kitahara
- From the Stanford University School of Medicine, CA (H.K., K.O., T.K., P.G.Y., A.C.Y., P.J.F., Y.H.); Yale University School of Medicine, New Haven, CT (A.J.L.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Kozo Okada
- From the Stanford University School of Medicine, CA (H.K., K.O., T.K., P.G.Y., A.C.Y., P.J.F., Y.H.); Yale University School of Medicine, New Haven, CT (A.J.L.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Takumi Kimura
- From the Stanford University School of Medicine, CA (H.K., K.O., T.K., P.G.Y., A.C.Y., P.J.F., Y.H.); Yale University School of Medicine, New Haven, CT (A.J.L.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Paul G. Yock
- From the Stanford University School of Medicine, CA (H.K., K.O., T.K., P.G.Y., A.C.Y., P.J.F., Y.H.); Yale University School of Medicine, New Haven, CT (A.J.L.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Alexandra J. Lansky
- From the Stanford University School of Medicine, CA (H.K., K.O., T.K., P.G.Y., A.C.Y., P.J.F., Y.H.); Yale University School of Medicine, New Haven, CT (A.J.L.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Jeffrey J. Popma
- From the Stanford University School of Medicine, CA (H.K., K.O., T.K., P.G.Y., A.C.Y., P.J.F., Y.H.); Yale University School of Medicine, New Haven, CT (A.J.L.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Alan C. Yeung
- From the Stanford University School of Medicine, CA (H.K., K.O., T.K., P.G.Y., A.C.Y., P.J.F., Y.H.); Yale University School of Medicine, New Haven, CT (A.J.L.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Peter J. Fitzgerald
- From the Stanford University School of Medicine, CA (H.K., K.O., T.K., P.G.Y., A.C.Y., P.J.F., Y.H.); Yale University School of Medicine, New Haven, CT (A.J.L.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
| | - Yasuhiro Honda
- From the Stanford University School of Medicine, CA (H.K., K.O., T.K., P.G.Y., A.C.Y., P.J.F., Y.H.); Yale University School of Medicine, New Haven, CT (A.J.L.); and Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.)
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Parikh RV, Khush KK, Luikart H, Pargaonkar VS, Kobayashi Y, Lee JH, Sinha S, Cohen G, Valantine HA, Yeung AC, Fearon WF. Impact of Asymmetric Dimethylarginine on Coronary Physiology Early After Heart Transplantation. Am J Cardiol 2017; 120:1020-1025. [PMID: 28754566 DOI: 10.1016/j.amjcard.2017.06.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/25/2017] [Accepted: 06/13/2017] [Indexed: 11/26/2022]
Abstract
Cardiac allograft vasculopathy is a major cause of long-term graft failure following heart transplantation. Asymmetric dimethylarginine (ADMA), a marker of endothelial dysfunction, has been mechanistically implicated in the development of cardiac allograft vasculopathy, but its impact on coronary physiology early after transplantation is unknown. Invasive indices of coronary physiology, namely, fractional flow reserve (FFR), the index of microcirculatory resistance, and coronary flow reserve, were measured with a coronary pressure wire in the left anterior descending artery within 8 weeks (baseline) and 1 year after transplant. Plasma levels of ADMA were concurrently assayed using high-performance liquid chromatography. In 46 heart transplant recipients, there was a statistically significant correlation between elevated ADMA levels and lower FFR values at baseline (r = -0.33; p = 0.024); this modest association persisted 1 year after transplant (r = -0.39; p = 0.0085). Patients with a baseline FFR <0.90 (a prognostically validated cutoff) had significantly higher baseline ADMA levels (0.63 ± 0.16 vs 0.54 ± 0.12 µM; p = 0.034). Baseline ADMA (odds ratio 1.80 per 0.1 µM; 95% confidence interval 1.07 to 3.03; p = 0.027) independently predicted a baseline FFR <0.90 after multivariable adjustment. Even after dichotomizing ADMA (≥0.60 µM, provides greatest diagnostic accuracy by receiver operating characteristic curve), this association remained significant (odds ratio 7.52, 95% confidence interval 1.74 to 32.49; p = 0.006). No significant relationship between ADMA and index of microcirculatory resistance or coronary flow reserve was detected. In conclusion, baseline ADMA was a strong independent predictor of FFR <0.90, suggesting that elevated ADMA levels are associated with abnormal epicardial function soon after heart transplantation.
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Fearon WF, Felix R, Hirohata A, Sakurai R, Jose PO, Yamasaki M, Nakamura M, Fitzgerald PJ, Valantine HA, Yock PG, Yeung AC. The effect of negative remodeling on fractional flow reserve after cardiac transplantation. Int J Cardiol 2017; 241:283-287. [PMID: 28413112 DOI: 10.1016/j.ijcard.2017.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/15/2016] [Revised: 04/01/2017] [Accepted: 04/07/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Negative remodeling is a common occurrence early after cardiac transplantation. Its impact on the development of myocardial ischemia is not well documented. The aim of this study is to investigate the impact of negative remodeling on fractional flow reserve after cardiac transplantation. METHODS Thirty-four cardiac transplant recipients underwent intravascular ultrasound (IVUS) and fractional flow reserve (FFR) assessment soon after transplantation and one year later. Patients were divided into those with and without negative remodeling based on IVUS, and the impact on FFR was assessed. In the 19 patients with negative remodeling, there was no significant change in plaque volume (119.3±82.0 to 131.3±91.2mm3, p=0.21), but vessel volume (775.6±212.0 to 621.9±144.1mm3, p<0.0001) and lumen volume (656.3±169.1 to 490.7±132.0mm3, p<0.0001) decreased significantly and FFR likewise decreased significantly (0.88±0.06 to 0.84±0.07, p=0.04). In the 15 patients without negative remodeling, vessel volume did not change (711.7±217.6 to 745.7±198.5, p=0.28), but there was a significant increase in plaque volume (126.8±88.3 to 194.4±92.7, p<0.001) and a resultant significant decrease in FFR (0.89±0.05 to 0.85±0.05, p=0.01). CONCLUSION Negative remodeling itself, without any change in plaque volume can cause a significant decrease in fractional flow reserve after cardiac transplantation and appears to be another possible mechanism for myocardial ischemia.
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Affiliation(s)
- William F Fearon
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, United States.
| | - Robert Felix
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, United States
| | - Atsushi Hirohata
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, United States
| | - Ryota Sakurai
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, United States
| | - Powell O Jose
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, United States
| | - Masao Yamasaki
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, United States
| | - Mamoo Nakamura
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, United States
| | - Peter J Fitzgerald
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, United States
| | - Hannah A Valantine
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, United States
| | - Paul G Yock
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, United States
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, United States
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Fearon WF, Okada K, Kobashigawa JA, Kobayashi Y, Luikart H, Sana S, Daun T, Chmura SA, Sinha S, Cohen G, Honda Y, Pham M, Lewis DB, Bernstein D, Yeung AC, Valantine HA, Khush K. Angiotensin-Converting Enzyme Inhibition Early After Heart Transplantation. J Am Coll Cardiol 2017; 69:2832-2841. [PMID: 28595700 DOI: 10.1016/j.jacc.2017.03.598] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/27/2017] [Accepted: 03/31/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cardiac allograft vasculopathy (CAV) remains a leading cause of mortality after heart transplantation (HT). Angiotensin-converting enzyme inhibitors (ACEIs) may retard the development of CAV but have not been well studied after HT. OBJECTIVES This study tested the safety and efficacy of the ACEI ramipril on the development of CAV early after HT. METHODS In this prospective, multicenter, randomized, double-blind, placebo-controlled trial, 96 HT recipients were randomized to undergo ramipril or placebo therapy. They underwent coronary angiography, endothelial function testing; measurements of fractional flow reserve (FFR) and coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR); and intravascular ultrasonography (IVUS) of the left anterior descending coronary artery, within 8 weeks of HT. At 1 year, the invasive assessment was repeated. Circulating endothelial progenitor cells (EPCs) were quantified at baseline and 1 year. RESULTS Plaque volumes at 1 year were similar between the ramipril and placebo groups (162.1 ± 70.5 mm3 vs. 177.3 ± 94.3 mm3, respectively; p = 0.73). Patients receiving ramipril had improvement in microvascular function as shown by a significant decrease in IMR (21.4 ± 14.7 to 14.4 ± 6.3; p = 0.001) and increase in CFR (3.8 ± 1.7 to 4.8 ± 1.5; p = 0.017), from baseline to 1 year. This did not occur with IMR (17.4 ± 8.4 to 21.5 ± 20.0; p = 0.72) or CFR (4.1 ± 1.8 to 4.1 ± 2.2; p = 0.60) in the placebo-treated patients. EPCs decreased significantly at 1 year in the placebo group but not in the ramipril group. CONCLUSIONS Ramipril does not slow development of epicardial plaque volume but does stabilize levels of endothelial progenitor cells and improve microvascular function, which have been associated with improved long-term survival after HT. (Angiotensin Converting Enzyme [ACE] Inhibition and Cardiac Allograft Vasculopathy; NCT01078363).
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Affiliation(s)
- William F Fearon
- Stanford Cardiovascular Institute and Division of Cardiovascular Medicine, Stanford, California; Cardiology Section, Palo Alto Veterans Affairs Health Care System, Palo Alto, California.
| | - Kozo Okada
- Stanford Cardiovascular Institute and Division of Cardiovascular Medicine, Stanford, California
| | - Jon A Kobashigawa
- Advanced Heart Disease Section, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Yuhei Kobayashi
- Stanford Cardiovascular Institute and Division of Cardiovascular Medicine, Stanford, California
| | - Helen Luikart
- Stanford Cardiovascular Institute and Division of Cardiovascular Medicine, Stanford, California
| | - Sean Sana
- Advanced Heart Disease Section, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Tiffany Daun
- Advanced Heart Disease Section, Cedars-Sinai Heart Institute, Los Angeles, California
| | - Steven A Chmura
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, Stanford University School of Medicine, Stanford, California
| | - Seema Sinha
- Stanford Cardiovascular Institute and Division of Cardiovascular Medicine, Stanford, California
| | - Garett Cohen
- Stanford Cardiovascular Institute and Division of Cardiovascular Medicine, Stanford, California
| | - Yasuhiro Honda
- Stanford Cardiovascular Institute and Division of Cardiovascular Medicine, Stanford, California
| | - Michael Pham
- Cardiology Section, Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - David B Lewis
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, Stanford University School of Medicine, Stanford, California
| | - Daniel Bernstein
- Department of Pediatrics, Division of Cardiology, Stanford University School of Medicine, Stanford, California
| | - Alan C Yeung
- Stanford Cardiovascular Institute and Division of Cardiovascular Medicine, Stanford, California
| | - Hannah A Valantine
- Stanford Cardiovascular Institute and Division of Cardiovascular Medicine, Stanford, California
| | - Kiran Khush
- Stanford Cardiovascular Institute and Division of Cardiovascular Medicine, Stanford, California
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35
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Kobayashi Y, Kim JB, Moneghetti KJ, Kobayashi Y, Zhang R, Brenner DA, O'Malley R, Schnittger I, Fischbein M, Miller DC, Yeung AC, Liang D, Haddad F, Fearon WF. Dynamic changes in aortic impedance after transcatheter aortic valve replacement and its impact on exploratory outcome. Int J Cardiovasc Imaging 2017; 33:1693-1701. [PMID: 28516313 DOI: 10.1007/s10554-017-1155-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 03/09/2017] [Accepted: 05/02/2017] [Indexed: 11/25/2022]
Abstract
Valvulo-arterial impedance (Zva) has been shown to predict worse outcome in medically managed aortic stenosis (AS) patients. We aimed to investigate the association between Zva and left ventricular (LV) adaptation and to explore the predictive value of Zva for cardiac functional recovery and outcome after transcatheter aortic valve replacement (TAVR). We prospectively enrolled 128 patients with AS who underwent TAVR. Zva was calculated as: (systolic blood pressure + mean transaortic gradient)/stroke volume index). Echocardiographic assessment occurred at baseline, 1-month and 1-year after TAVR. The primary endpoints were to investigate associations between Zva and global longitudinal strain (GLS) at baseline as well as GLS change after TAVR. The secondary was to compare all-cause mortality after TAVR between patients with pre-defined Zva (=5 mmHg m2/ml), stroke volume index (=35 ml/m2), and GLS (=-15%) cutoffs. The mean GLS was reduced (-13.0 ± 3.2%). The mean Zva was 5.2 ± 1.6 mmHg*m2/ml with 55% of values ≥5.0 mmHg*m2/ml, considered to be abnormally high. Higher Zva correlated with worse GLS (r = -0.33, p < 0.001). After TAVR, Zva decreased significantly (5.1 ± 1.6 vs. 4.5 ± 1.6 mmHg*m2/ml, p = 0.001). A reduction of Zva at 1-month was associated with GLS improvement at 1-month (r = -0.31, p = 0.001) and at 1-year (r = -0.36 and p = 0.001). By Kaplan-Meier analysis, patients with higher Zva at baseline had higher mortality (Log-rank p = 0.046), while stroke volume index and GLS did not differentiate outcome (Log-rank p = 0.09 and 0.25, respectively). As a conclusion, Zva is correlated with GLS in AS as well as GLS improvement after TAVR. Furthermore, a high baseline Zva may have an additional impact to traditional parameters on predicting worse mortality after TAVR.
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Affiliation(s)
- Yukari Kobayashi
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2103, Stanford, CA, 94305, USA.,Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Juyong B Kim
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2103, Stanford, CA, 94305, USA.,Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Kegan J Moneghetti
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2103, Stanford, CA, 94305, USA.,Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Yuhei Kobayashi
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2103, Stanford, CA, 94305, USA.,Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Ran Zhang
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2103, Stanford, CA, 94305, USA.,Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Daniel A Brenner
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2103, Stanford, CA, 94305, USA.,Stanford Cardiovascular Institute, Stanford, CA, USA.,Kaiser Permanente, Hawaii Region, Moanalua Medical Center, Honolulu, HI, USA
| | - Ryan O'Malley
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2103, Stanford, CA, 94305, USA.,Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Ingela Schnittger
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2103, Stanford, CA, 94305, USA.,Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Michael Fischbein
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2103, Stanford, CA, 94305, USA.,Stanford Cardiovascular Institute, Stanford, CA, USA
| | - D Craig Miller
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2103, Stanford, CA, 94305, USA.,Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2103, Stanford, CA, 94305, USA.,Stanford Cardiovascular Institute, Stanford, CA, USA
| | - David Liang
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2103, Stanford, CA, 94305, USA.,Stanford Cardiovascular Institute, Stanford, CA, USA
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2103, Stanford, CA, 94305, USA.,Stanford Cardiovascular Institute, Stanford, CA, USA
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive Room H2103, Stanford, CA, 94305, USA. .,Stanford Cardiovascular Institute, Stanford, CA, USA.
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Kawana M, Lee AM, Liang DH, Yeung AC. Acute Right Ventricular Failure After Successful Opening of Chronic Total Occlusion in Right Coronary Artery Caused by a Large Intramural Hematoma. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.116.004674. [PMID: 28115374 DOI: 10.1161/circinterventions.116.004674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Masataka Kawana
- From the Division of Cardiovascular Medicine, Department of Medicine (M.K., D.H.L., A.C.Y.) and Department of Cardiothoracic Surgery (A.M.L.), Stanford University School of Medicine, CA
| | - Anson M Lee
- From the Division of Cardiovascular Medicine, Department of Medicine (M.K., D.H.L., A.C.Y.) and Department of Cardiothoracic Surgery (A.M.L.), Stanford University School of Medicine, CA
| | - David H Liang
- From the Division of Cardiovascular Medicine, Department of Medicine (M.K., D.H.L., A.C.Y.) and Department of Cardiothoracic Surgery (A.M.L.), Stanford University School of Medicine, CA
| | - Alan C Yeung
- From the Division of Cardiovascular Medicine, Department of Medicine (M.K., D.H.L., A.C.Y.) and Department of Cardiothoracic Surgery (A.M.L.), Stanford University School of Medicine, CA.
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37
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Okada K, Honda Y, Luikart H, Yock PG, Fitzgerald PJ, Yeung AC, Valantine H, Khush K, Fearon W. TCT-818 Early Left Ventricular Dysfunction is Associated with Cardiac Allograft Vasculopathy and Late Mortality After Heart Transplantation. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.909] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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38
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Okada K, Fearon WF, Luikart H, Kitahara H, Otagiri K, Tanaka S, Kimura T, Yock PG, Fitzgerald PJ, Yeung AC, Valantine HA, Khush KK, Honda Y. Attenuated-Signal Plaque Progression Predicts Long-Term Mortality After Heart Transplantation: IVUS Assessment of Cardiac Allograft Vasculopathy. J Am Coll Cardiol 2016; 68:382-92. [PMID: 27443435 PMCID: PMC4959008 DOI: 10.1016/j.jacc.2016.05.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 04/04/2016] [Accepted: 05/03/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although cardiac allograft vasculopathy (CAV) is typically characterized by diffuse coronary intimal thickening with pathological vessel remodeling, plaque instability may also play an important role in CAV. Previous studies of native coronary atherosclerosis have demonstrated associations between attenuated-signal plaque (ASP), plaque instability, and adverse clinical events. OBJECTIVES This study's aim was to characterize the association between ASP and long-term mortality post-heart transplantation. METHODS In 105 heart transplant recipients, serial (baseline and 1-year post-transplant) intravascular ultrasound was performed in the first 50 mm of the left anterior descending artery. The ASP score was calculated by grading the measured angle of attenuation from grades 0 to 4 (specifically, 0°, 1° to 90°, 91° to 180°, 181° to 270°, and >270°) at 1-mm intervals. The primary endpoint was all-cause death or retransplantation. RESULTS At 1-year post-transplant, 10.5% of patients demonstrated ASP progression (newly developed or increased ASP). Patients with ASP progression had a higher incidence of acute cellular rejection during the first year (63.6% vs. 22.3%; p = 0.006) and tendency for greater intimal growth (percent intimal volume: 9.2 ± 9.3% vs. 4.4 ± 5.3%; p = 0.07) than those without. Over a median follow-up of 4.6 years, there was a significantly lower event-free survival rate in patients with ASP progression at 1-year post-transplant compared with those without. In contrast, maximum intimal thickness did not predict long-term mortality. CONCLUSIONS ASP progression appears to reflect chronic inflammation related to acute cellular rejection and is an independent predictor of long-term mortality after heart transplantation. Serial assessments of plaque instability may enhance identification of high-risk patients who may benefit from closer follow-up and targeted medical therapies.
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Affiliation(s)
- Kozo Okada
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Helen Luikart
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Hideki Kitahara
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Kyuhachi Otagiri
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Shigemitsu Tanaka
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Takumi Kimura
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Paul G Yock
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Peter J Fitzgerald
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Hannah A Valantine
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Kiran K Khush
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California.
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39
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Kobayashi Y, Fearon WF, Honda Y, Tanaka S, Pargaonkar V, Fitzgerald PJ, Lee DP, Stefanick M, Yeung AC, Tremmel JA. Effect of Sex Differences on Invasive Measures of Coronary Microvascular Dysfunction in Patients With Angina in the Absence of Obstructive Coronary Artery Disease. JACC Cardiovasc Interv 2016; 8:1433-1441. [PMID: 26404195 DOI: 10.1016/j.jcin.2015.03.045] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/01/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study investigated sex differences in coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR) in patients with angina in the absence of obstructive coronary artery disease. BACKGROUND Coronary microvascular dysfunction is associated with worse long-term outcomes, especially in women. Coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR) are 2 methods of assessing the coronary microcirculation. METHODS We prospectively enrolled 117 women and 40 men with angina in the absence of obstructive coronary artery disease. We performed CFR, IMR, fractional flow reserve, and quantitative coronary angiography in the left anterior descending artery. Coronary flow was assessed with a thermodilution method by obtaining mean transit time (Tmn) (an inverse correlate to absolute flow) at rest and hyperemia. RESULTS All patients had minimal atherosclerosis by quantitative coronary angiography (% diameter stenosis: 23.2 ± 12.3%), and epicardial disease was milder in women (fractional flow reserve: 0.88 ± 0.04 vs. 0.87 ± 0.04; p = 0.04). IMR was similar between the sexes (20.7 ± 9.8 vs. 19.1 ± 8.0; p = 0.45), but CFR was lower in women (3.8 ± 1.6 vs. 4.8 ± 1.9; p = 0.004). This was primarily due to a shorter resting Tmn in women (p = 0.005), suggesting increased resting coronary flow, whereas hyperemic Tmn was identical (p = 0.79). In multivariable analysis, female sex was an independent predictor of lower CFR and shorter resting Tmn. CONCLUSIONS Despite similar microvascular function in women and men by IMR, CFR is lower in women. This discrepancy appears to be due to differences in resting coronary flow between the sexes. The effect of sex differences should be considered in interpretation of physiological indexes using resting coronary flow.
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Affiliation(s)
- Yuhei Kobayashi
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - William F Fearon
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - Yasuhiro Honda
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - Shigemitsu Tanaka
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - Vedant Pargaonkar
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - Peter J Fitzgerald
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - David P Lee
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - Marcia Stefanick
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - Alan C Yeung
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California
| | - Jennifer A Tremmel
- Stanford Cardiovascular Institute and Stanford University Medical Center, Stanford, California.
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40
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Chiu P, Fearon WF, Raleigh LA, Burdon G, Rao V, Boyd JH, Yeung AC, Miller DC, Fischbein MP. Salvage Extracorporeal Membrane Oxygenation Prior to "Bridge" Transcatheter Aortic Valve Replacement. J Card Surg 2016; 31:403-5. [PMID: 27109017 DOI: 10.1111/jocs.12750] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We describe a patient who presented in profound cardiogenic shock due to bioprosthetic aortic valve stenosis requiring salvage Extracorporeal Membrane Oxygenation followed by a "bridge" valve-in-valve transcatheter aortic valve replacement. doi: 10.1111/jocs.12750 (J Card Surg 2016;31:403-405).
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Affiliation(s)
- Peter Chiu
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Lindsay A Raleigh
- Department of Anesthesiology, Stanford University School of Medicine, Stanford, California
| | - Grayson Burdon
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Vidya Rao
- Department of Anesthesiology, Stanford University School of Medicine, Stanford, California
| | - Jack H Boyd
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - David Craig Miller
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
| | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California
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41
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Yang HM, Khush K, Luikart H, Okada K, Lim HS, Kobayashi Y, Honda Y, Yeung AC, Valantine H, Fearon WF. Invasive Assessment of Coronary Physiology Predicts Late Mortality After Heart Transplantation. Circulation 2016; 133:1945-50. [PMID: 27143679 DOI: 10.1161/circulationaha.115.018741] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 03/14/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this study is to determine the prognostic value of invasively assessing coronary physiology early after heart transplantation. METHODS AND RESULTS Seventy-four cardiac transplant recipients had fractional flow reserve, coronary flow reserve, index of microcirculatory resistance (IMR), and intravascular ultrasound performed down the left anterior descending coronary artery soon after (baseline) and 1 year after heart transplantation. The primary end point was the cumulative survival free of death or retransplantation at a mean follow-up of 4.5±3.5 years. The cumulative event-free survival was significantly lower in patients with a fractional flow reserve <0.90 at baseline (42% versus 79%; P=0.01) or an IMR ≥20 measured 1 year after heart transplantation (39% versus 69%; P=0.03). Patients in whom IMR decreased or did not change from baseline to 1 year had higher event-free survival compared with patients with an increase in IMR (66% versus 36%; P=0.03). Fractional flow reserve <0.90 at baseline (hazard ratio, 0.13; 95% confidence interval, 0.02-0.81; P=0.03), IMR ≥20 at 1 year (hazard ratio, 3.93; 95% confidence interval, 1.08-14.27; P=0.04), and rejection during the first year (hazard ratio, 6.00; 95% confidence interval, 1.56-23.09; P=0.009) were independent predictors of death/retransplantation, whereas intravascular ultrasound parameters were not. CONCLUSIONS Invasive measures of coronary physiology (fractional flow reserve and IMR) determined early after heart transplantation are significant predictors of late death or retransplantation.
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Affiliation(s)
- Hyoung-Mo Yang
- From Stanford University, Stanford, CA (H.-M.Y., K.K., H.L., K.O., H.-S.L., Y.K., Y.H., A.C.Y., H.V., W.F.F.); and Ajou University School of Medicine, Suwon, South Korea (H.-M.Y., H.-S.L.)
| | - Kiran Khush
- From Stanford University, Stanford, CA (H.-M.Y., K.K., H.L., K.O., H.-S.L., Y.K., Y.H., A.C.Y., H.V., W.F.F.); and Ajou University School of Medicine, Suwon, South Korea (H.-M.Y., H.-S.L.)
| | - Helen Luikart
- From Stanford University, Stanford, CA (H.-M.Y., K.K., H.L., K.O., H.-S.L., Y.K., Y.H., A.C.Y., H.V., W.F.F.); and Ajou University School of Medicine, Suwon, South Korea (H.-M.Y., H.-S.L.)
| | - Kozo Okada
- From Stanford University, Stanford, CA (H.-M.Y., K.K., H.L., K.O., H.-S.L., Y.K., Y.H., A.C.Y., H.V., W.F.F.); and Ajou University School of Medicine, Suwon, South Korea (H.-M.Y., H.-S.L.)
| | - Hong-Seok Lim
- From Stanford University, Stanford, CA (H.-M.Y., K.K., H.L., K.O., H.-S.L., Y.K., Y.H., A.C.Y., H.V., W.F.F.); and Ajou University School of Medicine, Suwon, South Korea (H.-M.Y., H.-S.L.)
| | - Yuhei Kobayashi
- From Stanford University, Stanford, CA (H.-M.Y., K.K., H.L., K.O., H.-S.L., Y.K., Y.H., A.C.Y., H.V., W.F.F.); and Ajou University School of Medicine, Suwon, South Korea (H.-M.Y., H.-S.L.)
| | - Yasuhiro Honda
- From Stanford University, Stanford, CA (H.-M.Y., K.K., H.L., K.O., H.-S.L., Y.K., Y.H., A.C.Y., H.V., W.F.F.); and Ajou University School of Medicine, Suwon, South Korea (H.-M.Y., H.-S.L.)
| | - Alan C Yeung
- From Stanford University, Stanford, CA (H.-M.Y., K.K., H.L., K.O., H.-S.L., Y.K., Y.H., A.C.Y., H.V., W.F.F.); and Ajou University School of Medicine, Suwon, South Korea (H.-M.Y., H.-S.L.)
| | - Hannah Valantine
- From Stanford University, Stanford, CA (H.-M.Y., K.K., H.L., K.O., H.-S.L., Y.K., Y.H., A.C.Y., H.V., W.F.F.); and Ajou University School of Medicine, Suwon, South Korea (H.-M.Y., H.-S.L.)
| | - William F Fearon
- From Stanford University, Stanford, CA (H.-M.Y., K.K., H.L., K.O., H.-S.L., Y.K., Y.H., A.C.Y., H.V., W.F.F.); and Ajou University School of Medicine, Suwon, South Korea (H.-M.Y., H.-S.L.).
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Kitahara H, Okada K, Tanaka S, Yang HM, Miki K, Kobayashi Y, Kimura T, Luikart H, Yock PG, Yeung AC, Fitzgerald PJ, Khush KK, Fearon WF, Honda Y. Association of periarterial neovascularization with progression of cardiac allograft vasculopathy and long-term clinical outcomes in heart transplant recipients. J Heart Lung Transplant 2016; 35:752-9. [PMID: 27068036 DOI: 10.1016/j.healun.2016.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 01/05/2016] [Accepted: 02/23/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND This study investigated the relationship between periarterial neovascularization, development of cardiac allograft vasculopathy (CAV), and long-term clinical outcomes after heart transplantation. Proliferation of the vasa vasorum is associated with arterial inflammation. The contribution of angiogenesis to the development of CAV has been suggested. METHODS Serial (baseline and 1-year post-transplant) intravascular ultrasound was performed in 102 heart transplant recipients. Periarterial small vessels (PSV) were defined as echolucent luminal structures <1 mm in diameter, located ≤2 mm outside of the external elastic membrane. The signal void structures were excluded when they connected to the coronary lumen (considered as side branches) or could not be followed in ≥3 contiguous frames. The number of PSV was counted at 1-mm intervals throughout the first 50 mm of the left anterior descending artery, and the PSV score was calculated as the sum of cross-sectional values. Patients with a PSV score increase of ≥ 4 between baseline and 1-year post-transplant were classified as the "proliferative" group. Maximum intimal thickness was measured for the entire analysis segment. RESULTS During the first year post-transplant, the proliferative group showed a greater increase in maximum intimal thickness (0.33 ± 0.36 mm vs 0.10 ± 0.28 mm, p < 0.001) and had a higher incidence of acute cellular rejection (50.0% vs 23.9%, p = 0.025) than the non-proliferative group. On Kaplan-Meier analysis, cardiac death-free survival rate over a median of 4.7 years was significantly lower in the proliferative group than in the non-proliferative group (hazard ratio, 3.10; p = 0.036). CONCLUSIONS The increase in PSV, potentially representing an angioproliferative response around the coronary arteries, was associated with early CAV progression and reduced survival after heart transplantation.
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Affiliation(s)
- Hideki Kitahara
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Kozo Okada
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Shigemitsu Tanaka
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Hyoung-Mo Yang
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Kojiro Miki
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Yuhei Kobayashi
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Takumi Kimura
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Helen Luikart
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Paul G Yock
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Peter J Fitzgerald
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Kiran K Khush
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California
| | - Yasuhiro Honda
- Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California.
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Okada K, Kitahara H, Yang HM, Tanaka S, Kobayashi Y, Kimura T, Luikart H, Yock PG, Yeung AC, Valantine HA, Fitzgerald PJ, Khush KK, Honda Y, Fearon WF. Paradoxical Vessel Remodeling of the Proximal Segment of the Left Anterior Descending Artery Predicts Long-Term Mortality After Heart Transplantation. JACC: Heart Failure 2015; 3:942-52. [DOI: 10.1016/j.jchf.2015.07.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/13/2015] [Accepted: 07/17/2015] [Indexed: 12/01/2022]
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Tremmel JA, Fearon WF, Lee BK, Lim HS, Yong AS, Yamada R, Tanaka S, Lee DP, Yeung AC. Response to Letters Regarding Article, "Invasive Evaluation of Patients With Angina in the Absence of Obstructive Coronary Artery Disease". Circulation 2015; 132:e244. [PMID: 26572677 DOI: 10.1161/circulationaha.115.017741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
| | - Bong-Ki Lee
- Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Hong-Seok Lim
- Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Andy S Yong
- Department of Cardiology, Royal Prince Alfred and Concord Hospitals, University of Sydney, Sydney, Australia
| | - Ryotaro Yamada
- Department of Cardiology, Tokai University Oiso Hospital, Oiso, Japan
| | | | - David P Lee
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
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Fearon WF, Yeung AC. Clinical relevance of myocardial injury after transcatheter aortic valve replacement. J Am Coll Cardiol 2015; 66:2089-2091. [PMID: 26541918 DOI: 10.1016/j.jacc.2015.09.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 09/04/2015] [Indexed: 11/16/2022]
Affiliation(s)
- William F Fearon
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California.
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California
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Zimmermann FM, De Bruyne B, Pijls NHJ, Desai M, Oldroyd KG, Park SJ, Reardon MJ, Wendler O, Woo J, Yeung AC, Fearon WF. Rationale and design of the Fractional Flow Reserve versus Angiography for Multivessel Evaluation (FAME) 3 Trial: a comparison of fractional flow reserve-guided percutaneous coronary intervention and coronary artery bypass graft surgery in patients with multivessel coronary artery disease. Am Heart J 2015; 170:619-626.e2. [PMID: 26386784 DOI: 10.1016/j.ahj.2015.06.024] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [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: 12/11/2014] [Accepted: 06/14/2015] [Indexed: 12/21/2022]
Abstract
UNLABELLED Guidelines recommend coronary artery bypass graft (CABG) surgery over percutaneous coronary intervention (PCI) for the treatment of 3-vessel coronary artery disease (3-VD). The inferior results of PCI demonstrated by previous large randomized trials comparing PCI and CABG might be explained by the use of suboptimal stent technology and by the lack of fractional flow reserve (FFR) guidance of PCI. TRIAL DESIGN The objective of this investigator-initiated, multicenter, randomized clinical trial is to investigate whether FFR-guided PCI with new-generation stents is noninferior to CABG in patients with 3-VD, not including the left main coronary artery. Eligible patients must have ≥50% coronary stenoses in all 3 major epicardial vessels or major side branches. Patients with a nondominant right coronary artery may be included only if the left anterior descending artery and left circumflex have ≥50% stenoses. Consecutive patients who meet all of the inclusion criteria and none of the exclusion criteria will be randomized in a 1:1 fashion to either CABG or FFR-guided PCI. Coronary artery bypass graft will be performed based on the angiogram as per clinical routine. Patients assigned to FFR-guided PCI will have FFR measured in each diseased vessel and only undergo stenting if the FFR is ≤0.80. The primary end point of the study is a composite of major adverse cardiac and cerebrovascular events, including death, myocardial infarction, repeat coronary revascularization, and stroke at 1 year. Key secondary end point will be a composite of death, myocardial infarction, and stroke at 3-year follow-up. Other secondary end points include the individual adverse events, cost-effectiveness, and quality of life at 2-year, 3-year, with up to 5-year follow-up. CONCLUSION The FAME 3 study will compare in a multicenter, randomized fashion FFR-guided PCI with contemporary drug-eluting stents to CABG in patients with 3-VD.
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Affiliation(s)
| | | | - Nico H J Pijls
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Manisha Desai
- Stanford University School of Medicine and Cancer Institute, Stanford, CA
| | | | - Seung-Jung Park
- Heart Institute, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
| | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital/King's Health Partners, London, UK
| | - Joseph Woo
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA
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Dash R, Kim PJ, Matsuura Y, Ikeno F, Metzler S, Huang NF, Lyons JK, Nguyen PK, Ge X, Foo CWP, McConnell MV, Wu JC, Yeung AC, Harnish P, Yang PC. Manganese-Enhanced Magnetic Resonance Imaging Enables In Vivo Confirmation of Peri-Infarct Restoration Following Stem Cell Therapy in a Porcine Ischemia-Reperfusion Model. J Am Heart Assoc 2015. [PMID: 26215972 PMCID: PMC4608088 DOI: 10.1161/jaha.115.002044] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background The exact mechanism of stem cell therapy in augmenting the function of ischemic cardiomyopathy is unclear. In this study, we hypothesized that increased viability of the peri-infarct region (PIR) produces restorative benefits after stem cell engraftment. A novel multimodality imaging approach simultaneously assessed myocardial viability (manganese-enhanced magnetic resonance imaging [MEMRI]), myocardial scar (delayed gadolinium enhancement MRI), and transplanted stem cell engraftment (positron emission tomography reporter gene) in the injured porcine hearts. Methods and Results Twelve adult swine underwent ischemia–reperfusion injury. Digital subtraction of MEMRI-negative myocardium (intrainfarct region) from delayed gadolinium enhancement MRI–positive myocardium (PIR and intrainfarct region) clearly delineated the PIR in which the MEMRI-positive signal reflected PIR viability. Human amniotic mesenchymal stem cells (hAMSCs) represent a unique population of immunomodulatory mesodermal stem cells that restored the murine PIR. Immediately following hAMSC delivery, MEMRI demonstrated an increased PIR viability signal compared with control. Direct PIR viability remained higher in hAMSC-treated hearts for >6 weeks. Increased PIR viability correlated with improved regional contractility, left ventricular ejection fraction, infarct size, and hAMSC engraftment, as confirmed by immunocytochemistry. Increased MEMRI and positron emission tomography reporter gene signal in the intrainfarct region and the PIR correlated with sustained functional augmentation (global and regional) within the hAMSC group (mean change, left ventricular ejection fraction: hAMSC 85±60%, control 8±10%; P<0.05) and reduced chamber dilatation (left ventricular end-diastole volume increase: hAMSC 24±8%, control 110±30%; P<0.05). Conclusions The positron emission tomography reporter gene signal of hAMSC engraftment correlates with the improved MEMRI signal in the PIR. The increased MEMRI signal represents PIR viability and the restorative potential of the injured heart. This in vivo multimodality imaging platform represents a novel, real-time method of tracking PIR viability and stem cell engraftment while providing a mechanistic explanation of the therapeutic efficacy of cardiovascular stem cells.
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Affiliation(s)
- Rajesh Dash
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.) Stanford Cardiovascular Institute, Stanford University, Stanford, CA (R.D., N.F.H., P.K.N., M.V.M.C., J.C.W., P.C.Y.)
| | - Paul J Kim
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.)
| | - Yuka Matsuura
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.)
| | - Fumiaki Ikeno
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.)
| | - Scott Metzler
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.)
| | - Ngan F Huang
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.) Stanford Cardiovascular Institute, Stanford University, Stanford, CA (R.D., N.F.H., P.K.N., M.V.M.C., J.C.W., P.C.Y.)
| | - Jennifer K Lyons
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.)
| | - Patricia K Nguyen
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.) Stanford Cardiovascular Institute, Stanford University, Stanford, CA (R.D., N.F.H., P.K.N., M.V.M.C., J.C.W., P.C.Y.)
| | - Xiaohu Ge
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.)
| | | | - Michael V McConnell
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.) Department of Electrical Engineering, Stanford University, Stanford, CA (M.V.M.C.) Stanford Cardiovascular Institute, Stanford University, Stanford, CA (R.D., N.F.H., P.K.N., M.V.M.C., J.C.W., P.C.Y.)
| | - Joseph C Wu
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.) Stanford Cardiovascular Institute, Stanford University, Stanford, CA (R.D., N.F.H., P.K.N., M.V.M.C., J.C.W., P.C.Y.)
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.)
| | | | - Phillip C Yang
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA (R.D., P.J.K., Y.M., F.I., S.M., N.F.H., J.K.L., P.K.N., X.G., M.V.M.C., J.C.W., A.C.Y., P.C.Y.) Stanford Cardiovascular Institute, Stanford University, Stanford, CA (R.D., N.F.H., P.K.N., M.V.M.C., J.C.W., P.C.Y.)
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Park SJ, Ahn JM, Kim YH, Park DW, Yun SC, Lee JY, Kang SJ, Lee SW, Lee CW, Park SW, Choo SJ, Chung CH, Lee JW, Cohen DJ, Yeung AC, Hur SH, Seung KB, Ahn TH, Kwon HM, Lim DS, Rha SW, Jeong MH, Lee BK, Tresukosol D, Fu GS, Ong TK. Trial of everolimus-eluting stents or bypass surgery for coronary disease. N Engl J Med 2015; 372:1204-12. [PMID: 25774645 DOI: 10.1056/nejmoa1415447] [Citation(s) in RCA: 332] [Impact Index Per Article: 36.9] [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] [Indexed: 11/19/2022]
Abstract
BACKGROUND Most trials comparing percutaneous coronary intervention (PCI) with coronary-artery bypass grafting (CABG) have not made use of second-generation drug-eluting stents. METHODS We conducted a randomized noninferiority trial at 27 centers in East Asia. We planned to randomly assign 1776 patients with multivessel coronary artery disease to PCI with everolimus-eluting stents or to CABG. The primary end point was a composite of death, myocardial infarction, or target-vessel revascularization at 2 years after randomization. Event rates during longer-term follow-up were also compared between groups. RESULTS After the enrollment of 880 patients (438 patients randomly assigned to the PCI group and 442 randomly assigned to the CABG group), the study was terminated early owing to slow enrollment. At 2 years, the primary end point had occurred in 11.0% of the patients in the PCI group and in 7.9% of those in the CABG group (absolute risk difference, 3.1 percentage points; 95% confidence interval [CI], -0.8 to 6.9; P=0.32 for noninferiority). At longer-term follow-up (median, 4.6 years), the primary end point had occurred in 15.3% of the patients in the PCI group and in 10.6% of those in the CABG group (hazard ratio, 1.47; 95% CI, 1.01 to 2.13; P=0.04). No significant differences were seen between the two groups in the occurrence of a composite safety end point of death, myocardial infarction, or stroke. However, the rates of any repeat revascularization and spontaneous myocardial infarction were significantly higher after PCI than after CABG. CONCLUSIONS Among patients with multivessel coronary artery disease, the rate of major adverse cardiovascular events was higher among those who had undergone PCI with the use of everolimus-eluting stents than among those who had undergone CABG. (Funded by CardioVascular Research Foundation and others; BEST ClinicalTrials.gov number, NCT00997828.).
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Affiliation(s)
- Seung-Jung Park
- From the Heart Institute (S.-J.P., J.-M.A., Y.-H.K., D.-W.P., J.-Y.L., S.-J.K., S.-W.L., C.W.L., S.-W.P., S.J.C., C.H.C., J.W.L.) and Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Catholic University of Korea, St. Mary's Hospital (K.B.S.), Gangnam Severance Hospital (H.M.K.), Korea University Anam (D.-S.L.), and Guro Hospital (S.-W.R.), Seoul, Keimyung University Dongsan Medical Center, Daegu (S.H.H.), Gachon University Gil Hospital, Incheon (T.H.A.), Chonnam National University Hospital, Gwangju (M.-H.J.), and Kangwon National University Hospital, Chuncheon (B.-K.L.) - all in South Korea; Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City (D.J.C.); Stanford University School of Medicine, Palo Alto, CA (A.C.Y.); Siriraj Hospital, Bangkok, Thailand (D.T.); Sir Run Run Shaw Hospital, Hangzhou, China (G.S.F.); and Sarawak General Hospital, Kuching, Malaysia (T.K.O.)
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Lee BK, Lim HS, Fearon WF, Yong AS, Yamada R, Tanaka S, Lee DP, Yeung AC, Tremmel JA. Invasive evaluation of patients with angina in the absence of obstructive coronary artery disease. Circulation 2015; 131:1054-60. [PMID: 25712205 DOI: 10.1161/circulationaha.114.012636] [Citation(s) in RCA: 243] [Impact Index Per Article: 27.0] [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] [Indexed: 12/16/2022]
Abstract
BACKGROUND More than 20% of patients presenting to the cardiac catheterization laboratory with angina have no angiographic evidence of coronary artery disease. Despite a "normal" angiogram, these patients often have persistent symptoms, recurrent hospitalizations, a poor functional status, and adverse cardiovascular outcomes, without a clear diagnosis. METHODS AND RESULTS In 139 patients with angina in the absence of obstructive coronary artery disease (no diameter stenosis >50%), endothelial function was assessed; the index of microcirculatory resistance, coronary flow reserve, and fractional flow reserve were measured; and intravascular ultrasound was performed. There were no complications. The average age was 54.0±11.4 years, and 107 (77%) were women. All patients had at least some evidence of atherosclerosis based on an intravascular ultrasound examination of the left anterior descending artery. Endothelial dysfunction (a decrease in luminal diameter of >20% after intracoronary acetylcholine) was present in 61 patients (44%). Microvascular impairment (an index of microcirculatory resistance ≥25) was present in 29 patients (21%). Seven patients (5%) had a fractional flow reserve ≤0.80. A myocardial bridge was present in 70 patients (58%). Overall, only 32 patients (23%) had no coronary explanation for their angina, with normal endothelial function, normal coronary physiological assessment, and no myocardial bridging. CONCLUSIONS The majority of patients with angina in the absence of obstructive coronary artery disease have occult coronary abnormalities. A comprehensive invasive assessment of these patients at the time of coronary angiography can be performed safely and provides important diagnostic information that may affect treatment and outcomes.
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Affiliation(s)
- Bong-Ki Lee
- From Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.)
| | - Hong-Seok Lim
- From Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.)
| | - William F Fearon
- From Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.).
| | - Andy S Yong
- From Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.)
| | - Ryotaro Yamada
- From Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.)
| | - Shigemitsu Tanaka
- From Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.)
| | - David P Lee
- From Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.)
| | - Alan C Yeung
- From Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.)
| | - Jennifer A Tremmel
- From Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA (B.-K.L., H.-S.L., W.F.F., A.S.Y., R.Y., S.T., D.P.L., A.C.Y., J.A.T.); Division of Cardiology, Kangwon National University School of Medicine, Chuncheon, Republic of Korea (B.-K.L.); and Department of Cardiology, Ajou University School of Medicine, Suwon, Republic of Korea (H.-S.L.)
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Diletti R, Garcia-Garcia HM, Bourantas C, Van Mieghem NM, van Geuns RJ, Muramatsu T, Zhang YJ, Mauri L, Belardi J, Silber S, Widimsky P, Leon M, Windecker S, Meredith I, Neumann FJ, Yeung AC, Saito S, Liu M, van Leeuwen F, Serruys PW. Impact of body mass index on long-term clinical outcomes after second-generation drug eluting stent implantation: Insights from the international global RESOLUTE program. Catheter Cardiovasc Interv 2015; 85:952-8. [PMID: 25689692 DOI: 10.1002/ccd.25828] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 06/07/2014] [Accepted: 01/03/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND An increased body mass index (BMI) is associated with a high risk of cardiovascular disease and reduction in life expectancy. However, several studies reported improved clinical outcomes in obese patients treated for cardiovascular diseases. The aim of the present study is to investigate the impact of BMI on long-term clinical outcomes after implantation of zotarolimus eluting stents. METHODS Individual patient data were pooled from the RESOLUTE Clinical Program comprising five trials worldwide. The study population was sorted according to BMI tertiles and clinical outcomes were evaluated at 2-year follow-up. RESULTS Data from a total of 5,127 patients receiving the R-ZES were included in the present study. BMI tertiles were as follow: I tertile (≤ 25.95 kg/m(2) -Low or normal weight) 1,727 patients; II tertile (>25.95 ≤ 29.74 kg/m(2) -overweight) 1,695 patients, and III tertile (>29.74 kg/m(2) -obese) 1,705 patients. At 2-years follow-up no difference was found for patients with high BMI (III tertile) compared with patients with normal or low BMI (I tertile) in terms of target lesion failure (I-III tertile, HR [95% CI] = 0.89 [0.69, 1.14], P = 0.341; major adverse cardiac events (I-III tertile, HR [95% CI] = 0.90 [0.72, 1.14], P = 0.389; cardiac death (I-III tertile, HR [95% CI] = 1.20 [0.73, 1.99], P = 0.476); myocardial infarction (I-III tertile, HR [95% CI] = 0.86 [0.55, 1.35], P = 0.509; clinically-driven target lesion revascularization (I-III tertile, HR [95% CI] = 0.75 [0.53, 1.08], P = 0.123; definite or probable stent thrombosis (I-III tertile, HR [95% CI] = 0.98 [0.49, 1.99], P = 0.964. CONCLUSIONS In the present study, the patients' body mass index was found to have no impact on long-term clinical outcomes after coronary artery interventions.
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Affiliation(s)
- Roberto Diletti
- Department of Interventional Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
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