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Stinis CT, Abbas AE, Teirstein P, Makkar RR, Chung CJ, Iyer V, Généreux P, Kipperman RM, Harrison JK, Hughes GC, Lyons JM, Rahman A, Kakouros N, Walker J, Roberts DK, Huang PH, Kar B, Dhoble A, Logsdon DP, Khanna PK, Aragon J, McCabe JM. Real-World Outcomes for the Fifth-Generation Balloon Expandable Transcatheter Heart Valve in the United States. JACC Cardiovasc Interv 2024; 17:1032-1044. [PMID: 38456883 DOI: 10.1016/j.jcin.2024.02.015] [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: 01/17/2024] [Revised: 02/14/2024] [Accepted: 02/14/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND The fifth-generation SAPIEN 3 Ultra Resilia valve (S3UR) incorporates several design changes as compared with its predecessors, the SAPIEN 3 (S3) and SAPIEN 3 Ultra (S3U) valves, including bovine leaflets treated with a novel process intended to reduce structural valve deterioration via calcification, as well as a taller external skirt on the 29-mm valve size to reduce paravalvular leak (PVL). The clinical performance of S3UR compared with S3 and S3U in a large patient population has not been previously reported. OBJECTIVES The aim of this study was to compare S3UR to S3/S3U for procedural, in-hospital, and 30-day clinical and echocardiographic outcomes after transcatheter aortic valve replacement (TAVR). METHODS Patients enrolled in the STS/ACC TVT (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy) Registry between January 1, 2021, and June 30, 2023, who underwent TAVR with S3UR or S3U/S3 valve platforms were propensity-matched and evaluated for procedural, in-hospital, and 30-day clinical and echocardiographic outcomes. RESULTS 10,314 S3UR patients were propensity matched with 10,314 patients among 150,539 S3U/S3 patients. At 30 days, there were no statistically significant differences in death, stroke, or bleeding, but a numerically higher hospital readmission rate in the S3UR cohort (8.5% vs 7.7%; P = 0.04). At discharge, S3UR patients exhibited significantly lower mean gradients (9.2 ± 4.6 mm Hg vs 12.0 ± 5.7 mm Hg; P < 0.0001) and larger aortic valve area (2.1 ± 0.7 cm2 vs 1.9 ± 0.6 cm2; P < 0.0001) than patients treated with S3/S3U. The 29-mm valve size exhibited significant reduction in mild PVL (5.3% vs 9.4%; P < 0.0001). CONCLUSIONS S3UR TAVR is associated with lower mean gradients and lower rates of PVL than earlier generations of balloon expandable transcatheter heart valve platforms.
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Affiliation(s)
- Curtiss T Stinis
- Division of Cardiology, Scripps Clinic, La Jolla, California, USA.
| | - Amr E Abbas
- Corewell Health East, William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Paul Teirstein
- Division of Cardiology, Scripps Clinic, La Jolla, California, USA
| | - Raj R Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Christine J Chung
- University of Washington Medical Center, Department of Medicine, Division of Cardiology, Seattle, Washington, USA
| | - Vijay Iyer
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, New York, USA
| | - Philippe Généreux
- Gagnon Cardiovascular Institute at Morristown Medical Center, Morristown, New Jersey, USA
| | - Robert M Kipperman
- Atlantic Health System Morristown Medical Center, Morristown, New Jersey, USA
| | - John K Harrison
- Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, North Carolina, USA
| | - G Chad Hughes
- Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, North Carolina, USA
| | | | - Ayaz Rahman
- Cardiology Associates of East Tennessee, Knoxville, Tennessee, USA
| | - Nikolaos Kakouros
- Division of Cardiology, University of Massachusetts School of Medicine, Worcester, MA, USA
| | - Jennifer Walker
- Department of Medicine, Division of Cardiology, University of North Carolina at Chapel Hill, North Carolina, USA
| | | | | | - Biswajit Kar
- Division of Cardiology, Department of Internal Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - Abhijeet Dhoble
- Division of Cardiology, Department of Internal Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | | | | | - Joseph Aragon
- Santa Barbara Cottage Hospital, Santa Barbara, California, USA
| | - James M McCabe
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
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Abbas AE, Madanat L, Khalili H, Mando R, Kheyrbek M, Chandra R, Niroula S, Hanson I, Dixon S, Renard B, Bloomingdale R, Cami E, Pridham B, Altshuler J, Kindzelski B, Fazzalari F, Shannon F, Vivacqua A. Aortic Regurgitation, Time to Aortic Valve Reintervention, and Mortality in Degenerated Trifecta Versus Non-Trifecta Bioprosthesis. Am J Cardiol 2024; 220:49-55. [PMID: 38580038 DOI: 10.1016/j.amjcard.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/04/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024]
Abstract
On July 31, 2023, the Trifecta valve was withdrawn from the market after concerns regarding early (≤5 years) structural valve deterioration (SVD), mainly as aortic regurgitation (AR). Our aim was to determine the timing, mechanism, and impact of bioprosthetic SVD in patients who underwent redo aortic valve replacement (redo-AVR) with either redo-SAVR or valve-in-valve transcatheter aortic valve replacement (TAVR) using Trifecta versus other bioprosthetic valves. Patients who underwent redo-AVR for SVD at our institution were categorized into 2 groups based on the valve type: Trifecta versus non-Trifecta. Multivariate Cox proportional hazard model and Kaplan-Meier curves were used to compare mortality. A total of 171 patients were included; 58 (34%) had previous SAVR with a Trifecta valve and 113 (66%) with non-Trifecta valve. A total of 103 patients (60%) underwent valve-in-valve TAVR and 68 redo-SAVR (40%). The age, gender, and Society of Thoracic Surgeons score were similar between Trifecta and non-Trifecta groups. In patients with bioprosthetic valves requiring redo-AVR, Trifecta valves had an earlier onset of greater than moderate AR (4.5 vs 11.9 years, p <0.001) and earlier time to redo-AVR (5.5 vs 12 years, p <0.001). AR was more common as the mechanism of SVD in Trifecta versus non-Trifecta valves (55.2% vs 30.1%, p = 0.006). All-cause adjusted mortality from index SAVR was higher in the Trifecta than in non-Trifecta group (hazard ratio 4.1, 95% confidence interval 1.5 to 11.5, p = 0.007). In conclusion, compared with non-Trifecta valves, Trifecta valves exhibit early SVD primarily as AR and progress rapidly to significant SVD requiring redo-AVR. Mortality is significantly higher with Trifecta than in non-Trifecta valves, potentially impacting the results of SAVR versus TAVR studies.
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Affiliation(s)
- Amr E Abbas
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan.
| | - Luai Madanat
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan
| | - Houman Khalili
- Department of Cardiovascular Medicine. Florida Atlantic University and Memorial Cardiovascular Institute, Hollywood, Florida
| | - Ramy Mando
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan
| | - Mazhed Kheyrbek
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan
| | - Rohit Chandra
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan
| | - Shailesh Niroula
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan
| | - Ivan Hanson
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Simon Dixon
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Brian Renard
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Richard Bloomingdale
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Elvis Cami
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Brittany Pridham
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan
| | - Jeffrey Altshuler
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Bogdan Kindzelski
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Franco Fazzalari
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Francis Shannon
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Alessandro Vivacqua
- Department of Cardiovascular Medicine. William Beaumont University Hospital, Corewell Health East, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan
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Madanat L, Allam M, Khalili H, Rabah A, Tariq R, Zamzam M, Rodés-Cabau J, Pilgrim T, Okuno T, Elmariah S, Pibarot P, Abbas AE. Long-Term Survival and Quality of Life Following Transcatheter Aortic Valve Replacement in Nonagenarians. Am J Cardiol 2024; 213:140-145. [PMID: 38134979 DOI: 10.1016/j.amjcard.2023.12.031] [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: 10/10/2023] [Revised: 11/16/2023] [Accepted: 12/17/2023] [Indexed: 12/24/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as a successful treatment option for severe aortic stenosis. However, the long-term outcomes of TAVR in nonagenarians is lacking. We aimed to examine the long-term mortality and quality of life in nonagenarians after TAVR. This is a multicenter, retrospective analysis on patients with severe aortic stenosis who underwent TAVR. Patients were divided into 2 groups: nonagenarians (age ≥90 years) and age <90 years. The Kansas City cardiomyopathy questionnaire (KCCQ) and New York Heart Association (NYHA) scores were compared before and after TAVR. All-cause mortality was compared between both groups at 30 days, 1 year, and 5 years after TAVR using the Cox proportional hazard model. A total of 6,896 patients were included, of whom 591 were nonagenarians. Nonagenarians had a higher Society of Thoracic Surgeons perioperative risk of mortality (8.1 ± 4.6% vs 5.4 ± 4.2%, p <0.001) before TAVR. Both groups were similar in KCCQ and NYHA scores at baseline. At 1 year after TAVR, there was no significant difference in improvement in the KCCQ overall score between those aged <90 years and nonagenarians (-4.76, 95% confidence interval [CI] -11.4 to 1.9, p = 0.161). Similarly, there was no statistically significant difference in improvement in NYHA class between the 2 groups at 1 year (odds ratio 1.07, 95% CI 0.85 to 1.25), p = 0.526). The unadjusted 30-day (3.2% vs 2.7%, hazard ratio 1.11, 95% CI 0.70 to 1.80, p = 0.667) and 5-year (28.0% vs 26.6%, hazard ratio 1.05, 95% CI 0.89 to 1.24, p = 0.60) all-cause mortality were similar between the 2 groups. In conclusion, this study demonstrates an excellent long-term mortality rate at 5 years after TAVR in nonagenarians, comparable to patients younger than 90 years. There is a significant and enduring improvement in functional status in nonagenarians, observed up to 1 year after TAVR.
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Affiliation(s)
- Luai Madanat
- William Beaumont University Hospital, Corewell Health East, Michigan
| | - Mohamed Allam
- William Beaumont University Hospital, Corewell Health East, Michigan
| | - Houman Khalili
- Florida Atlantic University, Boca Raton, Florida; Memorial Cardiovascular Institute, Hollywood, Florida
| | - Andrew Rabah
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Rehan Tariq
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Mazen Zamzam
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Josep Rodés-Cabau
- Université Laval, Québec, Canada; Québec Heart and Lung Institute, Québec, Canada
| | | | | | | | - Philippe Pibarot
- Université Laval, Québec, Canada; Québec Heart and Lung Institute, Québec, Canada
| | - Amr E Abbas
- William Beaumont University Hospital, Corewell Health East, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan.
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Thourani VH, Abbas AE, Ternacle J, Hahn RT, Makkar R, Kodali SK, George I, Kapadia S, Svensson LG, Szeto WY, Herrmann HC, Ailawadi G, Leipsic J, Blanke P, Webb J, Jaber WA, Russo M, Malaisrie SC, Yadav P, Clavel MA, Khalique OK, Weissman NJ, Douglas P, Bax J, Dahou A, Xu K, Bapat V, Alu MC, Leon MB, Mack MJ, Pibarot P. Patient-Prosthesis Mismatch After Surgical Aortic Valve Replacement: Analysis of the PARTNER Trials. Ann Thorac Surg 2024:S0003-4975(24)00079-1. [PMID: 38316377 DOI: 10.1016/j.athoracsur.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Our objective was to compare the impact of patient-prosthesis mismatch (PPM) for 2 years after surgical aortic valve replacement within the prospective, randomized Placement of Aortic Transcatheter Valves (PARTNER) trials. METHODS Surgical aortic valve replacement patients from the PARTNER 1, 2, and 3 trials were included. PPM was classified as moderate (indexed effective orifice area ≤0.85 cm2/m2) or severe (indexed effective orifice area ≤0.65 cm2/m2). The primary endpoint was the composite of all-cause death and heart failure rehospitalization at 2 years. RESULTS By the predicted PPM method (PPMP), 59.1% had no PPM, 38.8% moderate PPM, and 2.1% severe PPM; whereas by the measured PPM method (PPMM), 42.4% had no PPM, 36.0% moderate, and 21.6% severe. Patients with no PPMP (23.6%) had a lower rate of the primary endpoint compared with patients with moderate (28.2%, P = .03) or severe PPMP (38.8%, P = .02). Using the PPMM method, there was no difference between the no (17.7%) and moderate PPMM groups (21.1%) in the primary outcome (P = .16). However, those with no PPMM or moderate PPMM were improved compared with severe PPMM (27.4%, P < .001 and P = .02, respectively). CONCLUSIONS Severe PPM analyzed by PPMP was only 2.1% for surgical aortic valve replacement patients. The PPMM method overestimated the incidence of severe PPM relative to PPMP, but was also associated with worse outcome. There was higher all-cause mortality in patients with severe PPM, thus surgical techniques to minimize PPM remain critical.
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Affiliation(s)
- Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia.
| | - Amr E Abbas
- Department of Cardiology, Beaumont Hospital, Detroit, Michigan
| | - Julien Ternacle
- Department of Cardiology, Haut-Leveque Cardiology Hospital, Bordeaux University, Pessac, France; Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec, Canada
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Raj Makkar
- Department of Cardiology, Cedars Sinai Medical Center, Los Angeles, California
| | - Susheel K Kodali
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Isaac George
- Division of Cardiac Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Samir Kapadia
- Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Department of Cardiac Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Wilson Y Szeto
- Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Howard C Herrmann
- Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Jonathon Leipsic
- Department of Cardiology, University of British Columbia, Vancouver, Canada
| | - Philipp Blanke
- Department of Cardiology, University of British Columbia, Vancouver, Canada
| | - John Webb
- Department of Cardiology, University of British Columbia, Vancouver, Canada
| | - Wael A Jaber
- Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Mark Russo
- Division of Cardiac Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - S Chris Malaisrie
- Division of Cardiac Surgery, Northwestern University, Chicago, Illinois
| | - Pradeep Yadav
- Department of Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Marie-Annick Clavel
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec, Canada
| | - Omar K Khalique
- Cardiovascular Research Foundation, New York, New York; Department of Cardiology, St. Francis Hospital, Roslyn, New York
| | | | - Pamela Douglas
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Ke Xu
- Edwards Lifesciences, Irvine, California
| | - Vinayak Bapat
- Department of Cardiac Surgery, Minneapolis Heart Institute, Minneapolis, Minnesota
| | - Maria C Alu
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Martin B Leon
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Michael J Mack
- Department of Cardiac Surgery, Baylor Scott and White Health, Dallas, Texas
| | - Philippe Pibarot
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec, Canada
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Nuche J, Abbas AE, Serra V, Vilalta V, Nombela-Franco L, Regueiro A, Al-Azizi KM, Iskander A, Conradi L, Forcillo J, Lilly S, Calabuig A, Fernandez-Nofrerias E, Mohammadi S, Giuliani C, Pelletier-Beaumont E, Pibarot P, Rodés-Cabau J. Balloon- vs Self-Expanding Transcatheter Valves for Failed Small Surgical Aortic Bioprostheses: 1-Year Results of the LYTEN Trial. JACC Cardiovasc Interv 2023; 16:2999-3012. [PMID: 37902146 DOI: 10.1016/j.jcin.2023.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 10/02/2023] [Accepted: 10/15/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Data comparing valve systems in the valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) field have been obtained from retrospective studies. OBJECTIVES The authors sought to compare the 1-year hemodynamic performance and clinical outcomes between balloon-expandable valves (BEV) SAPIEN 3/ULTRA (Edwards Lifesciences) and self-expanding valves (SEV) Evolut R/PRO/PRO+ (Medtronic) in ViV-TAVR. METHODS Patients with a failed small (≤23 mm) surgical valve undergoing ViV-TAVR were randomized to receive a SEV or a BEV. Patients had a clinical and valve hemodynamic (Doppler echocardiography) evaluation at 1-year follow-up. Study outcomes were defined according to VARC-2/VARC-3 criteria. Intended performance of the valve was defined as mean gradient <20 mm Hg, peak velocity <3 m/s, Doppler velocity index ≥0.25 and less than moderate AR. RESULTS A total of 98 patients underwent ViV-TAVR (46 BEV, 52 SEV). At 1-year follow-up, patients receiving a SEV had a lower mean transaortic gradient (22 ± 8 mm Hg BEV vs 14 ± 7 mm Hg SEV; P < 0.001), and a higher rate of intended valve performance (BEV: 30%, SEV:76%; P < 0.001). There were no cases of greater than mild aortic regurgitation. There were no differences in functional status (NYHA functional class >II, BEV: 7.3%, SEV: 4.1%; P = 0.505) or quality of life (Kansas City Cardiomyopathy Questionnaire, BEV: 77.9 ± 21.2, SEV: 81.8 ± 14.8; P = 0.334). No differences in all-cause mortality (BEV: 6.5%, SEV: 3.8; P = 0.495), heart failure hospitalization (BEV: 6.5%, SEV: 1.9%; P = 0.214), stroke (BEV: 0%, SEV: 1.9%; P = 0.369), myocardial infarction (BEV: 0%, SEV: 1.9%; P = 0.347), or pacemaker implantation (BEV: 2.2%, SEV: 1.9%; P = 0.898) were found. CONCLUSIONS In patients who underwent ViV-TAVR for failed small aortic bioprostheses, those receiving a SEV exhibited a better valve hemodynamic profile at 1-year follow-up. There were no differences between SEV and BEV regarding functional status, quality of life, or clinical outcomes.
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Affiliation(s)
- Jorge Nuche
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Amr E Abbas
- Corewell Health East, William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Vicenç Serra
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Ander Regueiro
- Clinic Cardiovascular Institute, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain
| | - Karim M Al-Azizi
- Baylor Scott and White The Heart Hospital Plano, Plano, Texas, USA
| | | | | | - Jessica Forcillo
- Centre Hospitalier Universitaire de Montreal, Montreal, Quebec, Canada
| | - Scott Lilly
- OSU Heart and Vascular Research Organization, Richard M Ross Hospital, Columbus, Ohio, USA
| | | | | | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Carlos Giuliani
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Clinic Cardiovascular Institute, Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer, University of Barcelona, Barcelona, Spain.
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Abbas AE, Khalili H, Madanat L, Elmariah S, Shannon F, Al-Azizi K, Waggoner T, Pilgrim T, Okuno T, Bavry A, Ternacle J, Christensen J, Cabau JR, Mack M, Pibarot P. Echocardiographic Versus Invasive Aortic Valve Gradients in Different Clinical Scenarios. J Am Soc Echocardiogr 2023; 36:1302-1314. [PMID: 37507058 DOI: 10.1016/j.echo.2023.06.016] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 06/06/2023] [Accepted: 06/15/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND The role of echocardiography in deriving transvalvular mean gradients from transaortic velocities in aortic stenosis (AS) and in structural valve degeneration (SVD) is well established. However, reports following surgical aortic valve replacement, post-transcatheter aortic valve replacement (TAVR), and valve-in-valve-TAVR (ViV-TAVR) have cautioned against the use of echocardiography-derived mean gradients to assess normal functioning bioprosthesis due to discrepancy compared with invasive measures in a phenomenon called discordance. METHODS In a multicenter study, intraprocedural echocardiographic and invasive mean gradients in AS, SVD, post-native TAVR, and post-ViV-TAVR were compared, when obtained concomitantly, and discharge echocardiographic gradients were recorded. Absolute discordance (intraprocedural echocardiographic - invasive mean gradient) and percent discordance (intraprocedural echocardiographic - invasive mean gradient/echocardiographic mean gradient) were calculated. Multivariable regression analysis was performed to determine variables independently associated with elevated postprocedure invasive gradients ≥20 mm Hg, absolute discordance >10 mm Hg, and discharge echocardiographic mean gradient ≥20 mm Hg. RESULTS A total of 5,027 patients were included in the registry: 4,725 native TAVR and 302 ViV-TAVR. Intraprocedural concomitant echocardiographic and invasive mean gradients were obtained pre-TAVR in AS (n = 2,418), pre-ViV-TAVR in SVD (n = 101), in post-ViV-TAVR (n = 77), and in post-TAVR (n = 823). Echocardiographic and invasive mean gradients demonstrated strong correlation (r = 0.69) and agreement (bias, 0.11; 95% CI, -0.4-0.62) in AS, moderate correlation (r = 0.56) and agreement (bias, 1.08; 95% CI, -2.53 to 4.59) in SVD, moderate correlation (r = 0.61) and weak agreement (bias, 6.47; 95% CI, 5.08-7.85) post-ViV-TAVR, and weak correlation (r = 0.18) and agreement (bias, 3.41; 95% CI, 3.16-3.65) post-TAVR. Absolute discordance occurs primarily in ViV-TVR and is not explained by sinotubular junction size and increases with increasing echocardiographic mean gradient. Percent discordance in AS and SVD (1.3% and 4%, respectively) was lower compared with post-TAVR/ViV-TAVR (66.7% and 100%, respectively). Compared with self-expanding valves, balloon expanding valves were independently associated with elevated discharge echocardiographic but lower invasive mean gradient (odds ratio = 3.411, 95% CI, 1.482-7.852, P = .004; vs odds ratio = 0.308, 95% CI, 0.130-0.731, P = .008, respectively). CONCLUSIONS Post-TAVR/ViV-TAVR, echocardiography is discordant from invasive mean gradients, and absolute discordance increases with increasing echocardiographic mean gradient and is not explained by sinotubular junction size. Percent discordance is significantly higher post-TAVR/ViV-TAVR than in AS and SVD. Post-TAVR/ViV-TAVR, poor correlation and wide limits of agreement suggest echocardiographic and invasive mean gradients may not be used interchangeably and a high residual echocardiographic mean gradient should be confirmed invasively before considering any additional procedure to "correct" the gradient. Transcatheter aortic valve replacement valve types have variable impact on echocardiographic and invasive mean gradients.
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Affiliation(s)
- Amr E Abbas
- Corewell Health, William Beaumont University Hospital, Royal Oak, Michigan; Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan.
| | | | - Luai Madanat
- Corewell Health, William Beaumont University Hospital, Royal Oak, Michigan
| | | | - Francis Shannon
- Corewell Health, William Beaumont University Hospital, Royal Oak, Michigan; Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan
| | | | | | | | | | - Anthony Bavry
- Department of Cardiovascular Medicine, University of Florida, Gainesville, Florida
| | - Julien Ternacle
- Université Laval/Québec Heart and Lung Institute, Québec, Ontario, Canada
| | | | - Josep R Cabau
- Université Laval/Québec Heart and Lung Institute, Québec, Ontario, Canada
| | | | - Philippe Pibarot
- Université Laval/Québec Heart and Lung Institute, Québec, Ontario, Canada
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Madanat L, Seeley E, Mando R, Shah K, Hanson I, Renard BM, Abbas AE, Keeley J, Haines DE, Mehta NK. Mortality Outcomes in Patients With Cardiac Implantable Electronic Devices Before and After Transcatheter Aortic Valve Replacement. Am J Cardiol 2023; 205:1-9. [PMID: 37573632 DOI: 10.1016/j.amjcard.2023.07.098] [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: 06/14/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 08/15/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) carries a risk of high-grade AV block requiring cardiac implantable electronic device (CIED) implantation, which has been associated with a higher mortality rate. However, the outcomes of TAVR in patients with preexisting CIEDs are not well understood. We conducted a retrospective analysis of consecutive patients who underwent TAVR from December 2014 to December 2019 at our institution. Patients were categorized into 3 groups: preexisting CIED pre-TAVR (group 1), CIED implanted within 30 days after TAVR (group 2), and no CIED implanted (group 3). Cox proportional hazard was conducted to determine the primary end point of all-cause mortality. A total of 366 patients were included, of whom 93 (25.4%), 51 (13.9%), and 222 (60.7%) comprised group 1, 2, and 3, respectively. The median follow-up time was 2.3 years. The all-cause mortality rate was higher in group 1 than group 2 (hazard ratio [HR] 2.60, 95% confidence interval [CI] 1.09 to 6.18, p = 0.03) and group 3 (HR 1.96, 95% CI 1.24 to 3.08, p = 0.004). On the multivariate analysis, there was no statistically significant difference in mortality among the groups (group 1 vs group 2: HR 1.95, 95% CI 0.70 to 5.44, p = 0.20 and group 1 vs group 3: HR 1.27, 95% CI 0.66 to 2.43, p = 0.47). Preoperative hemoglobin ≤12 g/100 ml was an independent predictor of all-cause mortality (HR 1.75, 95% CI 1.10 to 2.80, p = 0.02). Group 1 had a higher 1 year congestive heart failure readmission rate (29%) than group 2 (17.6%) and group 3 (8.1%; p <0.0001). In conclusion, there was no difference in the adjusted long-term survival based on the CIED grouping. However, patients with preexisting CIEDs had higher all-cause mortality and 1-year congestive heart failure readmission rates owing to their higher co-morbidity burden, irrespective of their Society of Thoracic Surgeons score. This can be taken into account for preoperative risk stratification.
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Affiliation(s)
- Luai Madanat
- Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Elizabeth Seeley
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Ramy Mando
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Kuldeep Shah
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Ivan Hanson
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Brian M Renard
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Amr E Abbas
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Jacob Keeley
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - David E Haines
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Nishaki K Mehta
- Oakland University William Beaumont School of Medicine, Rochester, Michigan; Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan; Cardiovascular Medicine, University of Virginia, Charlottesville, Virginia.
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Pathangey G, Hanzel GS, Shannon FL, Hanson I, Lau W, Vivacqua A, Abbas AE. LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT: 1-YEAR EFFICACY AND MORTALITY OUTCOMES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01466-3] [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: 03/06/2023]
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9
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Madanat L, Schott J, Mando R, Shannon F, Khalili H, Rodes-Cabau J, Wood D, Sathananthan J, Pibarot P, Abbas AE. Discordance vs Pressure Recovery in Aortic Stenosis and Post-TAVR. JACC Cardiovasc Imaging 2023:S1936-878X(23)00038-4. [PMID: 37038878 DOI: 10.1016/j.jcmg.2023.01.006] [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] [Received: 09/22/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 04/12/2023]
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10
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Rabah M, Allen S, Abbas AE, Dixon S. A novel comprehensive radiation shielding system eliminates need for personal lead aprons in the catheterization laboratory. Catheter Cardiovasc Interv 2023; 101:79-86. [PMID: 36453459 DOI: 10.1002/ccd.30490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVES This clinical study evaluated the efficacy of a novel radiation shielding system for the cardiac catheterization laboratory designed to provide comprehensive protection that obviates the need for personal lead aprons. BACKGROUND Invasive Cardiologists are exposed to occupational health hazards related directly to radiation exposure (RE) and indirectly to the orthopedic burden of wearing only partially protective lead aprons. Innovations to reduce these risks are warranted. A novel comprehensive shielding system (ProtegoTM , Image Diagnostics Inc, Fitchburg, Ma) has been validated in pre-clinical studies to provide excellent radiation protection, sufficient for the State of Michigan to certify it for use without need for personal lead aprons. METHODS This clinical analysis measured RE to a single Physician operator utilizing the ProtegoTM shield (and not wearing personal lead apron) during routine cardiac catheterization procedures (diagnostic and interventional). RE was measured at both thyroid and waist level with a real-time dosimetry system (RaysafeTM , Billdal, Sweden), calculated on a median per case basis (mrems). Additional parameters collected included procedure type, access site, per case fluoroscopy time, and patient factors including body mass index. RESULTS In n=98 cases (25% diagnostic, 75% interventional including 22% chronic total occlusions), median/case RE was 0.4 mrems (thyroid) and 0.2 mrems (waist). RE=0 in 12 cases. In no case did radiation exposure exceed 3.2 mrems. CONCLUSION The ProtegoTM shield system provides excellent RE protection to the Physician operator, without the need for personal lead aprons and has the potential to reduce catheterization laboratory occupational health hazards.
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Affiliation(s)
- Maher Rabah
- Department of Cardiovascular Medicine, Beaumont Hospitals, Royal Oak, Michigan, USA
| | - Sorcha Allen
- Department of Cardiovascular Medicine, Beaumont Hospitals, Royal Oak, Michigan, USA
| | - Amr E Abbas
- Department of Cardiovascular Medicine, Beaumont Hospitals, Royal Oak, Michigan, USA
| | - Simon Dixon
- Department of Cardiovascular Medicine, Beaumont Hospitals, Royal Oak, Michigan, USA
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Hanzel GS, Abbas AE, Schreiber TL, O'Neill WW. Account of the First Transcatheter Aortic Valve Replacement in North America. JACC Cardiovasc Interv 2022; 15:2440-2444. [PMID: 36480987 DOI: 10.1016/j.jcin.2022.09.042] [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: 08/24/2022] [Accepted: 09/13/2022] [Indexed: 11/18/2022]
Affiliation(s)
- George S Hanzel
- Division of Cardiovascular Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
| | - Amr E Abbas
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, Beaumont Health and Spectrum Health, Royal Oak, Michigan, USA
| | | | - William W O'Neill
- Department of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan, USA
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Tawney AM, Schott JP, Safian RD, Goldstein JA, Bloomingdale RJ, O’Connell TF, Bilolikar AN, Abbas AE, Renard BM, Hanson ID. Valve-in-Mitral Annular Calcification Transcatheter Mitral Valve Replacement After Thrombosis of Extracardiac Valved Conduit. JACC Case Rep 2022; 4:1267-1273. [PMID: 36406921 PMCID: PMC9666751 DOI: 10.1016/j.jaccas.2022.07.024] [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: 04/06/2022] [Revised: 06/16/2022] [Accepted: 07/13/2022] [Indexed: 11/26/2022]
Abstract
We report a patient with severe mitral annular calcification, mitral stenosis/regurgitation, hypertrophic obstructive cardiomyopathy, and subaortic membrane treated with valved left atrium-left ventricle conduit, septal myectomy, and membrane resection. Subsequent thrombosis of the conduit prompted successful valve-in- mitral annular calcification transcatheter mitral valve replacement and laceration of the anterior mitral leaflet to prevent outflow obstruction. (Level of Difficulty: Advanced.).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ivan D. Hanson
- Address for correspondence: Dr. Ivan D. Hanson, Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, 3601 West 13 Mile Road, Royal Oak, Michigan 48073, USA. @IvanHansonMD
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Herrmann HC, Pibarot P, Wu C, Hahn RT, Tang GHL, Abbas AE, Playford D, Ruel M, Jilaihawi H, Sathananthan J, Wood DA, De Paulis R, Bax JJ, Rodes-Cabau J, Cameron DE, Chen T, Del Nido PJ, Dweck MR, Kaneko T, Latib A, Moat N, Modine T, Popma JJ, Raben J, Smith RL, Tchetche D, Thomas MR, Vincent F, Yoganathan A, Zuckerman B, Mack MJ, Leon MB. Bioprosthetic Aortic Valve Hemodynamics: Definitions, Outcomes, and Evidence Gaps: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 80:527-544. [PMID: 35902177 DOI: 10.1016/j.jacc.2022.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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] [Received: 02/10/2022] [Revised: 05/19/2022] [Accepted: 06/01/2022] [Indexed: 12/23/2022]
Abstract
A virtual workshop was organized by the Heart Valve Collaboratory to identify areas of expert consensus, areas of disagreement, and evidence gaps related to bioprosthetic aortic valve hemodynamics. Impaired functional performance of bioprosthetic aortic valve replacement is associated with adverse patient outcomes; however, this assessment is complicated by the lack of standardization for labelling, definitions, and measurement techniques, both after surgical and transcatheter valve replacement. Echocardiography remains the standard assessment methodology because of its ease of performance, widespread availability, ability to do serial measurements over time, and correlation with outcomes. Management of a high gradient after replacement requires integration of the patient's clinical status, physical examination, and multimodality imaging in addition to shared patient decisions regarding treatment options. Future priorities that are underway include efforts to standardize prosthesis sizing and labelling for both surgical and transcatheter valves as well as trials to characterize the consequences of adverse hemodynamics.
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Affiliation(s)
- Howard C Herrmann
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Philippe Pibarot
- Department of Medicine, Québec Heart and Lung Institute, Laval University, Québec City, Quebec, Canada
| | - Changfu Wu
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Rebecca T Hahn
- Columbia University Medical Center, New York, New York, USA
| | | | - Amr E Abbas
- Beaumont Hospital Royal Oak, Royal Oak, Michigan, USA
| | - David Playford
- The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Marc Ruel
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Hasan Jilaihawi
- Heart Valve Center, NYU Langone Health, New York, New York, USA
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A Wood
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jeroen J Bax
- Leiden University Medical Centre, Leiden, the Netherlands
| | - Josep Rodes-Cabau
- Department of Medicine, Québec Heart and Lung Institute, Laval University, Québec City, Quebec, Canada
| | - Duke E Cameron
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tiffany Chen
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pedro J Del Nido
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Tsuyoshi Kaneko
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Neil Moat
- Abbott Structural Heart, Santa Clara, California, USA
| | - Thomas Modine
- Hopital Cardiologique de Haut Leveque, Bordeaux, France
| | | | - Jamie Raben
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Robert L Smith
- Baylor Scott and White, The Heart Hospital, Plano, Texas, USA
| | | | | | | | - Ajit Yoganathan
- Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Bram Zuckerman
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Michael J Mack
- Baylor Scott and White, The Heart Hospital, Plano, Texas, USA
| | - Martin B Leon
- Columbia University Medical Center, New York, New York, USA
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Shen M, Oh JK, Guzzetti E, Singh GK, Pawade T, Tastet L, Clavel MA, Delgado V, Bax JJ, Dweck MR, Abbas AE, Mando R, Falconi ML, Perez de Arenaza D, Poh KK, Kong W, Tay E, Pressman G, Brito D, Song JK, Pibarot P. Computed Tomography Aortic Valve Calcium Scoring in Patients With Bicuspid Aortic Valve Stenosis. Struct Heart 2022; 6:100027. [PMID: 37273477 PMCID: PMC10236792 DOI: 10.1016/j.shj.2022.100027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 01/25/2022] [Accepted: 02/24/2022] [Indexed: 06/06/2023]
Abstract
Background Sex-specific thresholds of computed tomography (CT)-derived aortic valve calcification (AVC) or AVC density (AVCd) to identify severe aortic stenosis (AS) have been established in populations that consisted mainly of Caucasians with a tricuspid aortic valve. The objective of this study was to evaluate the accuracy (i.e., sensitivity and specificity) of previously established thresholds to identify severe AS in patients with bicuspid aortic valve (BAV) and according to ethnicity: Caucasian vs. Asian. Methods We built a multicenter registry of echocardiographic and CT data collected in BAV patients with at least mild AS and preserved left ventricular ejection fraction from 7 different centers. Anatomic severity of AS obtained by CT-derived AVC and AVCd was compared to hemodynamic severity of AS obtained by echocardiography. Results Among 485 BAV patients (60% men, 73% Asians), the best thresholds of AVC and AVCd to identify severe AS in BAV patients were 2315 arbitrary units (AU) (sensitivity [Se]/specificity [Spe] = 82/78%) in men, 1103 AU (Se/Spe = 80/82%) in women, and 561 AU/cm2 (Se/Spe = 86/91%) in men, and 301 AU/cm2 (Se/Spe = 83/82%) in women, respectively. According to ethnicity, thresholds for severe AS in Caucasian patients were, respectively, in men and women: 2208 AU (Se/Spe = 83/83%) and 1230 AU (Se/Spe = 87/82%) for AVC and 474 AU/cm2 (Se/Spe = 88/83%) and 358 AU/cm2 (Se/Spe = 80/82%) for AVCd. In Asian patients, they were 2582 AU (Se/Spe = 76/78%) and 924 AU (Se/Spe = 84/80%) for AVC and 640 AU/cm2 (Se/Spe = 82/89%) and 255 AU/cm2 (Se/Spe = 86/80%) for AVCd. Conclusions The optimal thresholds to identify hemodynamically severe AS in BAV patients are similar in Caucasians but appear to be higher in Asian men, compared with thresholds previously reported in tricuspid aortic valve patients. Nonetheless, the thresholds currently proposed in the guidelines have good accuracy and can be applied in BAV patients to confirm AS severity.
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Affiliation(s)
- Mylène Shen
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | - Jin Kyung Oh
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Korea
| | - Ezequiel Guzzetti
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | - Gurpreet K. Singh
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tania Pawade
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Lionel Tastet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J. Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marc R. Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Amr E. Abbas
- Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, Michigan, USA
| | - Ramy Mando
- Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, Michigan, USA
| | - Mariano Luis Falconi
- Department of Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Kian Keong Poh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - William Kong
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Edgar Tay
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Gregg Pressman
- Department of Cardiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Daniel Brito
- Department of Cardiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Jae Kwan Song
- Valvular Heart Disease Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Université Laval, Quebec City, Quebec, Canada
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15
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Khalili H, Kadri AN, Pilgrim T, Bavry AA, Okuno T, Al-Azizi K, Waggoner T, Elmariah S, Maini BS, Pibarot P, Abbas AE. DEVELOPMENT OF A SCORING SYSTEM FOR PREDICTING HIGH RESIDUAL GRADIENT AT PRE-DISCHARGE ECHOCARDIOGRAPHY FOLLOWING TAVR. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01653-9] [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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16
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Clavel MA, Hahn RT, Abbas AE, Daubert MA, Douglas PS, Elmariah S, Zhao Y, Mack MJ, Leon MB, Pibarot P. EFFECT OF SEX AND LOW FLOW AFTER SURGICAL OR TRANSCATHETER AORTIC VALVE REPLACEMENT: AN ANALYSIS OF PARTNER 2 AND 3 TRIALS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01708-9] [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: 11/30/2022]
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17
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Khalili H, Pibarot P, Elmariah S, Pilgrim T, Maini BS, Bavry AA, Okuno T, Al-Azizi K, Waggoner T, Abbas AE. SEVERE PPM FOLLOWING TAVR IN SMALL ANNULUS IN SUPRA VERSUS INTRA-ANNULAR VALVE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01764-8] [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: 10/18/2022]
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18
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Mando R, Abbas AE, Allen O, Renard BM, Gallagher MJ, Shannon FL, Vivacqua A, Hanson I. THE RELATIONSHIP OF AORTIC VALVE CALCIUM SCORE AND GLOMERULAR FILTRATION RATE IN PATIENTS WITH SEVERE AORTIC STENOSIS AND CHRONIC KIDNEY DISEASE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01681-3] [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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Abbas AE, Health B, Oak R. From Killip To Forrester To Echocardiography: Beyond Myocardial Infarction. J Am Soc Echocardiogr 2021; 35:443-444. [PMID: 34875313 DOI: 10.1016/j.echo.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Amr E Abbas
- Oakland University William Beaumont School of Medicine, Auburn Hills, MI
| | - Beaumont Health
- Oakland University William Beaumont School of Medicine, Auburn Hills, MI
| | - Royal Oak
- Oakland University William Beaumont School of Medicine, Auburn Hills, MI
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20
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Barker M, Abbas AE, Webb JG, Pibarot P, Sathananthan J, Brunner N, Wang DD, Wang J, Leon MB, Wood DA. Standardized Invasive Hemodynamics for Management of Patients With Elevated Echocardiographic Gradients Post-Transcatheter Aortic Valve Replacement at Midterm Follow-Up. Circ Cardiovasc Interv 2021; 15:e011243. [PMID: 34802254 DOI: 10.1161/circinterventions.121.011243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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)
- Madeleine Barker
- Department of Cardiology, Center for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, University of British Columbia, Vancouver, Canada (M.B., J.G.W., J.S., N.B., J.W., D.A.W.)
| | - Amr E Abbas
- Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, MI (A.E.A.)
| | - John G Webb
- Department of Cardiology, Center for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, University of British Columbia, Vancouver, Canada (M.B., J.G.W., J.S., N.B., J.W., D.A.W.)
| | - Philippe Pibarot
- Department of Medicine, Laval University, Quebec City, QC, Canada (P.P.)
| | - Janarthanan Sathananthan
- Department of Cardiology, Center for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, University of British Columbia, Vancouver, Canada (M.B., J.G.W., J.S., N.B., J.W., D.A.W.)
| | - Nathan Brunner
- Department of Cardiology, Center for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, University of British Columbia, Vancouver, Canada (M.B., J.G.W., J.S., N.B., J.W., D.A.W.)
| | - Dee Dee Wang
- Department of Cardiology, Center for Structural Heart Disease, Henry Ford Hospital, Detroit, MI (D.D.W.)
| | - Jia Wang
- Department of Cardiology, Center for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, University of British Columbia, Vancouver, Canada (M.B., J.G.W., J.S., N.B., J.W., D.A.W.)
| | - Martin B Leon
- Cardiology Department, NewYork-Presbyterian/Columbia University Medical Center (M.B.L.)
| | - David A Wood
- Department of Cardiology, Center for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, University of British Columbia, Vancouver, Canada (M.B., J.G.W., J.S., N.B., J.W., D.A.W.)
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Abbas AE, Mando R, Kadri A, Khalili H, Hanzel G, Shannon F, Al-Azizi K, Waggoner T, Kassas S, Pilgrim T, Okuno T, Camacho A, Selberg A, Elmariah S, Bavry A, Ternacle J, Christensen J, Gheewala N, Pibarot P, Mack M. Comparison of Transvalvular Aortic Mean Gradients Obtained by Intraprocedural Echocardiography and Invasive Measurement in Balloon and Self-Expanding Transcatheter Valves. J Am Heart Assoc 2021; 10:e021014. [PMID: 34585593 PMCID: PMC8649128 DOI: 10.1161/jaha.120.021014] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Concerns about discordance between echocardiographic and invasive mean gradients after transcatheter aortic valve replacement (TAVR) with balloon-expandable valves (BEVs) versus self-expanding valves (SEVs) exist. Methods and Results In a multicenter study, direct-invasive and echocardiography-derived transvalvular mean gradients obtained before and after TAVR were compared as well as post-TAVR and discharge echocardiographic mean gradients in BEVs versus SEVs in 808 patients. Pre-TAVR, there was good correlation (R=0.614; P<0.0001) between direct-invasive and echocardiography-derived mean gradients and weak correlation (R=0.138; P<0.0001) post-TAVR. Compared with post-TAVR echocardiographic mean gradients, both valves exhibit lower invasive and higher discharge echocardiographic mean gradients. Despite similar invasive mean gradients, a small BEV exhibits higher post-TAVR and discharge echocardiographic mean gradients than a large BEV, whereas small and large SEVs exhibit similar post-TAVR and discharge mean gradients. An ejection fraction <50% (P=0.028) and higher Society of Thoracic Surgeons predicted risk of mortality score (P=0.007), but not invasive or echocardiographic mean gradient ≥10 mm Hg (P=0.378 and P=0.341, respectively), nor discharge echocardiographic mean gradient ≥20 mm Hg (P=0.393), were associated with increased 2-year mortality. Conclusions Invasively measured and echocardiography-derived transvalvular mean gradients correlate well in aortic stenosis but weakly post-TAVR. Post-TAVR, echocardiography overestimates transvalvular mean gradients compared with invasive measurements, and poor correlation suggests these modalities cannot be used interchangeably. Moreover, echocardiographic mean gradients are higher on discharge than post-TAVR in all valves. Despite similar invasive mean gradients, a small BEV exhibits higher post-TAVR and discharge echocardiographic mean gradients than a large BEV, whereas small and large SEVs exhibit similar post-TAVR and discharge mean gradients. Immediately post-TAVR, elevated echocardiographic-derived mean gradients should be assessed with caution and compared with direct-invasive mean gradients. A low ejection fraction and higher Society of Thoracic Surgeons score, but not elevated mean gradients, are associated with increased 2-year mortality.
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Affiliation(s)
- Amr E Abbas
- Beaumont Hospital Royal Oak Royal Oak MI.,Oakland University William Beaumont School of Medicine Auburn Hills MI
| | - Ramy Mando
- Beaumont Hospital Royal Oak Royal Oak MI
| | - Amer Kadri
- Beaumont Hospital Royal Oak Royal Oak MI
| | | | - George Hanzel
- Beaumont Hospital Royal Oak Royal Oak MI.,Oakland University William Beaumont School of Medicine Auburn Hills MI
| | - Francis Shannon
- Beaumont Hospital Royal Oak Royal Oak MI.,Oakland University William Beaumont School of Medicine Auburn Hills MI
| | | | | | | | | | | | | | | | | | | | - Julien Ternacle
- Université Laval/Québec Heart and Lung Institute Québec Canada
| | | | - Neil Gheewala
- Pima Heart and Vascular Tucson Medical Center Tucson AZ
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Kadri AN, Hanzel G, Elmariah S, Shannon F, Al-Azizi K, Boura J, Mack M, Abbas AE. Invasive versus echocardiographic gradients in degenerated surgical aortic valve prostheses: A multicenter study. JTCVS Open 2021; 7:51-60. [PMID: 36003692 PMCID: PMC9390586 DOI: 10.1016/j.xjon.2021.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/04/2021] [Indexed: 01/26/2023]
Abstract
Objectives To compare echocardiographic and invasive mean gradients obtained concomitantly in degenerated bioprosthetic surgical aortic valves (SAVRs). Methods In a multicenter study, we compared concomitant echocardiographic and invasive mean gradients of SAVR, obtained before valve-in-valve transcatheter aortic valve replacement in all patients, patients with primary stenosis (AS), primary aortic regurgitation (AR), and mixed aortic valve disease (MAVD), and in small versus large valves (≤ or >23 mm). Dimensionless index (DI) was calculated in all groups. Results In total, 74 patients were included and data presented as median (interquartile range). Echocardiography-catheterization mean gradient discordance was observed in all patients (invasive = 22 mm Hg [11-34] vs echocardiographic = 32 mm Hg [21-42], P = .013), small valves (invasive = 15 mm Hg [8-34] vs echocardiographic = 28 mm Hg [21-41], P = .013), and large valves (invasive = 20 mm Hg [8.5-27.13] vs echocardiographic = 32 mm Hg [25.5 – 41.5], P < .0001), with a bias of 8 ± 15 mm Hg and wide limits of agreement (–22 to 39 mm Hg) on Bland–Altman plots, indicating these modalities may not be interchangeable. Discordance occurred in AR (invasive = 3 mm Hg [1-6] vs echocardiographic = 12 mm Hg [7-22], P = .017) and in MAVD (invasive = 19 mm Hg [12-29] vs echocardiographic = 31 mm Hg [23-39], P < .0001) but not in AS (invasive = 35 mm Hg [24-45] vs echocardiographic = 41 mm Hg [30-50], P = .45). A lower DI (0.21 [0.14-0.25]) occurred in AS compared with MAVD (0.31 [0.19-0.39]) and AR (0.55 [0.51-0.69]), P < .0001. Conclusions Discordance between echocardiography and invasive mean gradients exists in degenerated SAVR, regardless of valve size, but depends on mechanism of failure and DI helps stratify these patients. With a discrepancy between echocardiographic mean gradients AND the patient's symptoms OR the valve leaflet structure and/or mobility on imaging, especially before redo-SAVR or valve-in-valve transcatheter aortic valve replacement, invasive gradients may adjudicate the true valvular hemodynamics.
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Affiliation(s)
- Amer N. Kadri
- Division of Cardiology, Beaumont Health, Dearborn, Mich
| | - George Hanzel
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, Mich
- Oakland University William Beaumont School of Medicine, Auburn Hills, Mich
| | - Sammy Elmariah
- Division of Cardiology, Massachusetts General Hospital, Boston, Mass
| | - Francis Shannon
- Oakland University William Beaumont School of Medicine, Auburn Hills, Mich
- Division of Cardiovascular Surgery, Beaumont Hospital, Royal Oak, Mich
| | - Karim Al-Azizi
- Division of Cardiology, The Heart Hospital Baylor Plano, Plano, Tex
| | - Judith Boura
- Department of General Medical Education, Ascension-Macomb Oakland Hospital, Warren, Mich
| | - Michael Mack
- Division of Cardiac Surgery, The Heart Hospital Baylor Plano, Plano, Tex
| | - Amr E. Abbas
- Department of Cardiovascular Medicine, Beaumont Hospital, Royal Oak, Mich
- Oakland University William Beaumont School of Medicine, Auburn Hills, Mich
- Address for reprints: Amr E. Abbas, MD, Beaumont Hospital, 3601 W 13 Mile Rd, Royal Oak, MI 48073.
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Abbas AE, Ternacle J, Pibarot P, Xu K, Alu M, Rogers E, Hahn RT, Leon M, Thourani VH. Impact of Flow on Prosthesis-Patient Mismatch Following Transcatheter and Surgical Aortic Valve Replacement. Circ Cardiovasc Imaging 2021; 14:e012364. [PMID: 34387097 DOI: 10.1161/circimaging.120.012364] [Citation(s) in RCA: 9] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Severe prosthesis-patient mismatch (PPM) is diagnosed by an indexed effective orifice area <0.65 cm2/m2, which is derived from stroke volume index. We examined the impact of flow, determined by stroke volume index, on severe PPM following transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). METHODS We included SAVR patients from the PARTNER 2A trial (Placement of Aortic Transcatheter Valve 2A) and TAVR patients from the PARTNER 2 S3i (Placement of Aortic Transcatheter Valve 2 S3i) registry. The primary end point was the separate analysis of all-cause death, cardiac death, and rehospitalization at 5 years. Following TAVR and SAVR, we compared the primary end points between severe versus no-severe PPM in all patients, in low flow (LF), and in normal flow. Multivariable analysis was performed to determine variables associated with the end points. RESULTS Nine hundred fifty-four TAVR and 726 SAVR patients with PPM and flow data were included. Severe PPM following TAVR was significantly lower compared with SAVR in all patients (9% versus 28%, P<0.0001), in normal flow (5% versus 8%, P=0.04), and in LF (20% versus 42%, P<0.0001). Severe PPM was associated with rehospitalization following TAVR (odds ratio, 1.52 [95% CI, 1.01-2.29], P=0.0456) and SAVR (odds ratio, 1.51 [95% CI, 1.06-2.16], P=0.0237). Severe PPM in LF was independently associated with cardiac death following TAVR (odds ratio, 1.85 [95% CI, 1.06-3.23], P=0.0308). Following SAVR, severe PPM in LF and low ejection fraction was associated with increased cardiac death (35.26% versus 12.51%, P=0.01) and rehospitalization (37.59% versus 15.46%, P=0.006) compared with severe PPM in LF and preserved ejection fraction, respectively. Severe PPM in normal flow was not associated with clinical outcomes despite higher gradients and smaller valves compared with severe PPM in LF. CONCLUSIONS Severe PPM is more common following SAVR compared with TAVR. Regardless of the implanted valve size or gradient, severe PPM impacts mortality only in patients with LF following TAVR and LF and low ejection fraction following SAVR. Severe PPM in normal flow is not associated with poor outcomes. Registration: URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01314313 and NCT02687035.
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Affiliation(s)
- Amr E Abbas
- Department of Internal Medicine. Oakland University William Beaumont School of Medicine, Auburn Hills, MI (A.E.A.).,Department of Cardiovascular Medicine. Beaumont Hospital Royal Oak, MI (A.E.A.)
| | - Julien Ternacle
- Institut Universitaire de cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, Canada (J.T., P.P.)
| | - Philippe Pibarot
- Institut Universitaire de cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, Canada (J.T., P.P.)
| | - Ke Xu
- Edwards Lifesciences, Irvine, CA (K.X., E.R.)
| | - Maria Alu
- Department of Cardiovascular Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital (M.A., R.T.H., M.L.).,Cardiovascular Research Foundation, New York, NY (M.A., R.T.H., M.L.)
| | - Erin Rogers
- Edwards Lifesciences, Irvine, CA (K.X., E.R.)
| | - Rebecca T Hahn
- Department of Cardiovascular Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital (M.A., R.T.H., M.L.).,Cardiovascular Research Foundation, New York, NY (M.A., R.T.H., M.L.)
| | - Martin Leon
- Department of Cardiovascular Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital (M.A., R.T.H., M.L.).,Cardiovascular Research Foundation, New York, NY (M.A., R.T.H., M.L.)
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA (V.H.T)
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Ternacle J, Guimaraes L, Vincent F, Côté N, Côté M, Lachance D, Clavel MA, Abbas AE, Pibarot P, Rodés-Cabau J. Reclassification of prosthesis-patient mismatch after transcatheter aortic valve replacement using predicted vs. measured indexed effective orifice area. Eur Heart J Cardiovasc Imaging 2021; 22:11-20. [PMID: 32995865 DOI: 10.1093/ehjci/jeaa235] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 04/08/2020] [Indexed: 12/16/2022] Open
Abstract
AIMS The objective was to compare the incidence and impact on outcomes of measured (PPMM) vs. predicted (PPMP) prosthesis-patient mismatch following transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS All consecutives patients who underwent TAVR between 2007 and 2018 were included. Effective orifice area (EOA) was measured by Doppler-echocardiography using the continuity equation and predicted according to the normal reference for each model and size of valve. PPM was defined using EOA indexed (EOAi) to body surface area as moderate if ≤0.85 cm2/m2 and severe if ≤ 0.65 cm2/m2 (respectively, ≤ 0.70 and ≤ 0.55 cm2/m2 if body mass index ≥ 30 kg/m2). The outcome endpoints were high residual gradient (≥20 mmHg) and the composite of cardiovascular mortality and hospital readmission for heart failure at 1 year. Overall, 1088 patients underwent a TAVR (55% male, age 79.1 ± 8.4 years, and STS score 6.6 ± 4.7%); balloon-expandable device was used in 83%. Incidence of moderate (10% vs. 27%) and severe (1% vs. 17%) PPM was markedly lower when defined by predicted vs. measured EOAi (P < 0.001). Balloon-expandable device implantation (OR: 1.90, P = 0.029) and valve-in-valve procedure (n = 118; OR: 3.21, P < 0.001) were the main factors associated with PPM occurrence. Compared with measured PPM, predicted PPM showed stronger association with high residual gradient. Severe measured or predicted PPM was not associated with clinical outcomes. CONCLUSION The utilization of the predicted EOAi reclassifies the majority of patients with PPM to no PPM following TAVR. Compared with measured PPM, predicted PPM had stronger association with haemodynamic outcomes, while both methods were not associated with clinical outcomes.
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Affiliation(s)
- Julien Ternacle
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
- Cardiology Department, Expert Valve Center, Henri Mondor ho spital, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
- INSERM Unit U955, Team 8, Paris-Est Creteil University, Val-de-Marne, 8 rue du Général Sarrail, 94010, Créteil, France
| | - Leonardo Guimaraes
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| | - Flavien Vincent
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
- Département de cardiologie, CHU de Lille, Institut Cœur Poumon, Université de Lille, INSERM U1011, Institut Pasteur de Lille, EGID, Boulevard du Professeur Jules Leclercq, 59000 Lille,, France
| | - Nancy Côté
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| | - Mélanie Côté
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| | - Dominique Lachance
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| | - Amr E Abbas
- Oakland University William Beaumont School of Medicine, Auburn Hills, 586 Pioneer Dr, Rochester, MI 48309, USA
- Beaumont Health, 3601 W 13 Mile Rd, Royal Oak, MI 48073, USA
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| | - Josep Rodés-Cabau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
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Ternacle J, Pibarot P, Herrmann HC, Kodali S, Leipsic J, Blanke P, Jaber W, Mack MJ, Clavel MA, Salaun E, Guzzetti E, Annabi MS, Bernier M, Beaudoin J, Khalique OK, Weissman NJ, Douglas P, Bax J, Dahou A, Xu K, Alu M, Rogers E, Leon M, Thourani VH, Abbas AE, Hahn RT. Prosthesis-Patient Mismatch After Aortic Valve Replacement in the PARTNER 2 Trial and Registry. JACC Cardiovasc Interv 2021; 14:1466-1477. [PMID: 34238557 DOI: 10.1016/j.jcin.2021.03.069] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aimed to compare incidence and impact of measured prosthesis-patient mismatch (PPMM) versus predicted PPM (PPMP) after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). BACKGROUND TAVR studies have used measured effective orifice area indexed (EOAi) to body surface area (BSA) to define PPM, but most SAVR series have used predicted EOAi. This difference may contribute to discrepancies in incidence and outcomes of PPM between series. METHODS The study analyzed SAVR patients from the PARTNER (Placement of Aortic Transcatheter Valves) 2A trial and TAVR patients from the PARTNER 2 SAPIEN 3 Intermediate Risk registry. PPM was classified as moderate if EOAi ≤0.85 cm2/m2 (≤0.70 if obese: body mass index ≥30 kg/m2) and severe if EOAi ≤0.65 cm2/m2 (≤0.55 if obese). PPMM was determined by the core lab-measured EOAi on 30-day echocardiogram. PPMP was determined by 2 methods: 1) using normal EOA reference values previously reported for each valve model and size (PPMP1; n = 929 SAVR, 1,069 TAVR) indexed to BSA; and 2) using normal reference EOA predicted from aortic annulus size measured by computed tomography (PPMP2; n = 864 TAVR only) indexed to BSA. Primary endpoint was the composite of 5-year all-cause death and rehospitalization. RESULTS The incidence of moderate and severe PPMP was much lower than PPMM in both SAVR (PPMP1: 28.4% and 1.2% vs. PPMM: 31.0% and 23.6%) and TAVR (PPMP1: 21.0% and 0.1% and PPMP2: 17.0% and 0% vs. PPMM: 27.9% and 5.7%). The incidence of severe PPMM and severe PPMP1 was lower in TAVR versus SAVR (P < 0.001). The presence of PPM by any method was associated with higher transprosthetic gradient. Severe PPMP1 was independently associated with events in SAVR after adjustment for sex and Society of Thoracic Surgeons score (hazard ratio: 3.18;95% CI: 1.69-5.96; P < 0.001), whereas no association was observed between PPM by any method and outcomes in TAVR. CONCLUSIONS EOAi measured by echocardiography results in a higher incidence of PPM following SAVR or TAVR than PPM based on predicted EOAi. Severe PPMP is rare (<1.5%), but is associated with increased all-cause death and rehospitalization after SAVR, whereas it is absent following TAVR.
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Affiliation(s)
- Julien Ternacle
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | - Philippe Pibarot
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada.
| | - Howard C Herrmann
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Susheel Kodali
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jonathon Leipsic
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Marie-Annick Clavel
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | - Erwan Salaun
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | - Ezequiel Guzzetti
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | | | - Mathieu Bernier
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | - Jonathan Beaudoin
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | - Omar K Khalique
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Neil J Weissman
- MedStar Heath Research Institute, Georgetown University, Washington, DC, USA
| | - Pamela Douglas
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Ke Xu
- Edwards Lifesciences, Irvine, California, USA
| | - Maria Alu
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Erin Rogers
- Edwards Lifesciences, Irvine, California, USA
| | - Martin Leon
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Amr E Abbas
- Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan, USA; Beaumont Hospital Royal Oak, Royal Oak, Michigan, USA
| | - Rebecca T Hahn
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
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Guzzetti E, Oh JK, Shen M, Dweck MR, Poh KK, Abbas AE, Mando R, Pressman GS, Brito D, Tastet L, Pawade T, Falconi ML, de Arenaza DP, Kong W, Tay E, Pibarot P, Song JK, Clavel MA. Validation of aortic valve calcium quantification thresholds measured by computed tomography in Asian patients with calcific aortic stenosis. Eur Heart J Cardiovasc Imaging 2021; 23:717-726. [PMID: 34172988 DOI: 10.1093/ehjci/jeab116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 05/20/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Sex-specific thresholds of aortic valve calcification (AVC) have been proposed and validated in Caucasians. Thus, we aimed to validate their accuracy in Asians. METHODS AND RESULTS Patients with calcific aortic stenosis (AS) from seven international centres were included. Exclusion criteria were ≥moderate aortic/mitral regurgitation and bicuspid valve. Optimal AVC and AVC-density sex-specific thresholds for severe AS were obtained in concordant grading and normal flow patients (CG/NF). We included 1263 patients [728 (57%) Asians, 573 (45%) women, 837 (66%) with CG/NF]. Mean gradient was 48 (26-64) mmHg and peak aortic velocity 4.5 (3.4-5.1) m/s. Optimal AVC thresholds were: 2145 Agatston Units (AU) in men and 1301 AU in women for Asians; and 1885 AU in men and 1129 AU in women for Caucasians. Overall, accuracy (% correctly classified) was high and comparable either using optimal or guidelines' thresholds (2000 AU in men, 1200 AU in women). However, accuracy was lower in Asian women vs. Caucasian women (76-78% vs. 94-95%; P < 0.001). Accuracy of AVC-density (476 AU/cm2 in men and 292 AU/cm2 in women) was comparable to absolute AVC in Caucasians (91% vs. 91%, respectively, P = 0.74), but higher than absolute AVC in Asians (87% vs. 81%, P < 0.001). There was no interaction between AVC/AVC-density and ethnicity (all P > 0.41) with regards to AS haemodynamic severity. CONCLUSION AVC thresholds defining severe AS are comparable in Asian and Caucasian populations, and similar to those proposed in the guidelines. However, accuracy of AVC to identify severe AS in Asians (especially women) is sub-optimal. Therefore, the use of AVC-density is preferable in Asians.
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Affiliation(s)
- Ezequiel Guzzetti
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada
| | - Jin Kyung Oh
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong 30099, Korea
| | - Mylène Shen
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Kian Keong Poh
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore 119074, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Amr E Abbas
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, MI 48073, USA
| | - Ramy Mando
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, MI 48073, USA
| | - Gregg S Pressman
- Division of Cardiology, Einstein Medical Center, Philadelphia, PA 19141, USA
| | - Daniel Brito
- Division of Cardiology, Einstein Medical Center, Philadelphia, PA 19141, USA
| | - Lionel Tastet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada
| | - Tania Pawade
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Mariano Luis Falconi
- Department of Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina
| | - Diego Perez de Arenaza
- Department of Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina
| | - William Kong
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore 119074, Singapore
| | - Edgar Tay
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore 119074, Singapore
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada
| | - Jae-Kwan Song
- Valvular Heart Disease Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul 138736, Korea
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Quebec City, Quebec G1V-4G5, Canada
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Kaneko T, Makkar RR, Krishnaswami A, Hermiller J, Greenbaum A, Babaliaros V, Shah PB, Bailey SH, Bapat V, Kapadia S, Abbas AE. Valve-in-Surgical-Valve With SAPIEN 3 for Transcatheter Aortic Valve Replacement Based on Society of Thoracic Surgeons Predicted Risk of Mortality. Circ Cardiovasc Interv 2021; 14:e010288. [PMID: 34003666 DOI: 10.1161/circinterventions.120.010288] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Tsuyoshi Kaneko
- Division of Cardiac Surgery (T.K.), Brigham and Women's Hospital, Boston, MA
| | - Raj R Makkar
- Department of Cardiology, Cedars Sinai Medical Center, Los Angeles, CA (R.R.M.)
| | | | | | - Adam Greenbaum
- Division of Cardiology, Emory University Medical Center, Atlanta, GA (A.G., V.B.)
| | - Vasilis Babaliaros
- Division of Cardiology, Emory University Medical Center, Atlanta, GA (A.G., V.B.)
| | - Pinak B Shah
- Division of Cardiology (P.B.S.), Brigham and Women's Hospital, Boston, MA
| | - Stephen H Bailey
- Division of Cardiac Surgery, Allegheny General Hospital, Pittsburgh, PA (S.H.B.)
| | - Vinnie Bapat
- Division of Cardiac Surgery, Minneapolis Heart Institute, MN (V.B.)
| | - Samir Kapadia
- The Heart Center of Indiana, Indianapolis (J.H., S.K.)
| | - Amr E Abbas
- Division of Cardiac Surgery, Minneapolis Heart Institute, MN (V.B.)
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Eng MH, Abbas AE, Hahn RT, Lee J, Wang DD, Eleid MF, O'Neill WW. Real world outcomes using 20 mm balloon expandable SAPIEN 3/ultra valves compared to larger valves (23, 26, and 29 mm)-a propensity matched analysis. Catheter Cardiovasc Interv 2021; 98:1185-1192. [PMID: 33984182 DOI: 10.1002/ccd.29756] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/30/2021] [Accepted: 05/03/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE/BACKGROUND Small balloon expandable valves have higher echocardiographic transvalvular gradients and rates of prosthesis-patient mismatch (PPM) compared to larger valves. However, the impact of these echocardiographic findings on clinical outcomes is unknown. We sought to determine the clinical outcomes of 20 mm SAPIEN 3 (S3 BEV) compared to larger S3 BEV in relation to echocardiographic hemodynamics. METHODS Using the STS/ACC transcatheter valve registry, we performed a propensity-matched comparison of patients undergoing treatment of native aortic valve stenosis using transfemoral, balloon-expandable implantation of 20 mm and ≥ 23 mm S3 BEVs. Baseline and procedure characteristics, echocardiographic variables and survival were analyzed. Multivariable logistic regression was used to identify predictors of 1-year mortality. RESULTS After propensity matching of the 20 mm and ≥ 23 mm SAPIEN 3 valves, 3,931 pairs with comparable baseline characteristics were identified. Small valves were associated with significantly higher echocardiographic gradients at discharge (15.7 ± 7.1 mmHg vs. 11.7 ± 5.5 mmHg, p < 0.0001) and severe PPM rates (21.5% vs. 9.7%, p < 0.0001). There was no significant difference in 1-year all-cause mortality (20 mm: 13.0% vs. ≥23 mm: 12.7%, p = 0.72) or other major adverse event rates and outcomes between the two cohorts. Based on a multivariable analysis, elevated discharge mean gradient (>20 mmHg), severe PPM and the use of 20 mm versus ≥23 mm were not independent predictors of 1-year mortality. CONCLUSION SAPIEN 3 20 mm valves were associated with higher echocardiographic gradients, and severe PPM rates compared to larger valves but these factors were not associated with significant differences in 1-year all-cause mortality or rehospitalization.
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Affiliation(s)
- Marvin H Eng
- Department of Medicine, Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Amr E Abbas
- Department of Cardiovascular Medicine, Beaumont Health, Royal Oak, Michigan, USA
| | - Rebecca T Hahn
- New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA
| | - James Lee
- Department of Medicine, Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Dee Dee Wang
- Department of Medicine, Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - William W O'Neill
- Department of Medicine, Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
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Halalau A, Halalau M, Carpenter C, Abbas AE, Sims M. Vestibular neuritis caused by severe acute respiratory syndrome coronavirus 2 infection diagnosed by serology: Case report. SAGE Open Med Case Rep 2021; 9:2050313X211013261. [PMID: 34035914 PMCID: PMC8127789 DOI: 10.1177/2050313x211013261] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/07/2021] [Indexed: 12/25/2022] Open
Abstract
Vestibular neuritis is a disorder selectively affecting the vestibular portion of the eighth cranial nerve generally considered to be inflammatory in nature. There have been no reports of severe acute respiratory syndrome coronavirus 2 causing vestibular neuritis. We present the case of a 42-year-old Caucasian male physician, providing care to COVID-19 patients, with no significant past medical history, who developed acute vestibular neuritis, 2 weeks following a mild respiratory illness, later diagnosed as COVID-19. Physicians should keep severe acute respiratory syndrome coronavirus 2 high on the list as a possible etiology when suspecting vestibular neuritis, given the extent and implications of the current pandemic and the high contagiousness potential.
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Affiliation(s)
- Alexandra Halalau
- Internal Medicine Department, Beaumont Health, Royal Oak, MI, USA.,William Beaumont School of Medicine, Oakland University, Rochester, MI, USA
| | | | - Christopher Carpenter
- Internal Medicine Department, Beaumont Health, Royal Oak, MI, USA.,William Beaumont School of Medicine, Oakland University, Rochester, MI, USA.,Infectious Disease Department, Beaumont Health, Royal Oak, MI, USA
| | - Amr E Abbas
- William Beaumont School of Medicine, Oakland University, Rochester, MI, USA.,Cardiovascular Department, Beaumont Health, Royal Oak, MI, USA
| | - Matthew Sims
- Internal Medicine Department, Beaumont Health, Royal Oak, MI, USA.,William Beaumont School of Medicine, Oakland University, Rochester, MI, USA.,Infectious Disease Department, Beaumont Health, Royal Oak, MI, USA
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Ternacle J, Abbas AE, Pibarot P. Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement: Has It Become Obsolete? JACC Cardiovasc Interv 2021; 14:977-980. [PMID: 33958171 DOI: 10.1016/j.jcin.2021.03.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Julien Ternacle
- Haut-Lévêque Cardiology Hospital, University Hospital of Bordeaux, Pessac, France
| | - Amr E Abbas
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, Michigan, USA
| | - Philippe Pibarot
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, Québec, Canada.
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Halalau A, Odish F, Imam Z, Sharrak A, Brickner E, Lee PB, Foglesong A, Michel A, Gill I, Qu L, Abbas AE, Carpenter CF. Epidemiology, Clinical Characteristics, and Outcomes of a Large Cohort of COVID-19 Outpatients in Michigan. Int J Gen Med 2021; 14:1555-1563. [PMID: 33953603 PMCID: PMC8089468 DOI: 10.2147/ijgm.s305295] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/15/2021] [Indexed: 01/08/2023] Open
Abstract
Background Most outpatients with coronavirus disease 2019 (COVID-19) do not initially demonstrate severe features requiring hospitalization. Understanding this population’s epidemiological and clinical characteristics to allow outcome anticipation is crucial in healthcare resource allocation. Methods Retrospective, multicenter (8 hospitals) study reporting on 821 patients diagnosed with COVID-19 by real-time reverse transcriptase–polymerase chain reaction assay of nasopharyngeal swabs and discharged home to self-isolate after evaluation in emergency departments (EDs) within Beaumont Health System in March, 2020. Outcomes were collected through April 14, 2020, with a minimum of 12 day follow-up and included subsequent ED visit, admission status, and mortality. Results Of the 821 patients, mean age was 49.3 years (SD 15.7), 46.8% were male and 55.1% were African-American. Cough was the most frequent symptom in 78.2% of patients with a median duration of 3 days (IQR 2–7), and other symptoms included fever 62.1%, rhinorrhea or nasal congestion 35.1% and dyspnea 31.2%. ACEI/ARBs usage was reported in 28.7% patients and 34.0% had diabetes mellitus. Return to the ED for re-evaluation was reported in 19.2% of patients from whom 54.4% were admitted. The patients eventually admitted to the hospital were older (mean age 54.4 vs 48.7 years, p=0.002), had higher BMI (35.4 kg/m2 vs 31.9 kg/m2, p=0.004), were more likely male (58.1% vs 45.4%, p=0.026), and more likely to have hypertension (52.3% vs 29.4%, p<0.001), diabetes mellitus (74.4% vs 29.3%, p<0.001) or prediabetes (25.6% vs 8.4%, p<0.001), COPD (39.5% vs 5.4%, p<0.001), and OSA (36% vs 19%, p<0.001). The overall mortality rate was 1.3%. Conclusion We found that 80.8% of patients did not return to the ED for re-evaluation. Sending patients with COVID-19 home if they experience mild symptoms is a safe approach for most patients and might mitigate some of the financial and staffing pressures on healthcare systems.
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Affiliation(s)
- Alexandra Halalau
- Internal Medicine Department, Beaumont Health, Royal Oak, MI, USA.,Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Fadi Odish
- Section of Gastroenterology and Hepatology, Department of Internal Medicine, Wright State University, Dayton, OH, USA
| | - Zaid Imam
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Beaumont Health, Royal Oak, MI, USA
| | - Aryana Sharrak
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Evan Brickner
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Paul Bumki Lee
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Adam Foglesong
- Internal Medicine Department, Beaumont Health, Royal Oak, MI, USA
| | - Adrian Michel
- Internal Medicine Department, Beaumont Health, Royal Oak, MI, USA
| | - Inayat Gill
- Internal Medicine Department, Beaumont Health, Royal Oak, MI, USA
| | - Lihua Qu
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA.,Outcome Research Department, Research Institute Beaumont Health, Royal Oak, MI, USA
| | - Amr E Abbas
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA.,Cardiovascular Department, Beaumont Health, Royal Oak, MI, USA
| | - Christopher F Carpenter
- Internal Medicine Department, Beaumont Health, Royal Oak, MI, USA.,Oakland University William Beaumont School of Medicine, Rochester, MI, USA.,Infectious Disease Section, Beaumont Health, Royal Oak, MI, USA
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Yu L, Halalau A, Dalal B, Abbas AE, Ivascu F, Amin M, Nair GB. Machine learning methods to predict mechanical ventilation and mortality in patients with COVID-19. PLoS One 2021; 16:e0249285. [PMID: 33793600 PMCID: PMC8016242 DOI: 10.1371/journal.pone.0249285] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/15/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The Coronavirus disease 2019 (COVID-19) pandemic has affected millions of people across the globe. It is associated with a high mortality rate and has created a global crisis by straining medical resources worldwide. OBJECTIVES To develop and validate machine-learning models for prediction of mechanical ventilation (MV) for patients presenting to emergency room and for prediction of in-hospital mortality once a patient is admitted. METHODS Two cohorts were used for the two different aims. 1980 COVID-19 patients were enrolled for the aim of prediction ofMV. 1036 patients' data, including demographics, past smoking and drinking history, past medical history and vital signs at emergency room (ER), laboratory values, and treatments were collected for training and 674 patients were enrolled for validation using XGBoost algorithm. For the second aim to predict in-hospital mortality, 3491 hospitalized patients via ER were enrolled. CatBoost, a new gradient-boosting algorithm was applied for training and validation of the cohort. RESULTS Older age, higher temperature, increased respiratory rate (RR) and a lower oxygen saturation (SpO2) from the first set of vital signs were associated with an increased risk of MV amongst the 1980 patients in the ER. The model had a high accuracy of 86.2% and a negative predictive value (NPV) of 87.8%. While, patients who required MV, had a higher RR, Body mass index (BMI) and longer length of stay in the hospital were the major features associated with in-hospital mortality. The second model had a high accuracy of 80% with NPV of 81.6%. CONCLUSION Machine learning models using XGBoost and catBoost algorithms can predict need for mechanical ventilation and mortality with a very high accuracy in COVID-19 patients.
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Affiliation(s)
- Limin Yu
- Department of Pathology, Beaumont Health System, Royal Oak, MI, United States of America
| | - Alexandra Halalau
- Department of Internal Medicine, Beaumont Health System, Royal Oak, MI, United States of America
| | - Bhavinkumar Dalal
- Division of Pulmonary and Critical Care Medicine, Beaumont Health System, Royal Oak, MI, United States of America
| | - Amr E. Abbas
- Department of Cardiovascular Medicine, Beaumont Health System, Royal Oak, MI, United States of America
| | - Felicia Ivascu
- Department of General Surgery, Beaumont Health System, Royal Oak, MI, United States of America
| | - Mitual Amin
- Department of Pathology, Beaumont Health System, Royal Oak, MI, United States of America
| | - Girish B. Nair
- Division of Pulmonary and Critical Care Medicine, Beaumont Health System, Royal Oak, MI, United States of America
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Pathangey G, Fadadu PP, Hospodar AR, Abbas AE. Angiotensin-converting enzyme 2 and COVID-19: patients, comorbidities, and therapies. Am J Physiol Lung Cell Mol Physiol 2021; 320:L301-L330. [PMID: 33237815 PMCID: PMC7938645 DOI: 10.1152/ajplung.00259.2020] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 02/07/2023] Open
Abstract
On March 11, 2020, the World Health Organization declared coronavirus disease 2019 (COVID-19) a pandemic, and the reality of the situation has finally caught up to the widespread reach of the disease. The presentation of the disease is highly variable, ranging from asymptomatic carriers to critical COVID-19. The availability of angiotensin-converting enzyme 2 (ACE2) receptors may reportedly increase the susceptibility and/or disease progression of COVID-19. Comorbidities and risk factors have also been noted to increase COVID-19 susceptibility. In this paper, we hereby review the evidence pertaining to ACE2's relationship to common comorbidities, risk factors, and therapies associated with the susceptibility and severity of COVID-19. We also highlight gaps of knowledge that require further investigation. The primary comorbidities of respiratory disease, cardiovascular disease, renal disease, diabetes, obesity, and hypertension had strong evidence. The secondary risk factors of age, sex, and race/genetics had limited-to-moderate evidence. The tertiary factors of ACE inhibitors and angiotensin II receptor blockers had limited-to-moderate evidence. Ibuprofen and thiazolidinediones had limited evidence.
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Affiliation(s)
- Girish Pathangey
- William Beaumont School of Medicine, Oakland University, Rochester, Michigan
| | | | | | - Amr E Abbas
- William Beaumont School of Medicine, Oakland University, Rochester, Michigan
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, Michigan
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Khalili H, Lodhi HA, Luna M, Hasan RK, Banerjee S, Harvey JE, Byrne T, Hanzel GS, Abbas AE, Bhatia N, Shreenivas SS, Mathews A, Bansal P, Morcos R, Maini B. Decline in the Volume of Structural Heart Procedures in the United States Due to the COVID-19 Pandemic. Structural Heart 2021; 5:97-98. [PMID: 35378851 PMCID: PMC8968307 DOI: 10.1080/24748706.2020.1836436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/05/2021] [Indexed: 11/16/2022]
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Ionescu F, Jaiyesimi I, Petrescu I, Lawler PR, Castillo E, Munoz-Maldonado Y, Imam Z, Narasimhan M, Abbas AE, Konde A, Nair GB. Association of anticoagulation dose and survival in hospitalized COVID-19 patients: A retrospective propensity score-weighted analysis. Eur J Haematol 2020; 106:165-174. [PMID: 33043484 PMCID: PMC7675265 DOI: 10.1111/ejh.13533] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [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: 09/16/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hypercoagulability may contribute to COVID-19 pathogenicity. The role of anticoagulation (AC) at therapeutic (tAC) or prophylactic doses (pAC) is unclear. OBJECTIVES We evaluated the impact on survival of different AC doses in COVID-19 patients. METHODS Retrospective, multi-center cohort study of consecutive COVID-19 patients hospitalized between March 13 and May 5, 2020. RESULTS A total of 3480 patients were included (mean age, 64.5 years [17.0]; 51.5% female; 52.1% black and 40.6% white). 18.5% (n = 642) required intensive care unit (ICU) stay. 60.9% received pAC (n = 2121), 28.7% received ≥3 days of tAC (n = 998), and 10.4% (n = 361) received no AC. Propensity score (PS) weighted Kaplan-Meier plot demonstrated different 25-day survival probability in the tAC and pAC groups (57.5% vs 50.7%). In a PS-weighted multivariate proportional hazards model, AC was associated with reduced risk of death at prophylactic (hazard ratio [HR] 0.35 [95% confidence interval {CI} 0.22-0.54]) and therapeutic doses (HR 0.14 [95% CI 0.05-0.23]) compared to no AC. Major bleeding occurred more frequently in tAC patients (81 [8.1%]) compared to no AC (20 [5.5%]) or pAC (46 [2.2%]) subjects. CONCLUSIONS Higher doses of AC were associated with lower mortality in hospitalized COVID-19 patients. Prospective evaluation of efficacy and risk of AC in COVID-19 is warranted.
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Affiliation(s)
- Filip Ionescu
- Department of Internal Medicine, Beaumont Health System, OUWB School of Medicine, Royal Oak, MI, USA
| | - Ishmael Jaiyesimi
- Department of Hematology and Oncology, Beaumont Health System, OUWB School of Medicine, Royal Oak, MI, USA
| | - Ioana Petrescu
- Department of Internal Medicine, Beaumont Health System, OUWB School of Medicine, Royal Oak, MI, USA
| | - Patrick R Lawler
- Peter Munk Cardiac Centre, University Health Network, and the Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Edward Castillo
- Department of Radiation Oncology, Beaumont Health System, OUWB school of Medicine, Royal Oak, MI, USA.,Department of Computational and Applied Mathematics, Rice University, Houston, TX, USA
| | - Yolanda Munoz-Maldonado
- Department of Hematology and Oncology, Beaumont Health System, OUWB School of Medicine, Royal Oak, MI, USA.,Statistical Savvy Consulting, LLC, Georgetown, TX, USA
| | - Zaid Imam
- Department of Internal Medicine, Beaumont Health System, OUWB School of Medicine, Royal Oak, MI, USA
| | | | - Amr E Abbas
- Department of Cardiovascular Medicine, Beaumont Health System, OUWB School of Medicine, Royal Oak, MI, USA
| | - Anish Konde
- Department of Hematology and Oncology, Beaumont Health System, OUWB School of Medicine, Royal Oak, MI, USA
| | - Girish B Nair
- Division of Pulmonary and Critical Care Medicine, Beaumont Health System, OUWB School of Medicine, Royal Oak, MI, USA
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Schott JP, Mertens AN, Bloomingdale R, O'Connell TF, Gallagher MJ, Dixon S, Abbas AE. Transthoracic echocardiographic findings in patients admitted with SARS-CoV-2 infection. Echocardiography 2020; 37:1551-1556. [PMID: 32949015 PMCID: PMC7537524 DOI: 10.1111/echo.14835] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 06/06/2020] [Revised: 07/28/2020] [Accepted: 08/02/2020] [Indexed: 12/28/2022] Open
Abstract
Introduction Severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2)–infected patients commonly have elevated troponin and D‐dimer levels, but limited imaging exists to support most likely etiologies in efforts to avoid staff exposure. The purpose of this study was to report transthoracic echocardiographic (TTE) findings in SARS‐CoV‐2 patients with correlating troponin and D‐dimer levels. Methods We identified 66 SARS‐CoV‐2 patients (mean age 60 ± 15.7 years) admitted within a large, eight‐hospital healthcare system over a 6‐week period with a TTE performed. TTE readers were blinded to laboratory data with intra‐observer and inter‐observer analysis assessed. Results Sixty‐six of 1780 SARS‐CoV‐2 patients were included and represented a high‐risk population as 38 (57.6%) were ICU‐admitted, 47 (71.2%) had elevated D‐dimer, 41 (62.1%) had elevated troponin, and 25 (37.9%) died. Right ventricular (RV) dilation was present in 49 (74.2%) patients. The incidence and average D‐dimer elevation was similar between moderate/severe vs. mild/no RV dilation (69.6% vs 67.6%, P = 1.0; 3736 ± 2986 vs 4141 ± 3351 ng/mL, P = .679). Increased left ventricular (LV) wall thickness was present in 46 (69.7%) with similar incidence of elevated troponin and average troponin levels compared to normal wall thickness (66.7% vs 52.4%, P = .231; 0.88 ± 1.9 vs 1.36 ± 2.4 ng/mL, P = .772). LV dilation was rare (n = 6, 9.1%), as was newly reduced LV ejection fraction (n = 2, 3.0%). Conclusion TTE in SARS‐CoV‐2 patients is scarce, technically difficult, and reserved for high‐risk patients. RV dilation is common in SARS‐CoV‐2 but does not correlate with elevated D‐dimer levels. Increased LV wall thickness is common, while newly reduced LV ejection fraction is rare, and neither correlates with troponin levels.
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Affiliation(s)
- Jason P Schott
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, MI, USA
| | - Amy N Mertens
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, MI, USA
| | - Richard Bloomingdale
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, MI, USA
| | - Thomas F O'Connell
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, MI, USA
| | - Michael J Gallagher
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, MI, USA.,Oakland University William Beaumont School of Medicine, Auburn Hills, MI, USA
| | - Simon Dixon
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, MI, USA.,Oakland University William Beaumont School of Medicine, Auburn Hills, MI, USA
| | - Amr E Abbas
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, MI, USA.,Oakland University William Beaumont School of Medicine, Auburn Hills, MI, USA
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O'Connell TF, Bradley CJ, Abbas AE, Williamson BD, Rusia A, Tawney AM, Gaines R, Schott J, Dmitrienko A, Haines DE. Hydroxychloroquine/Azithromycin Therapy and QT Prolongation in Hospitalized Patients With COVID-19. JACC Clin Electrophysiol 2020; 7:16-25. [PMID: 33478708 PMCID: PMC7406234 DOI: 10.1016/j.jacep.2020.07.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [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: 05/22/2020] [Revised: 07/29/2020] [Accepted: 07/30/2020] [Indexed: 01/11/2023]
Abstract
Objectives This study aimed to characterize corrected QT (QTc) prolongation in a cohort of hospitalized patients with coronavirus disease-2019 (COVID-19) who were treated with hydroxychloroquine and azithromycin (HCQ/AZM). Background HCQ/AZM is being widely used to treat COVID-19 despite the known risk of QT interval prolongation and the unknown risk of arrhythmogenesis in this population. Methods A retrospective cohort of COVID-19 hospitalized patients treated with HCQ/AZM was reviewed. The QTc interval was calculated before drug administration and for the first 5 days following initiation. The primary endpoint was the magnitude of QTc prolongation, and factors associated with QTc prolongation. Secondary endpoints were incidences of sustained ventricular tachycardia or ventricular fibrillation and all-cause mortality. Results Among 415 patients who received concomitant HCQ/AZM, the mean QTc increased from 443 ± 25 ms to a maximum of 473 ± 40 ms (87 [21%] patients had a QTc ≥500 ms). Factors associated with QTc prolongation ≥500 ms were age (p < 0.001), body mass index <30 kg/m2 (p = 0.005), heart failure (p < 0.001), elevated creatinine (p = 0.005), and peak troponin (p < 0.001). The change in QTc was not associated with death over the short period of the study in a population in which mortality was already high (hazard ratio: 0.998; p = 0.607). No primary high-grade ventricular arrhythmias were observed. Conclusions An increase in QTc was seen in hospitalized patients with COVID-19 treated with HCQ/AZM. Several clinical factors were associated with greater QTc prolongation. Changes in QTc were not associated with increased risk of death.
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Affiliation(s)
- Thomas F O'Connell
- Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine and Beaumont Hospital, Royal Oak, Michigan, USA
| | - Christopher J Bradley
- Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine and Beaumont Hospital, Royal Oak, Michigan, USA
| | - Amr E Abbas
- Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine and Beaumont Hospital, Royal Oak, Michigan, USA
| | - Brian D Williamson
- Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine and Beaumont Hospital, Royal Oak, Michigan, USA
| | - Akash Rusia
- Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine and Beaumont Hospital, Royal Oak, Michigan, USA
| | - Adam M Tawney
- Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine and Beaumont Hospital, Royal Oak, Michigan, USA
| | - Rick Gaines
- Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine and Beaumont Hospital, Royal Oak, Michigan, USA
| | - Jason Schott
- Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine and Beaumont Hospital, Royal Oak, Michigan, USA
| | | | - David E Haines
- Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine and Beaumont Hospital, Royal Oak, Michigan, USA.
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Abbas AE. Letter by Abbas Regarding Articles, "Balloon-Expandable Versus Self-Expanding Transcatheter Aortic Valve Replacement: A Propensity-Matched Comparison From the FRANCE-TAVI Registry" and "Impact of Sapien 3 Balloon-Expandable Versus Evolut R Self-Expandable Transcatheter Aortic Valve Implantation in Patients With Aortic Stenosis: Data From a Nationwide Analysis". Circulation 2020; 141:e908-e909. [PMID: 32539615 DOI: 10.1161/circulationaha.120.046066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Amr E Abbas
- Department of Cardiovascular Medicine, Beaumont Hospital Royal Oak, Royal Oak, MI. Oakland University William Beaumont School of Medicine, Auburn Hills, MI
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Abbas AE, Mando R, Hanzel G, Goldstein J, Shannon F, Pibarot P. Hemodynamic principles of prosthetic aortic valve evaluation in the transcatheter aortic valve replacement era. Echocardiography 2020; 37:738-757. [DOI: 10.1111/echo.14663] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/28/2020] [Accepted: 03/29/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
- Amr E. Abbas
- Beaumont Health Royal Oak Michigan
- Oakland University William Beaumont School of Medicine Auburn Hills Michigan
| | | | - George Hanzel
- Beaumont Health Royal Oak Michigan
- Oakland University William Beaumont School of Medicine Auburn Hills Michigan
| | - James Goldstein
- Beaumont Health Royal Oak Michigan
- Oakland University William Beaumont School of Medicine Auburn Hills Michigan
| | - Francis Shannon
- Beaumont Health Royal Oak Michigan
- Oakland University William Beaumont School of Medicine Auburn Hills Michigan
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Vivacqua A, Robinson J, Abbas AE, Altshuler JM, Shannon FL, Podolsky RH, Sakwa MP. Single-dose cardioplegia protects myocardium as well as traditional repetitive dosing: A noninferiority randomized study. J Thorac Cardiovasc Surg 2020; 159:1857-1863.e1. [DOI: 10.1016/j.jtcvs.2019.03.125] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 03/01/2019] [Accepted: 03/09/2019] [Indexed: 11/15/2022]
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Abbas AE, Mando R, Ternacle J, Pibarot P, Rodes-Cabau J, Guimaraes L, Hanzel GS, Sigua-Arce P, Safian RD, Lau W, Shannon F. THE IMPACT OF AORTIC VALVE VELOCITY AND MEAN GRADIENT ON THE INCIDENCE AND SEVERITY OF PROSTHESIS PATIENT MISMATCH FOLLOWING TAVR. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32116-1] [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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Mando R, Hanzel GS, Hite A, Sigua-Arce P, Gallagher M, Lau W, Pibarot P, Shannon F, Abbas AE. ECHOCARDIOGRAPHIC/CATHETERIZATION DISCORDANCE IN LOW VS. HIGH GRADIENT AND LOW VS. NORMAL FLOW AORTIC STENOSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32111-2] [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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Gaines R, Mando R, Tucker C, Assar S, Hite A, Hanzel GS, Gallagher M, Shannon F, Abbas AE. CT VERSUS ECHOCARDIOGRAPHIC STROKE VOLUME INDEX COMPARED TO INVASIVELY DERIVED CARDIAC INDEX TO ASSESS FLOW IN PATIENTS WITH AORTIC STENOSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32428-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Balinski AM, Karabon P, Pathangey G, Abbas AE. TRANSCATHETER AORTIC VALVE REPLACEMENT TEMPORAL TRENDS: PROCEDURAL VOLUME IMPACT ON LENGTH OF STAY AND READMISSIONS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31895-7] [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: 11/13/2022]
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Abbas AE, Mando R, Hanzel GS, Shannon F, Gallagher M, Kassas S, Al-Azizi K, Christensen J, Szerlip M, Potluri S, Harrington K, Mack M. IMMEDIATE POST-TAVR SIMULTANEOUS ECHOCARDIOGRAPHIC AND INVASIVE MEAN GRADIENTS IN BALLOON VS. SELF-EXPANDING VALVES: A MULTI-CENTER RETROSPECTIVE STUDY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32117-3] [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: 12/01/2022]
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Gaines R, Mando R, Tucker C, Assar S, Hite A, Hanzel GS, Gallagher M, Shannon F, Abbas AE. ECHOCARDIOGRAPHIC VS. COMPUTED TOMOGRAPHIC-DERIVED ENERGY LOSS INDEX COMPARED TO INVASIVE AORTIC VALVE AREA IN AORTIC STENOSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32429-3] [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: 11/29/2022]
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Kadri AN, Bernardo M, Werns SW, Abbas AE. TAVR VS. SAVR IN PATIENTS WITH CANCER AND AORTIC STENOSIS: A NATIONWIDE READMISSION DATABASE REGISTRY STUDY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32766-2] [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: 10/24/2022]
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Bakhos CT, Salami AC, Kaiser LR, Petrov RV, Abbas AE. Outcomes of octogenarians with esophageal cancer: an analysis of the National Cancer Database. Dis Esophagus 2019; 32:1-8. [PMID: 30596899 DOI: 10.1093/dote/doy128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 04/08/2018] [Revised: 10/26/2018] [Indexed: 12/11/2022]
Abstract
The optimal treatment of esophageal cancer in octogenarians is controversial. While the safety of esophagectomy has been demonstrated in elderly patients, surgery and multimodality therapy are still offered to a select group. Additionally, the long-term outcomes in octogenarians have not been thoroughly compared to those in younger patients. We sought to compare the outcomes of esophageal cancer treatment between octogenarians and non-octogenarians in the National Cancer Database (2004-2014). The major endpoints were early postoperative mortality and long-term survival. A total of 107,921 patients were identified [octogenarian-16,388 (15.2%)]. Compared to non-octogenarians, octogenarians were more likely to be female, of higher socioeconomic status, and had more Charlson comorbidities (p < 0.001 for all). Octogenarians were significantly less likely to undergo esophagectomy (11.5% vs. 33.3%; p < 0.001) and multimodality therapy (2.0% vs. 18.5%; p < 0.001), a trend that persisted following stratification by tumor stage and Charlson comorbidities. Both 30-day and 90-day mortality were higher in the octogenarian group, even after multivariable adjustment (p ≤ 0.001 for both). Octogenarians who underwent multimodality therapy had worse long-term survival when compared to younger patients, except for those with stage III tumors and no comorbidities (HR: 1.29; p = 0.153). Within the octogenarian group, postoperative mortality was lower in academic centers, and the long-term survival was similar between multimodality treatment and surgery alone (HR: 0.96; p = 0.62). In conclusion, octogenarians are less likely to be offered treatment irrespective of tumor stage or comorbidities. Although octogenarians have higher early mortality and poorer overall survival compared to younger patients, outcomes may be improved when treatment is performed at academic centers. Multimodality treatment did not seem to confer a survival advantage compared to surgery alone in octogenarians, and more prospective studies are necessary to better elucidate the optimal treatment in this patient population.
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Affiliation(s)
- C T Bakhos
- Department of Thoracic Medicine and Surgery, Temple University Hospital.,Department of Surgery, Albert Einstein Healthcare Network, Philadelphia, USA
| | - A C Salami
- Department of Surgery, Albert Einstein Healthcare Network, Philadelphia, USA
| | - L R Kaiser
- Department of Thoracic Medicine and Surgery, Temple University Hospital
| | - R V Petrov
- Department of Thoracic Medicine and Surgery, Temple University Hospital
| | - A E Abbas
- Department of Thoracic Medicine and Surgery, Temple University Hospital
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Renard BM, Cami E, Jiddou-Patros MR, Said A, Kado H, Trivax J, Berman A, Gulati A, Rabah M, Timmis S, Shoukfeh M, Abbas AE, Hanzel G, Hanson I, Dixon S, Safian RD. Optimizing the Technique for Invasive Fractional Flow Reserve to Assess Lesion-Specific Ischemia. Circ Cardiovasc Interv 2019; 12:e007939. [DOI: 10.1161/circinterventions.119.007939] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 11/16/2022]
Abstract
Background:
Invasive fractional flow reserve (FFR
INV
) is the standard technique for assessing myocardial ischemia. Pressure distortions and measurement location may influence FFR
INV
interpretation. We report a technique for performing invasive fractional flow reserve (FFR
INV
) by minimizing pressure distortions and identifying the proper location to measure FFR
INV
.
Methods:
FFR
INV
recordings were obtained prospectively during manual hyperemic pullback in 100 normal and diseased coronary arteries with single stenosis, using 4 measurements from the terminal vessel, distal-to-the-lesion, proximal vessel, and guiding catheter. FFR
INV
profiles were developed by plotting FFR
INV
values (
y
-axis) and site of measurement (
x
-axis), stratified by stenosis severity. FFR
INV
≤0.8 was considered positive for lesion-specific ischemia.
Results:
Erroneous FFR
INV
values were observed in 10% of vessels because of aortic pressure distortion and in 21% because of distal pressure drift; these were corrected by disengagement of the guiding catheter and re-equalization of distal pressure/aortic pressure, respectively. There were significant declines in FFR
INV
from the proximal to the terminal vessel in normal and stenotic coronary arteries (
P
<0.001). The rate of positive FFR
INV
was 41% when measured from the terminal vessel and 20% when measured distal-to-the-lesion (
P
<0.001); 41.5% of positive terminal measurements were reclassified to negative when measured distal-to-the-lesion. Measuring FFR
INV
20 to 30 mm distal-to-the-lesion (rather than from the terminal vessel) can reduce errors in measurement and optimize the assessment of lesion-specific ischemia.
Conclusions:
Meticulous technique (disengagement of the guiding catheter, FFR
INV
pullback) is required to avoid erroneous FFR
INV
, which occur in 31% of vessels. Even with optimal technique, FFR
INV
values are influenced by stenosis severity and the site of pressure measurement. FFR
INV
values from the terminal vessel may overestimate lesion-specific ischemia, leading to unnecessary revascularization.
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Affiliation(s)
- Brian M. Renard
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Elvis Cami
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | | | - Ahmad Said
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Herman Kado
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Justin Trivax
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Aaron Berman
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Akhil Gulati
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Maher Rabah
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Steven Timmis
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Mazen Shoukfeh
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Amr E. Abbas
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - George Hanzel
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Ivan Hanson
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Simon Dixon
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
| | - Robert D. Safian
- Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, MI
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