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Doldi PM, Stolz L, Kassar M, Kalbacher D, Petronio AS, Butter C, von Bardeleben RS, Iliadis C, Grayburn P, Hausleiter J. Paradox of disproportionate atrial functional mitral regurgitation and survival after transcatheter edge-to-edge repair. ESC Heart Fail 2024. [PMID: 38602287 DOI: 10.1002/ehf2.14789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/28/2024] [Accepted: 03/15/2024] [Indexed: 04/12/2024] Open
Abstract
AIMS This study aims to assess the applicability of the mitral regurgitation (MR) proportionality concept in patients with atrial functional mitral regurgitation (aFMR) treated with transcatheter edge-to-edge repair (M-TEER). We hypothesized that patients with disproportionate MR (higher MR relative to left ventricular size) would exhibit different outcomes compared to those with proportionate MR, despite undergoing M-TEER. METHODS AND RESULTS We retrospectively analysed 98 patients with aFMR from the EuroSMR registry who underwent M-TEER between 2008 and 2019. Patients met criteria for aFMR (normal indexed left ventricular end-diastolic volume [LVEDV], preserved left ventricular ejection fraction [LVEF] ≥ 50% without regional wall motion abnormalities, and structurally normal mitral valves). We excluded patients with missing effective regurgitant orifice area (EROA) or LVEDV data. The primary endpoint was 2-year mortality, with an EROA/LVEDV ratio employed to differentiate disproportionate from proportionate MR. Procedural success and baseline characteristics were analysed, and multivariate Cox proportional hazards models were used to identify mortality predictors. The mean patient age was 79 ± 7.3 years, with 68.8% female, and 79% had a history of atrial fibrillation. The mean EROA was 0.27 ± 0.14 cm2, and LVEDV was 95.6 ± 33.7 mL. Disproportionate MR was identified with an EROA/LVEDV ratio >0.339 cm2/100 mL. While procedural success was similar in both groups, disproportionate MR was associated with a numerically higher estimate of systolic pulmonary artery pressures (sPAP) and rates of NYHA ≥III and TR ≥ 3+. Disproportionate MR had a significant association with increased 2-year mortality (P < 0.001). The EROA/LVEDV ratio and tricuspid annular plane systolic excursion (TAPSE) were independent predictors of 2-year mortality (EROA/LVEDV: HR: 1.35, P = 0.010; TAPSE: HR: 0.85, P = 0.020). CONCLUSIONS This analysis introduces the MR proportionality concept in aFMR patients and its potential prognostic value. Paradoxically, disproportionate MR in aFMR was linked to a 1.35-fold increase in 2-year mortality post-M-TEER, emphasizing the importance of accurate preprocedural FMR characterization. Our findings in patients with disproportionate MR indicate that a high degree of aFMR with high regurgitant volumes may lead to aggravated symptoms, which is a known contributor to increased mortality following M-TEER. These results underline the need for further research into the pathophysiology of aFMR to inform potential preventative and therapeutic strategies, ensuring optimal patient outcomes.
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Affiliation(s)
- Philipp M Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Mohammad Kassar
- Universitätsklinik für Kardiologie, Bern University Hospital, Inselspital Bern, Bern, Switzerland
| | - Daniel Kalbacher
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany
| | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Christian Butter
- Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany
| | | | - Christos Iliadis
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Paul Grayburn
- Department of Internal Medicine, Division of Cardiology, Baylor University Medical Center, Dallas, TX, USA
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
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Ehrenfels MA, Fretter C, von Stein J, Körber MI, Wienemann H, Baldus S, Pfister R, Iliadis C. Role of preexisting right ventricular remodeling in symptoms and prognosis after transcatheter tricuspid valve repair. Clin Res Cardiol 2024:10.1007/s00392-024-02428-z. [PMID: 38446149 DOI: 10.1007/s00392-024-02428-z] [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: 12/04/2023] [Accepted: 02/27/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Severe tricuspid regurgitation (TR) is associated with chronic volume overload and right ventricular remodeling (RVR). Transcatheter tricuspid valve repair (TTVr) reduces TR and can improve quality of life (QoL), but the role of preprocedural RVR on TTVr outcomes remains unclear. AIMS To investigate the role of RVR on outcomes after TTVr for severe TR. METHODS Consecutive patients undergoing TTVr (61% edge-to-edge vs. 39% direct annuloplasty) for severe TR were retrospectively compared by preexisting RVR which was defined as dilation of RV mid-level diameter (> 35 mm) according to guidelines. QoL was evaluated using NYHA class, Minnesota Living with Heart Failure Questionnaire (MLHFQ), 36-Item Short Form Health Survey (SF-36), and 6-min walking distance (6MWD) 1-month after TTVr. Mid-term mortality and heart failure (HF) hospitalization were assessed through 1 year. RESULTS RVR was present in 137 of 223 patients (61%). Symptoms and QoL improved equally in both groups: ≥ 1 NYHA class (57% vs. 65% of patients with vs. without RVR, respectively), 6MWD (36% vs. 34%), MLHFQ (81% vs. 69%), and SF-36 (68% vs. 65%) improvement. One-year mortality and HF hospitalization were significantly higher in patients with RVR (24% and 30%, respectively) than in patients without (8% and 13%, both p < 0.05). In multivariable analysis, RVR was independently associated with mortality (HR 2.3, 95%CI (1.0-5.0), p = 0.04) and the combined endpoint of mortality or rehospitalization (HR 2.0, 95%CI (1.1-3.8), p = 0.03). CONCLUSIONS TTVr was associated with significant QoL improvement after 1 month, irrespective of RVR. Despite increased mortality and rehospitalization for heart failure, TTVr in the presence of RVR still provides substantial symptomatic benefit for patients with severe TR.
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Affiliation(s)
- Marc-André Ehrenfels
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Caroline Fretter
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Jennifer von Stein
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Maria Isabel Körber
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Hendrik Wienemann
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Stephan Baldus
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Roman Pfister
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Christos Iliadis
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Strasse 62, 50937, Cologne, Germany.
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Paitazoglou C, Bergmann MW, Kilicaslan B, Kilic T, Bartunek J, Pfister R, Iliadis C, Kaya EB, Ozdemir R. Treatment With an Interatrial Shunt in Heart Failure: 1-Year Outcomes of the PRELIEVE Study. JACC Heart Fail 2024; 12:591-594. [PMID: 38180430 DOI: 10.1016/j.jchf.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/02/2023] [Accepted: 10/11/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Christina Paitazoglou
- University Heart Center Lübeck, Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), University Schleswig-Holstein (UKSH) Campus Lübeck, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany.
| | - Martin W Bergmann
- Department of Cardiology and Intensive Care Medicine, Asklepios Klinik Altona, Hamburg, Germany.
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Dreyfus J, Galloo X, Taramasso M, Heitzinger G, Benfari G, Kresoja KP, Juarez-Casso F, Omran H, Bohbot Y, Iliadis C, Russo G, Topilsky Y, Weber M, Nombela-Franco L, Sala A, Eixerés-Esteve A, Iung B, Obadia JF, Estevez Loureiro R, Riant E, Donal E, Hausleiter J, Badano L, Le Tourneau T, Coisne A, Modine T, Latib A, Praz F, Windecker S, Zamorano JL, von Bardeleben RS, Tang GHL, Hahn R, Webb J, Muraru D, Nejjari M, Chan V, De Bonis M, Carnero-Alcazar M, Nickenig G, Pfister R, Tribouilloy C, Rudolph V, Crestanello J, Lurz P, Bartko P, Maisano F, Bax J, Enriquez-Sarano M, Messika-Zeitoun D. TRI-SCORE and benefit of intervention in patients with severe tricuspid regurgitation. Eur Heart J 2024; 45:586-597. [PMID: 37624856 DOI: 10.1093/eurheartj/ehad585] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND AND AIMS Benefit of tricuspid regurgitation (TR) correction and timing of intervention are unclear. This study aimed to compare survival rates after surgical or transcatheter intervention to conservative management according to a TR clinical stage as assessed using the TRI-SCORE. METHODS A total of 2,413 patients with severe isolated functional TR were enrolled in TRIGISTRY (1217 conservatively managed, 551 isolated tricuspid valve surgery, and 645 transcatheter valve repair). The primary endpoint was survival at 2 years. RESULTS The TRI-SCORE was low (≤3) in 32%, intermediate (4-5) in 33%, and high (≥6) in 35%. A successful correction was achieved in 97% and 65% of patients in the surgical and transcatheter groups, respectively. Survival rates decreased with the TRI-SCORE in the three treatment groups (all P < .0001). In the low TRI-SCORE category, survival rates were higher in the surgical and transcatheter groups than in the conservative management group (93%, 87%, and 79%, respectively, P = .0002). In the intermediate category, no significant difference between groups was observed overall (80%, 71%, and 71%, respectively, P = .13) but benefit of the intervention became significant when the analysis was restricted to patients with successful correction (80%, 81%, and 71%, respectively, P = .009). In the high TRI-SCORE category, survival was not different to conservative management in the surgical and successful repair group (61% and 68% vs 58%, P = .26 and P = .18 respectively). CONCLUSIONS Survival progressively decreased with the TRI-SCORE irrespective of treatment modality. Compared to conservative management, an early and successful surgical or transcatheter intervention improved 2-year survival in patients at low and, to a lower extent, intermediate TRI-SCORE, while no benefit was observed in the high TRI-SCORE category.
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Affiliation(s)
- Julien Dreyfus
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France
| | - Xavier Galloo
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiology, Free University Brussels (VUB), University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | | | - Gregor Heitzinger
- Department for Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | - Giovanni Benfari
- Cardiovascular Disease Department, Mayo Clinic, Rochester, MN, USA
- Section of Cardiology, Department of Medicine, University of Verona, Italy
| | - Karl-Patrick Kresoja
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | - Hazem Omran
- General and Interventional Cardiology, Heart & Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Christos Iliadis
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Giulio Russo
- Policlinico Tor Vergata, University of Rome, Rome, Italy
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv, Israel
| | | | | | - Alessandra Sala
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Bernard Iung
- Cardiology Department, Bichat Hospital, APHP, and INSERM LVTS U1148, Université de Paris, Paris, France
| | - Jean-François Obadia
- Department of Cardiovascular Surgery and Transplantation, Louis Pradel Cardiovascular Hospital, Claude Bernard University, Bron, France
| | | | - Elisabeth Riant
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France
| | - Erwan Donal
- Cardiology Department, LTSI UMR1099, INSERM, Université de Rennes-1, CHU de RENNES, Rennes, France
| | - Jörg Hausleiter
- Medical Clinic and Polyclinic I, University Hospital of Munich, Munich, Germany
| | - Luigi Badano
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Thierry Le Tourneau
- CNRS, INSERM, l'institut du thorax, Université de Nantes, CHU de Nantes, Nantes, France
| | - Augustin Coisne
- Department of Clinical Physiology and Echocardiography-Heart Valve Clinic, CHU Lille, Lille, France
- Institut Pasteur de Lille, U1011- EGID, Univ. Lille, Inserm, CHU Lille, Lille, France
| | - Thomas Modine
- Department of Cardiology and Cardio-Vascular Surgery, Hôpital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Bordeaux, France
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, NY, USA
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Jose Luis Zamorano
- Department of Cardiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
| | - Rebecca Hahn
- Cardiology Department, NewYork-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - John Webb
- St. Paul Hospital, Vancouver, British Columbia, Canada
| | - Denisa Muraru
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Mohammed Nejjari
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France
| | - Vincent Chan
- Department of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michele De Bonis
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Roman Pfister
- Department for Internal Medicine III, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Volker Rudolph
- General and Interventional Cardiology, Heart & Diabetes Center NRW, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Philipp Bartko
- Department for Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria
| | - Francesco Maisano
- Cardiac Surgery and Heart Valve Center, Ospedale San Raffaele, University Vita Salute, Milano, Italy
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Gietzen T, Althoff J, Ochs L, Gerçek M, von Stein J, Hasse C, Iliadis C, Friedrichs K, Rudolph V, Baldus S, Pfister R, Körber MI. Incidence and clinical impact of renal failure and bleeding following transcatheter tricuspid valve annuloplasty. Clin Res Cardiol 2024:10.1007/s00392-024-02388-4. [PMID: 38358419 DOI: 10.1007/s00392-024-02388-4] [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: 12/05/2023] [Accepted: 01/30/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Bleeding is the most common complication after percutaneous leaflet-based tricuspid valve repair and associated with acute kidney injury (AKI) and adverse outcome. TTVA with the Cardioband system is a technically more complex procedure; however, frequency and prognostic impact of postinterventional bleeding and renal complications have not been thoroughly examined. AIMS This study was performed to determine the incidence and clinical impact of bleeding complications (MVARC criteria) and acute kidney injury (KDIGO criteria) following transcatheter tricuspid valve annuloplasty (TTVA). METHODS In a bi-center retrospective analysis of patients undergoing TTVA between 2018 and 2022, we examined frequency, predictors, and clinical impact of bleeding and renal failure. RESULTS In 145 consecutive patients, the incidence of any MVARC bleeding was 20.7% (n = 30), whereas major MVARC bleeding occurred in 6.9% (n = 10). The incidence of AKI was 18.6% (n = 27). Risk factors for bleeding events included low baseline hemoglobin and elevated baseline creatinine levels. Risk factors for AKI included diabetes mellitus, arterial hypertension, high body mass index, and elevated baseline creatinine levels. Neither procedure duration nor amount of contrast media was associated with AKI or bleeding. Both bleeding and AKI led to a longer hospital stay. At 3 months, 10.0% (n = 3) of patients with bleeding and 7.8% (n = 9) of patients without bleeding complications died (p = 0.70). Additionally, mortality rate was 7.4% (n = 2) in patients with AKI compared to 8.5% (n = 10) without AKI (p = 0.83). CONCLUSION While about a fifth of patients undergoing TTVA suffered from postinterventional AKI or bleeding, none of these complications was associated with higher mortality at short-term follow-up. One important risk factor for both complications was chronic renal dysfunction, indicating a high-risk patient population. The most frequent bleeding localizations were the femoral access site, pericardial hemorrhage, and the esophagus, which need explicit attention in periprocedural management.
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Affiliation(s)
- Thorsten Gietzen
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Jan Althoff
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Laurin Ochs
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Muhammed Gerçek
- Clinic of General and Interventional Cardiology/Angiology, Heart and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Jennifer von Stein
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Caroline Hasse
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Christos Iliadis
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Kai Friedrichs
- Clinic of General and Interventional Cardiology/Angiology, Heart and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Volker Rudolph
- Clinic of General and Interventional Cardiology/Angiology, Heart and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Stephan Baldus
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Roman Pfister
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Maria Isabel Körber
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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Schäfer M, Nöth H, Metze C, Iliadis C, Körber MI, Halbach M, Baldus S, Pfister R. Frailty, periinterventional complications and outcome in patients undergoing percutaneous mitral and tricuspid valve repair. Clin Res Cardiol 2024:10.1007/s00392-024-02397-3. [PMID: 38358418 DOI: 10.1007/s00392-024-02397-3] [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: 12/22/2023] [Accepted: 02/05/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Frailty is common in elderly and multimorbid patients and associated with increased vulnerability to stressors. METHODS In a single centre study frailty according to Fried criteria was assessed in consecutive patients before transcatheter mitral and tricuspid valve repair. Postprocedural infections, blood transfusion and bleeding and renal failure were retrospectively assessed from records. Median follow-up time for survival was 560 days (IQR: 363 to 730 days). RESULTS 90% of 626 patients underwent mitral valve repair, 5% tricuspid valve repair, and 5% simultaneous mitral and tricuspid valve repair. 47% were classified as frail. Frailty was associated with a significantly increased frequency of bleeding (16 vs 10%; p = 0.016), blood transfusions (9 vs 3%; p = < 0.001) and infections (18 vs 10%; p = 0.006), but not with acute kidney injury (20 vs 20%; p = 1.00). Bleeding and infections were associated with longer hospital stays, with a more pronounced effect in frail patients (interaction test p < 0.05, additional 3.2 and 4.1 days in frail patients, respectively). Adjustment for the occurrence of complications did not attenuate the increased risk of mortality associated with frailty (HR 2.24 [95% CI 1.62-3.10]; p < 0.001). CONCLUSIONS Bleeding complications and infections were more frequent in frail patients undergoing transcatheter mitral and tricuspid valve repair and partly explained the longer hospital stay. Albeit some of the complications were associated with higher long-term mortality, this did not explain the strong association between frailty and mortality. Further research is warranted to explore interventions targeting periprocedural complications to improve outcomes in this vulnerable population.
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Affiliation(s)
- Matthieu Schäfer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Köln, Germany.
| | - Hannah Nöth
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Köln, Germany
| | - Clemens Metze
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Köln, Germany
| | - Christos Iliadis
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Köln, Germany
| | - Maria Isabel Körber
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Köln, Germany
| | - Marcel Halbach
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Köln, Germany
| | - Stephan Baldus
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Köln, Germany
| | - Roman Pfister
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Köln, Germany
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Sialakis C, Frantzana A, Iliadis C, Ouzounakis P, Antoniou Sialaki P, Kourkouta L. Comparison of Robotic Versus Conventional Open Thyroidectomy for Recurrent Laryngeal Nerve Safety: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e53860. [PMID: 38465121 PMCID: PMC10924667 DOI: 10.7759/cureus.53860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/12/2024] Open
Abstract
This review aims to investigate the safety of recurrent laryngeal nerve (RLN) by comparing robotic thyroidectomy (RT) versus open thyroidectomy (OT) in Western and Asian populations. Two main outcomes of this review were (1) the safety of RLN comparing the robotic and OT assessing transient and permanent laryngeal nerve (PLN) palsy as a postoperative complication in each surgical procedure and (2) the safety of RLN comparing the robotic and OT assessing transient and permanent laryngeal nerve (PLN) palsy as a postoperative complication between studies conducted in USA/Europe and Asia. We searched relevant literature in electronic databases such as PubMed, MEDLINE, Cochrane CENTRAL, ScienceDirect, and Cumulative Index to Nursing & Allied Health (CINAHL) up to September 2022. Further research was performed during January 2024 in the Scopus database. Two primary outcomes were set: transient RLN palsy and permanent RLN palsy, comparing RT and OT. In this review, 18 non-randomized studies were included. A statistically significant difference between robotic and conventional OT was not observed either in transient RLN or in permanent RLN palsy. The odds ratio (OR) for the overall comparison of transient RLN palsy was 1.18, and the 95% confidence interval (95% CI) was 0.80-1.74. The subgroup analysis for transient RLN palsy between USA/Europe studies was OR 1.28, and the 95% CI was 0.64-2.58. The subgroup analysis for transient RLN palsy between Asian studies was OR 1.14, and the 95% CI was 0.72-1.82. The OR for the overall comparison of permanent RLN palsy was OR 0.90, and the 95% CI was 0.38-2.15. The subgroup analysis for permanent RLN palsy between USA/Europe studies was OR 0.45, and the 95% CI was 0.07-2.97. The subgroup analysis for permanent RLN palsy between Asian studies was OR 1.13, and the 95% CI was 0.42-3.05. Heterogeneity I2 was 0% in all outcomes. The Mantel-Haenszel method fixed effect was used. First, RT and open conventional thyroidectomy have comparable safety for RLN, although the analysis showed no statistically significant results. Second, no statistically significant results were found for RLN safety in either USA/Europe or Asian studies. Considering that there is not a statistically significant difference between the two approaches for RLN safety, and due to the limited number of studies from Western countries, the results should be considered with caution. Important factors such as the patient's body characteristics, the existing thyroid pathology, and the surgical approach should be kept in mind. More comparable studies are needed on the Western population.
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Affiliation(s)
| | - Aikaterini Frantzana
- Epidemiology and Public Health, George Papanikolaou General Hospital of Thessaloniki, Thessaloniki, GRC
- Public Health, European University Cyprus, Nicosia, CYP
| | - Christos Iliadis
- Nuclear Medicine, Private Diagnostic Health Center, Thessaloniki, GRC
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Kalkan A, Metze C, Iliadis C, Körber MI, Baldus S, Pfister R. Prognostic impact of cancer history in patients undergoing transcatheter mitral valve repair. Clin Res Cardiol 2024; 113:94-106. [PMID: 37581720 PMCID: PMC10808190 DOI: 10.1007/s00392-023-02266-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/10/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND History of cancer is common in patients undergoing transcatheter mitral valve repair (TMVR). OBJECTIVES Aim was to examine the impact of cancer history on outcomes after TMVR. METHODS In patients of a monocentric prospective registry of TMVR history of cancer was retrospectively assessed from records. Associations with 6-week functional outcomes and clinical outcomes during a median follow-up period of 594 days were examined. RESULTS Of 661 patients (mean age 79 years; age-range 37-101 years; 56.1% men), 21.6% had a history of cancer with active disease in 4.1%. Compared with non-cancer patients, cancer patients had a similar procedural success rate (reduction of mitral regurgitation to grade 2 or lower 91.6% vs. 88%; p = 0.517) and similar relevant improvement in 6-min walking distance, NYHA class, Minnesota Living with Heart Failure Questionnaire score and Short Form 36 scores. 1-year survival (83% vs. 82%; p = 0.813) and 1-year survival free of heart failure decompensation (75% vs. 76%; p = 0.871) were comparable between cancer and non-cancer patients. Patients with an active cancer disease showed significantly higher mortality compared with patients having a history of cancer (hazard ratio 2.05 [95% CI 1.11-3.82; p = 0.023]) but similar mortality at landmark analysis of 1 year. CONCLUSION TMVR can be performed with equal efficacy in patients with and without cancer and symptomatic mitral regurgitation. Cancer patients show comparable clinical outcome and short-term functional improvement as non-cancer patients. However, longterm mortality was increased in patients with active cancer underlining the importance of patient selection within the heart-team evaluation.
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Affiliation(s)
- Alev Kalkan
- Department III of Internal Medicine, Heart Center, University Hospital of Cologne, Cologne, Germany.
- Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, North Rhine-Westphalia, Germany.
| | - Clemens Metze
- Department III of Internal Medicine, Heart Center, University Hospital of Cologne, Cologne, Germany.
- Heart Center, University of Cologne, Kerpener Str. 62, 50937, Cologne, North Rhine-Westphalia, Germany.
| | - Christos Iliadis
- Department III of Internal Medicine, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Maria I Körber
- Department III of Internal Medicine, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department III of Internal Medicine, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Roman Pfister
- Department III of Internal Medicine, Heart Center, University Hospital of Cologne, Cologne, Germany
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Ochs L, Körber MI, Wienemann H, Tichelbäcker T, Iliadis C, Metze C, Brüwer M, Schmidt T, Omran H, Fortmeier V, Friedrich K, Rudolph V, Baldus S, Pfister R. Comparison of transcatheter leaflet-approximation and direct annuloplasty in tricuspid regurgitation. Clin Res Cardiol 2024; 113:126-137. [PMID: 37642720 PMCID: PMC10808287 DOI: 10.1007/s00392-023-02287-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Transcatheter repair emerges as a treatment option in patients with tricuspid regurgitation (TR) and high surgical risk. AIMS This study aimed to compare leaflet-based and annuloplasty-based transcatheter repair in patients with TR. METHODS In a retrospective analysis consecutive patients undergoing either transcatheter edge-to-edge repair (TEER) or direct annuloplasty (AP) for relevant TR at 2 centers were compared with respect to baseline characteristics, procedural efficacy and safety (death, myocardial infarction, procedure or device-related cardiothoracic surgery, or stroke at 30 days). RESULTS 161 patients (57% female, median age 79 [75-82] years) with comparable clinical baseline characteristics in the TEER (n = 87) and AP (n = 74) group were examined. Baseline TR grade was significantly less severe in the TEER compared to the AP group (torrential 9.2 vs. 31.1%, p = 0.001). Technical success and improvement of TR grades were not significantly different across groups. In analysis matched for baseline TR severity, reduction of TR grade to less than moderate was significantly more common in the AP group (47.8 vs. 26.1%, p = 0.031). Major or more severe bleeding occurred in 9.2% of TEER and 20.3% of AP patients (p = 0.049) without any fatal bleedings. Major adverse events (MAE) were similar across groups with four patients (4.7%) in the TEER group and five patients (6.9%) in the AP group (p = 0.733) and 6-month survival did not differ significantly. CONCLUSIONS Differences observed between patients treated with TEER and AP provide first evidence for tailoring distinct transcatheter treatment techniques to individual patient characteristics.
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Affiliation(s)
- Laurin Ochs
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Maria Isabel Körber
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Hendrik Wienemann
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Tobias Tichelbäcker
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Christos Iliadis
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Clemens Metze
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Monique Brüwer
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Tobias Schmidt
- Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Hazem Omran
- Department of General and Interventional Cardiology, Heart and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Vera Fortmeier
- Department of General and Interventional Cardiology, Heart and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Kai Friedrich
- Department of General and Interventional Cardiology, Heart and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Volker Rudolph
- Department of General and Interventional Cardiology, Heart and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Stephan Baldus
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Roman Pfister
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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Iliadis C, Weber M, Horn P, Harr C, Gavazzoni M, Nickenig G, Westenfeld R, Taramasso M, Alessandrini H, Pfister R. Imaging Predictors of Successful Transcatheter Direct Annuloplasty in Secondary Mitral Regurgitation. JACC Cardiovasc Interv 2023; 16:2945-2947. [PMID: 37943198 DOI: 10.1016/j.jcin.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 11/10/2023]
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Ouzounakis P, Kourkouta L, Frantzana A, Iliadis C, Tsaloglidou A, Koukourikos K, Sialakis C, Alexopoulos E. Satisfaction of Patients with HIV/AIDS Infection from the Care Provided in the Special Infection Unit of University General Hospital of Alexandroupoli. Mater Sociomed 2023; 35:184-189. [PMID: 37795167 PMCID: PMC10545923 DOI: 10.5455/msm.2023.35.184-189] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023] Open
Abstract
Background C HIV/AIDS infection is characterized by a very low number of T lymphocytes (CD4), which makes sufferers vulnerable to various infections, and so they seek continuous care in Special Infections Units. Objective The purpose of the survey is to investigate the factors that contribute to the satisfaction derived from the health services provided to people living with the human immunodeficiency virus; and they are monitored at the Special Infections Unit of the University General Hospital of Alexandroupoli. Methods All patients who came to the Special Infections Unit of the University General Hospital of Alexandroupoli during the period June - July 2021 were asked to complete an anonymous questionnaire on satisfaction derived from the health services provided (E - PQ - SPCSS) and satisfaction derived from their work and quality of life (Occupational Stress Questionnaire, JCQ). The statistical package SPSS 19.0 was used for the statistical analysis of the data. With the help of the ANOVA statistical test, the differences between the variables were checked. P-Value in all audits was set at 0.05. Values showing equal to or less than 0.05 were considered statistically significant. Results They were 85 patients who participated. Amongst them, they were mainly men (75.3%), the mean age was 35-50 years (50.6%), residents of Thrace (62.3%). 37.7% of the participants said they had some difficulty accessing SIU. Quality of life was positively correlated with education (p<0.001) where the higher reported level of education was, the higher satisfaction rates were. A positive correlation (p<0.001) was also observed amongst income rates where the higher incomes reported, the higher the satisfaction rates were. Lower incomes were significantly associated (p = 0.029) with mental disorders (anxiety, depression). Quality of life was positively associated with both satisfaction with medical as well as nursing care (p <0.008). The adequacy and clarity of the information the patients receive from SIU physicians during their visit shows a significant positive correlation (p<0.001). In addition, there is a significant correlation regarding the problems patients may have experienced in the last 6 months in terms of access to treatment (p<0.021). Conclusion Participants showed high satisfaction rates from the medical and nursing care provided at the SIU of the PGNA. The opportunity of expression given to users - patients through satisfaction studies promotes and creates a climate of trust between them and the decision-making teams of health units.
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Affiliation(s)
| | - Lambrini Kourkouta
- Nursing Department, International University of Greece, Thessaloniki, Greece
| | - Aikaterini Frantzana
- Department of Health Sciences, School of Sciences, European University Cyprus, General Hospital “G. Papanikolaou Thessaloniki, Greece
| | | | - Areti Tsaloglidou
- Nursing Department, International Hellenic University, Thessaloniki, Greece
| | | | - Christos Sialakis
- Trainee ENT GNTH "G. Gennimatas - Agios Dimitrios" Hospital, Thessaloniki, Greece
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Metze C, Iliadis C, Körber MI, von Stein J, Halbach M, Baldus S, Pfister R. Disentangling Heart Failure and Physical Frailty: Prospective Study of Patients Undergoing Percutaneous Mitral Valve Repair. JACC Heart Fail 2023; 11:972-982. [PMID: 37227390 DOI: 10.1016/j.jchf.2023.04.011] [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] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/27/2023] [Accepted: 04/04/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Frailty and heart failure share pathophysiology and clinical characteristics. OBJECTIVES The aim of this study was to analyze the contribution of heart failure to the physical frailty phenotype by examining patients with heart failure before and after percutaneous mitral valve repair (PMVR). METHODS Frailty according to the Fried criteria (weight loss, weakness, exhaustion, slowness, and low activity) was assessed in consecutive patients before and 6 weeks after PMVR. RESULTS A total of 118 of 258 patients (45.7%) (mean age: 78 ± 9 years, 42% female, 55% with secondary mitral regurgitation) were frail at baseline, which significantly decreased to 74 patients (28.7 %) at follow-up (P < 0.001). The frequency of frailty domains slowness, exhaustion, and inactivity significantly decreased, whereas weakness remained unchanged. Baseline frailty was significantly associated with comorbidities, N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, and functional capacity, whereas frailty after PMVR was not associated with NT-proBNP levels. Predictors of postprocedural reversibility of frailty were NYHA functional class CONCLUSIONS Treatment of mitral regurgitation in patients with heart failure is associated with almost a halved burden of physical frailty, particularly in patients with a less advanced phenotype. Considering the prognostic relevance of frailty dynamics, this data warrants further evaluation of the concept of frailty as a primary treatment target.
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Affiliation(s)
- Clemens Metze
- Faculty of Medicine, University of Cologne, and Department III of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Christos Iliadis
- Faculty of Medicine, University of Cologne, and Department III of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Maria I Körber
- Faculty of Medicine, University of Cologne, and Department III of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Jennifer von Stein
- Faculty of Medicine, University of Cologne, and Department III of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Marcel Halbach
- Faculty of Medicine, University of Cologne, and Department III of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Stephan Baldus
- Faculty of Medicine, University of Cologne, and Department III of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Roman Pfister
- Faculty of Medicine, University of Cologne, and Department III of Internal Medicine, University Hospital Cologne, Cologne, Germany.
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Sialakis C, Sialaki PA, Frantzana A, Iliadis C, Ouzounakis P, Kourkouta L. Prevalence of anxiety and depression of health care workers during COVID-19 - a systematic review and meta-analysis. Med Pharm Rep 2023; 96:246-253. [PMID: 37577023 PMCID: PMC10419692 DOI: 10.15386/mpr-2579] [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: 10/04/2022] [Accepted: 02/25/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction During the COVID-19 pandemic, the workload of healthcare workers managing the disease, increased significantly. The objective of this review is to determine the anxiety and depression prevalence among healthcare workers during the pandemic period. Methods We searched systematically the literature in five electronic databases such as PubMed, CINAHL, ScienceDirect, MEDLINE, and Cochrane COVID-19 study register. The last online research was performed in May 2022. We included only cross-sectional studies and performed a meta-analysis of pooled prevalence. Publication bias was assessed with a funnel plot and Egger's and Begg's tests. A random effect was applied and heterogenicity I2 was calculated. Quality assessment of included studies was performed using the Joanna Briggs Institute tool. Results In this review, we included 14 cross-sectional studies comprising 7780 healthcare workers. Participants were from the whole spectrum of healthcare workers. The pooled prevalence of depression was 33.8% (95% CI: 24.6 - 43.6), heterogenicity I2: 98.69%. The pooled prevalence of anxiety was 41.3% (95% CI: 30.2 - 52.9), heterogenicity I2: 99.01%. Conclusion One-third of healthcare workers suffered from depression, and more than one-third suffered from anxiety during the COVID-19 pandemic. Increased measures of surveillance of mental health should have been taken, as well as the support of healthcare workers running a high risk of psychological distress during the COVID-19 pandemic.
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Affiliation(s)
- Christos Sialakis
- General Hospital “Agios Dimitrios-G. Gennimatas”, Thessaloninki, Greece
| | | | - Aikaterini Frantzana
- School of Sciences, Department of Health Sciences, School of Medicine, European University Cyprus, Nicosia, Cyprus
- George Papanikolaou General Hospital of Thessaloniki, Greece
| | | | | | - Labrini Kourkouta
- Nursing Department, International University of Greece, Thessaloniki, Greece
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14
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Lauder L, Bergmann MW, Paitazoglou C, Özdemir R, Iliadis C, Bartunek J, Lauten A, Keller T, Weber S, Sievert H, Anker SD, Mahfoud F. Predicted impact of atrial flow regulator on survival in heart failure with reduced and preserved ejection fraction. ESC Heart Fail 2023. [PMID: 37312287 PMCID: PMC10375067 DOI: 10.1002/ehf2.14384] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/21/2023] [Accepted: 04/03/2023] [Indexed: 06/15/2023] Open
Abstract
AIMS We aim to assess the theoretical impact of the atrial flow regulator (AFR) on survival in heart failure. METHODS AND RESULTS The prospective, multicentre, open-label, non-randomised PRELIEVE study (NCT03030274) assessed the safety and efficacy of the Occlutech AFR device in patients with symptomatic heart failure with reduced ejection fraction (HFrEF) (left ventricular ejection fraction (LVEF) ≥ 15% and <40%) or heart failure with preserved ejection fraction (HFpEF) (LVEF ≥40% and <70%) and elevated PCWP (≥15 mmHg at rest or ≥25 mmHg during exercise). In this analysis, after the first 60 patients completed 12 months of follow-up, the theoretical impact of AFR implantation on survival was assessed by comparing the observed mortality rate with the median predicted probability for one-year mortality. Each subject's risk of mortality was predicted from individual baseline data using the Meta-Analysis Global Group in Chronic HF (MAGGIC) prognostic model. A total of 87 patients (46% female, median age 69 years [IQR 62-74]) had undergone successful device implantation for the treatment of HFrEF (53%) and HFpEF (47%). Sixty patients had a complete 12 month follow-up. The median follow-up was 351 days (interquartile range [IQR] 202-370). Six (7%) patients died during follow-up (8.6 deaths per 100 patient-years; 95% confidence interval [CI] 2.7 to 15.5), all of which had HFrEF. The median predicted mortality rate for the overall study population was 12.2 deaths per 100 patient-years (95% CI 10.2 to 14.7). While the observed mortality rate (0 deaths per 100 patient-years) was significantly lower than the median predicted mortality rate (9.3 deaths per 100 patient-years; 95% CI 8.4 to 11.1) in patients with HFpEF (-9.3 deaths per 100 patient-years; 95% CI -11.1 to -8.4), there was no difference in patients with HFrEF (-3.6 deaths per 100 patient-years; 95% CI -9.5 to 3.0). Four deaths were HF-related deaths (5.7 HF-related deaths per 100 patient-years; 95% CI 1.4 to 11.9; 10.8 HF-related deaths per 100 patient-years; 95% CI 2.5 to 23.1 in the HFrEF subgroup). CONCLUSIONS In patients with HFpEF, the mortality rate following AFR implantation was lower than the predicted mortality rate. Dedicated randomised, controlled trials are needed - and currently ongoing - to investigate whether the AFR improves mortality.
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Affiliation(s)
- Lucas Lauder
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes and Saarland University, Homburg, Germany
| | - Martin W Bergmann
- Department of Interventional Cardiology, Cardiologicum Hamburg, Hamburg, Germany
| | - Christina Paitazoglou
- University Heart Center Lübeck, Medical Clinic II, Cardiology, Angiology, Intensive Care Medicine, UKSH University Hospital Schleswig Holstein, Lübeck, Germany
| | - Ramazan Özdemir
- Department of Cardiology, Bezmiâlem Vakıf University, Istanbul, Turkey
| | - Christos Iliadis
- Department of Cardiology, Pulmonology, Angiology and Intensive Care Medicine, Heart Center University Clinic Köln, Köln, Germany
| | - Jozef Bartunek
- Cardiovascular Center, Onze-Lieve-Vrouw Hospital, Aalst, Belgium
| | - Alexander Lauten
- Department of General and Interventional Cardiology, Helios Klinikum Erfurt, Erfurt, Germany
| | | | | | | | - Stefan D Anker
- Department of Cardiology (CVK) and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes and Saarland University, Homburg, Germany
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Wienemann H, Mauri V, Ochs L, Körber MI, Eghbalzadeh K, Iliadis C, Halbach M, Wahlers T, Baldus S, Adam M, Kuhn E. Contemporary treatment of mitral valve disease with transcatheter mitral valve implantation. Clin Res Cardiol 2023; 112:571-584. [PMID: 36107228 PMCID: PMC10159974 DOI: 10.1007/s00392-022-02095-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Transcatheter mitral valve implantation (TMVI) with self-expanding (SAV) or balloon-expandable (BAV) valves are rising as promising treatment options for high-risk patients with symptomatic mitral valve (MVD) disease unsuitable for alternative treatment options. AIMS The aim of this study was to examine the clinical, procedural and outcome parameters of patients undergoing SAV or BAV for MVD. METHODS In this observational and single-center case series, fifteen consecutive patients treated with the Tendyne Mitral Valve System (SAV) and thirty-one patients treated with SAPIEN prosthesis (BAV) were included. RESULTS The patients (aged 78 years [interquartile range (IQR): 65.5 to 83.1 years], 41% women, EuroSCORE II 10.3% [IQR: 5.5 to 17.0%] were similar regarding baseline characteristics, despite a higher rate of prior heart valve surgery and prevalence of MV stenosis in the SAV-group. At discharge, the SAV-group had a mean transvalvular gradient of 4.2 mmHg, whereas the BAV-group had a mean transvalvular gradient of 6.2 mmHg. None or trace paravalvular leakage (PVL) was assessed in 85% in SAV-group and 80% in the BAV-group. 320 day all-cause and cardiac mortality rates were comparable in both groups (SAV: 26.7% vs BAV: 20%, p = 0.60). Four deaths occurred early in the SAV-group until 32 days of follow-up. CONCLUSIONS In high-risk patients with MVD, TMVI presents a promising treatment option with encouraging mid-term outcomes and good valve durability. TMVI either with BAV or SAV may be developed to an established treatment option.
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Affiliation(s)
- Hendrik Wienemann
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany.
| | - Victor Mauri
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Laurin Ochs
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Maria Isabel Körber
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Faculty of Medicine and University Hospital Cologne, Department of Cardiothoracic Surgery, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Christos Iliadis
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Marcel Halbach
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Thorsten Wahlers
- Faculty of Medicine and University Hospital Cologne, Department of Cardiothoracic Surgery, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Stephan Baldus
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Matti Adam
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
| | - Elmar Kuhn
- Faculty of Medicine and University Hospital Cologne, Department of Cardiothoracic Surgery, University of Cologne, Kerpener Str. 61, 50937, Cologne, Germany
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16
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Adamo M, Tomasoni D, Stolz L, Stocker TJ, Pancaldi E, Koell B, Karam N, Besler C, Giannini C, Sampaio F, Praz F, Ruf T, Pechmajou L, Neuss M, Iliadis C, Baldus S, Butter C, Kalbacher D, Lurz P, Melica B, Petronio AS, von Bardeleben RS, Windecker S, Butler J, Fonarow GC, Hausleiter J, Metra M. Impact of Transcatheter Edge-to-Edge Mitral Valve Repair on Guideline-Directed Medical Therapy Uptitration. JACC Cardiovasc Interv 2023; 16:896-905. [PMID: 37100553 DOI: 10.1016/j.jcin.2023.01.362] [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: 10/11/2022] [Revised: 12/26/2022] [Accepted: 01/17/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Guideline-directed medical therapy (GDMT) optimization is mandatory before transcatheter edge-to-edge mitral valve repair (M-TEER) in patients with secondary mitral regurgitation (SMR) and heart failure (HF) with reduced ejection fraction (HFrEF). However, the effect of M-TEER on GDMT is unknown. OBJECTIVES The authors sought to evaluate frequency, prognostic implications and predictors of GDMT uptitration after M-TEER in patients with SMR and HFrEF. METHODS This is a retrospective analysis of prospectively collected data from the EuroSMR Registry. The primary events were all-cause death and the composite of all-cause death or HF hospitalization. RESULTS Among the 1,641 EuroSMR patients, 810 had full datasets regarding GDMT and were included in this study. GDMT uptitration occurred in 307 patients (38%) after M-TEER. Proportion of patients receiving angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors, beta-blockers, and mineralocorticoid receptor antagonists was 78%, 89%, and 62% before M-TEER and 84%, 91%, and 66% 6 months after M-TEER (all P < 0.001). Patients with GDMT uptitration had a lower risk of all-cause death (adjusted HR: 0.62; 95% CI: 0.41-0.93; P = 0.020) and of all-cause death or HF hospitalization (adjusted HR: 0.54; 95% CI: 0.38-0.76; P < 0.001) compared with those without. Degree of MR reduction between baseline and 6-month follow-up was an independent predictor of GDMT uptitration after M-TEER (adjusted OR: 1.71; 95% CI: 1.08-2.71; P = 0.022). CONCLUSIONS GDMT uptitration after M-TEER occurred in a considerable proportion of patients with SMR and HFrEF and is independently associated with lower rates for mortality and HF hospitalizations. A greater decrease in MR was associated with increased likelihood for GDMT uptitration.
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Affiliation(s)
- Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Daniela Tomasoni
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Thomas J Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Edoardo Pancaldi
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Benedikt Koell
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicole Karam
- Department of Cardiology, European Hospital Georges Pompidou, and Paris Cardiovascular Research Center, INSERM U970, Paris, France
| | - Christian Besler
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Cristina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | | | - Fabien Praz
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Tobias Ruf
- Zentrum für Kardiologie, Johannes-Gutenberg-Universität, Mainz, Germany
| | - Louis Pechmajou
- Department of Cardiology, European Hospital Georges Pompidou, and Paris Cardiovascular Research Center, INSERM U970, Paris, France
| | - Michael Neuss
- Immanuel Heart Center Bernau, Brandenburg Medical School Theodor Fontane, Cardiology, Bernau, Germany
| | - Christos Iliadis
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Christian Butter
- Immanuel Heart Center Bernau, Brandenburg Medical School Theodor Fontane, Cardiology, Bernau, Germany
| | - Daniel Kalbacher
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Bruno Melica
- Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
| | - Anna S Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | | | - Stephan Windecker
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, Mississippi, USA
| | - Gregg C Fonarow
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
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17
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Körber MI, Roder F, Gerçek M, Koell B, Kalbacher D, Iliadis C, Brüwer M, Friedrichs KP, Rudolph V, Baldus S, Pfister R. Leaflet Morphology and its Implications for Direct Transcatheter Annuloplasty of Tricuspid Regurgitation. JACC Cardiovasc Interv 2023; 16:693-702. [PMID: 36990560 DOI: 10.1016/j.jcin.2023.01.364] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 01/09/2023] [Accepted: 01/24/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Leaflet morphology has been associated with treatment success in edge-to-edge repair of tricuspid regurgitation (TR), but the impact on annuloplasty is unclear. OBJECTIVES The authors sought to examine the association of leaflet morphology with efficacy and safety of direct annuloplasty in TR. METHODS The authors analyzed patients who underwent catheter-based direct annuloplasty with the Cardioband at 3 centers. Leaflet morphology was assessed according to number and location of leaflets by echocardiography. Patients with simple morphology (2 or 3 leaflets) were compared with complex morphology (>3 leaflets). RESULTS The study included 120 patients (median age 80 years) with ≥severe TR. A total of 48.3% of patients had a 3-leaflet morphology, 5% a 2-leaflet morphology, and 46.7% had >3 tricuspid leaflets. Baseline characteristics did not differ relevantly between groups except for a higher incidence of torrential TR grade (50 vs 26.6%) in complex morphologies. Postprocedural improvement of 1 (90.6% vs 92.9%) and 2 (71.9% vs 67.9%) TR grades was not significantly different between groups, but patients with complex morphology had more often residual TR ≥3 at discharge (48.2 vs 26.6%; P = 0.014). This difference did not remain significant (P = 0.112) after adjusting for baseline TR severity, coaptation gap, and nonanterior jet localization. Safety endpoints including complications of the right coronary artery, and technical success did not show significant differences. CONCLUSIONS Efficacy and safety of transcatheter direct annuloplasty using Cardioband are not affected by leaflet morphology. Assessment of leaflet morphology should be part of procedural planning in patients with TR and might help to individually tailor repair techniques to patient anatomy.
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Affiliation(s)
- Maria Isabel Körber
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department for Internal Medicine III, Germany.
| | - Fabian Roder
- Clinic for General and Interventional Cardiology/Angiology, Heart- and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Muhammed Gerçek
- Clinic for General and Interventional Cardiology/Angiology, Heart- and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Benedikt Koell
- University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site/Hamburg/Lübeck/Kiel, Germany
| | - Daniel Kalbacher
- University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site/Hamburg/Lübeck/Kiel, Germany
| | - Christos Iliadis
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department for Internal Medicine III, Germany
| | - Monique Brüwer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department for Internal Medicine III, Germany
| | - Kai Peter Friedrichs
- Clinic for General and Interventional Cardiology/Angiology, Heart- and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Heart- and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Stephan Baldus
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department for Internal Medicine III, Germany
| | - Roman Pfister
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department for Internal Medicine III, Germany
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18
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Stolz L, Doldi PM, Orban M, Karam N, Puscas T, Wild MG, Popescu A, von Bardeleben RS, Iliadis C, Baldus S, Adamo M, Thiele H, Besler C, Unterhuber M, Ruf T, Pfister R, Higuchi S, Koell B, Giannini C, Petronio A, Kassar M, Weckbach LT, Butter C, Stocker TJ, Neuss M, Melica B, Braun D, Windecker S, Massberg S, Praz F, Näbauer M, Kalbacher D, Lurz P, Metra M, Bax JJ, Hausleiter J. Staging Heart Failure Patients With Secondary Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair. JACC Cardiovasc Interv 2023; 16:140-151. [PMID: 36697148 DOI: 10.1016/j.jcin.2022.10.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/29/2022] [Accepted: 10/02/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Secondary mitral regurgitation (SMR) is a progressive disease with characteristic pathophysiological changes that may influence prognosis. Although the staging of SMR patients suffering from heart failure with reduced ejection fraction (HFrEF) according to extramitral cardiac involvement has prognostic value in medically treated patients, such data are so far lacking for edge-to-edge mitral valve repair (M-TEER). OBJECTIVES This study sought to classify M-TEER patients into disease stages based on the phenotype of extramitral cardiac involvement and to assess its impact on symptomatic and survival outcomes. METHODS Based on echocardiographic and clinical assessment, patients were assigned to 1 of the following HFrEF-SMR groups: left ventricular involvement (Stage 1), left atrial involvement (Stage 2), right ventricular volume/pressure overload (Stage 3), or biventricular failure (Stage 4). A Cox regression model was implemented to investigate the impact of HFrEF-SMR stages on 2-year all-cause mortality. The symptomatic outcome was assessed with New York Heart Association functional class at follow-up. RESULTS Among a total of 849 eligible patients who underwent M-TEER for relevant SMR from 2008 until 2019, 9.5% (n = 81) presented with left ventricular involvement, 46% (n = 393) with left atrial involvement, 15% (n = 129) with right ventricular pressure/volume overload, and 29% (n = 246) with biventricular failure. An increase in HFrEF-SMR stage was associated with increased 2-year all-cause mortality after M-TEER (HR: 1.39; CI: 1.23-1.58; P < 0.01). Furthermore, higher HFrEF-SMR stages were associated with significantly less symptomatic improvement at follow-up. CONCLUSIONS The classification of M-TEER patients into HFrEF-SMR stages according to extramitral cardiac involvement provides prognostic value in terms of postinterventional survival and symptomatic improvement.
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Affiliation(s)
- Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Philipp M Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Mathias Orban
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Nicole Karam
- Department of Cardiology, European Hospital Georges Pompidou and Paris Cardiovascular Research Center (INSERM U970), Paris, France
| | - Tania Puscas
- Department of Cardiology, European Hospital Georges Pompidou and Paris Cardiovascular Research Center (INSERM U970), Paris, France
| | - Mirjam G Wild
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Aniela Popescu
- Zentrum für Kardiologie, Johannes-Gutenberg-Universität, Mainz, Germany
| | | | - Christos Iliadis
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, Azienda Socio Sanitaria Territoriale Spedali Civili and University of Brescia, Brescia, Italy
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Christian Besler
- Cardiac Catheterization Laboratory and Cardiology, Azienda Socio Sanitaria Territoriale Spedali Civili and University of Brescia, Brescia, Italy
| | - Matthias Unterhuber
- Cardiac Catheterization Laboratory and Cardiology, Azienda Socio Sanitaria Territoriale Spedali Civili and University of Brescia, Brescia, Italy
| | - Tobias Ruf
- Zentrum für Kardiologie, Johannes-Gutenberg-Universität, Mainz, Germany
| | - Roman Pfister
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Satoshi Higuchi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Benedikt Koell
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Luebeck/Kiel, Germany
| | - Christina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Anna Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Mohammad Kassar
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Ludwig T Weckbach
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Christian Butter
- Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany
| | - Thomas J Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael Neuss
- Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany
| | - Bruno Melica
- Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Stephan Windecker
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Fabien Praz
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Micheal Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Daniel Kalbacher
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Luebeck/Kiel, Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology, Azienda Socio Sanitaria Territoriale Spedali Civili and University of Brescia, Brescia, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Turku Heart Center, University of Turku and Turku University Hospital, Turku, Finland
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.
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19
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Mauri V, Sugiura A, Spieker M, Iliadis C, Horn P, Öztürk C, Besler C, Riebisch M, Al-Hammadi O, Ruf T, Gerçek M, Grothusen C, Mehr M, Becher MU, Mues C, Boeder N, Kreidel F, Friedrichs K, Westenfeld R, Braun D, Baldus S, Rassaf T, Thiele H, Nickenig G, Hausleiter J, Möllmann H, Kelm M, Rudolph V, von Bardeleben RS, Nef HM, Luedike P, Lurz P, Pfister R. Early Outcomes of 2 Mitral Valve Transcatheter Leaflet Approximation Devices: A Propensity Score-Matched Multicenter Comparison. JACC Cardiovasc Interv 2022; 15:2541-2551. [PMID: 36543448 DOI: 10.1016/j.jcin.2022.10.008] [Citation(s) in RCA: 10] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/12/2022] [Accepted: 10/04/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND In addition to the edge-to-edge MitraClip repair system, the edge-to-spacer PASCAL repair system was approved for percutaneous treatment of severe mitral regurgitation (MR). Comparative data are lacking. OBJECTIVES The aim of this study was to compare procedural and short-term safety and efficacy of 2 leaflet-based transcatheter mitral valve repair systems. METHODS Procedural and 30-day outcomes were investigated in a propensity score-matched cohort of 307 PASCAL and 307 MitraClip patients at 10 sites. Matching criteria included sex, age, left ventricular ejection fraction, New York Heart Association functional class, MR etiology, left ventricular end-diastolic diameter, left atrial volume index, and vena contracta width. The primary efficacy endpoints were technical success and degree of residual MR at discharge. The primary safety endpoint was the rate of major adverse events (MAE). RESULTS Technical success was 97.0% in the PASCAL group and 98.0% in the MitraClip group (P = 0.624). MR ≤2+ at discharge was comparable in both groups (PASCAL: 93.8% vs MitraClip: 92.4%; P = 0.527), with more patients exhibiting MR ≤1+ in the PASCAL group (70.5% vs 56.6%; P < 0.001). The postprocedural mean gradient was significantly higher in the MitraClip group (3.3 ± 1.5 mm Hg vs 3.9 ± 1.7 mm Hg; P < 0.001). At 30 days, all-cause mortality and MAE rates were similar (mortality: 1.7% vs 3.3%; P = 0.299; MAE: 3.9% vs 5.2%; P = 0.562). CONCLUSIONS In this first large propensity score-matched comparison, procedural success rates and MAE did not differ significantly between patients treated with the PASCAL or MitraClip valve repair system. Procedural results with less than moderate MR and no elevated transmitral gradient were more common in the PASCAL group, which might have an impact on long-term outcome.
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Affiliation(s)
- Victor Mauri
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Max Spieker
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Christos Iliadis
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Patrick Horn
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Can Öztürk
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Christian Besler
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Matthias Riebisch
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Essen, Germany
| | - Osamah Al-Hammadi
- Medizinische Klinik I, Department of Cardiology, University of Giessen, Giessen, Germany
| | - Tobias Ruf
- Heart Valve Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Muhammed Gerçek
- General and Interventional Cardiology, Heart and Diabetes Centre NRW Bad Oeynhausen, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Christina Grothusen
- Medical Clinic I, Department of Cardiology, St-Johannes-Hospital, Dortmund, Germany; Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Michael Mehr
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Christoph Mues
- Medical Clinic I, Department of Cardiology, St-Johannes-Hospital, Dortmund, Germany
| | - Niklas Boeder
- Medizinische Klinik I, Department of Cardiology, University of Giessen, Giessen, Germany
| | - Felix Kreidel
- Heart Valve Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Kai Friedrichs
- General and Interventional Cardiology, Heart and Diabetes Centre NRW Bad Oeynhausen, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Essen, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Helge Möllmann
- Medical Clinic I, Department of Cardiology, St-Johannes-Hospital, Dortmund, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Volker Rudolph
- General and Interventional Cardiology, Heart and Diabetes Centre NRW Bad Oeynhausen, Ruhr University Bochum, Bad Oeynhausen, Germany
| | | | - Holger M Nef
- Medizinische Klinik I, Department of Cardiology, University of Giessen, Giessen, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Essen, Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Roman Pfister
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Cologne, Germany.
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20
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Wienemann H, Hof A, Ludwig S, Veulemans V, Sedaghat A, Iliadis C, Meertens M, Macherey S, Hohmann C, Kuhn E, Al-Kassou B, Wilde N, Schofer N, Bleiziffer S, Maier O, Kelm M, Baldus S, Rudolph TK, Adam M, Mauri V. Transcatheter aortic valve implantation with different self-expanding devices-a propensity score-matched multicenter comparison. Hellenic J Cardiol 2022; 70:1-9. [PMID: 36538975 DOI: 10.1016/j.hjc.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Several supra-annular self-expanding transcatheter systems are commercially available for transcatheter aortic valve implantation (TAVI). Comparative data in large-scale multicenter studies are scant. METHODS This study included a total of 5175 patients with severe aortic stenosis undergoing TAVI with the ACURATE neo (n = 1095), Evolut R (n = 3365), or Evolut PRO (n = 715) by a transfemoral approach at five high-volume centers. Propensity score matching resulted in 654 triplets. Outcomes are reported according to the Valve Academic Research Consortium-3 (VARC-3) consensus. RESULTS Moderate or severe paravalvular regurgitation (PVR) occurred significantly more often in the ACURATE neo group (5.2%) than in the Evolut R (1.8%) and Evolut PRO (3.3%) groups (p = 0.003). The rates of major vascular-/access-related complications (4.6%, 3.8%, and 5.0%; p = 0.56), type 3 or 4 bleeding (3.2%, 2.1%, and 4.1%; p = 0.12), and 30-day mortality (2.4%, 2.6%, and 3.7%; p = 0.40) were comparable. The rate of new permanent pacemaker implantation (PPI) was significantly lower in the ACURATE neo group (9.5%, 17.6%, and 16.8%; p < 0.001). Independent predictors for 2-year survival were a Society of Thoracic Surgeons (STS) risk score ≥5%, diabetes mellitus, a glomerular filtration rate <30 ml/min, baseline mean transvalvular gradient ≤ 30 mm Hg, treating center, and relevant PVR. CONCLUSION In this multicenter study, TAVI with the ACURATE neo, Evolut R, or Evolut PRO was feasible and safe. The rate of relevant PVR was more frequent after the ACURATE neo implantation, with, however, lower rates of PPI. Two-year survival was mainly driven by baseline comorbidities.
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Affiliation(s)
- Hendrik Wienemann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Alexander Hof
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Sebastian Ludwig
- University Hamburg, University Heart and Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - Verena Veulemans
- Heinrich-Heine University, University Hospital Düsseldorf, Department of Cardiology, Pneumology, and Vascular Medicine, Düsseldorf, Germany
| | - Alexander Sedaghat
- University of Bonn, University Hospital Bonn, Clinic II for Internal Medicine, Bonn, Germany
| | - Christos Iliadis
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Max Meertens
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Sascha Macherey
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Christopher Hohmann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Elmar Kuhn
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Cardiothoracic Surgery, Cologne, Germany
| | - Baravan Al-Kassou
- University of Bonn, University Hospital Bonn, Clinic II for Internal Medicine, Bonn, Germany
| | - Nihal Wilde
- University of Bonn, University Hospital Bonn, Clinic II for Internal Medicine, Bonn, Germany
| | - Niklas Schofer
- University Hamburg, University Heart and Vascular Center Hamburg, Department of Cardiology, Hamburg, Germany
| | - Sabine Bleiziffer
- Ruhr University Bochum, Heart and Diabetes Centre North Rhine Westphalia, Clinic for Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Germany
| | - Oliver Maier
- Heinrich-Heine University, University Hospital Düsseldorf, Department of Cardiology, Pneumology, and Vascular Medicine, Düsseldorf, Germany
| | - Malte Kelm
- Heinrich-Heine University, University Hospital Düsseldorf, Department of Cardiology, Pneumology, and Vascular Medicine, Düsseldorf, Germany
| | - Stephan Baldus
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Tanja Katharina Rudolph
- Ruhr University Bochum, Heart and Diabetes Center North Rhine Westphalia, Clinic for General and Interventional Cardiology, Bad Oeynhausen, Germany
| | - Matti Adam
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany
| | - Victor Mauri
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany.
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21
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Stolz L, Weckbach LT, Karam N, Kalbacher D, Praz F, Lurz P, Omran H, Iliadis C, Hausleiter J, Näbauer M, Stocker TJ, Doldi PM, Ludwig S, Koell B, Kassar M, Besler C, Unterhuber M, Rommel KP, Pfister R, Eatemadi J, Rudolph V. Invasive Right Ventricular to Pulmonary Artery Coupling in Patients Undergoing Transcatheter Edge-to-Edge Tricuspid Valve Repair. JACC Cardiovasc Imaging 2022; 16:564-566. [PMID: 36526578 DOI: 10.1016/j.jcmg.2022.10.004] [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: 08/31/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 12/15/2022]
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22
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Sugiura A, Kavsur R, Spieker M, Iliadis C, Mauri V, Tanaka T, Goto T, Weber M, Kelm M, Baldus S, Nickenig G, Westenfeld R, Pfister R, Becher MU. Impact of right ventricular-pulmonary arterial coupling on clinical outcomes of tricuspid regurgitation. EUROINTERVENTION 2022; 18:852-861. [PMID: 35550286 PMCID: PMC9724878 DOI: 10.4244/eij-d-22-00045] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/25/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND In terms of pathophysiology, tricuspid regurgitation (TR) and right ventricular (RV) function are linked to each other. AIMS This study sought to evaluate RV-pulmonary artery (PA) coupling and its impact on clinical outcomes of TR in patients undergoing mitral transcatheter edge-to-edge repair (TEER). METHODS We calculated RV-PA coupling ratios in patients undergoing mitral TEER from August 2010 to March 2019 by dividing the tricuspid annular plane systolic excursion (TAPSE) by the echocardiographic estimated PA systolic pressure (PASP). TR was graded as none/trace, mild, moderate, or severe. The primary outcome was all-cause mortality or rehospitalisation within 12 months. RESULTS Among 744 patients analysed, severe TR was documented in 22.3% of patients and the mean TAPSE/PASP was 0.43±0.25. Technical success of TEER was achieved in 97.2% of participants. Severe TR vs TR ≤moderate (adjusted HR 1.92, 95% CI: 1.39-2.66) and TAPSE/PASP (adjusted HR 0.45, 95% CI: 0.22-0.93) were associated with the outcome. Patients were divided according to the TAPSE/PASP tertile. Compared to patients with TR ≤moderate, patients with severe TR had a higher event rate (TAPSE/PASP <0.30: 32.9% vs 45.1%; 0.30≤ TAPSE/PASP <0.44: 27.8% vs 41.8%; TAPSE/PASP ≥0.44: 16.0% vs 40.4%), whereas the prognostic significance of TR was attenuated in patients with reduced TAPSE/PASP (i.e., RV-PA uncoupling; interaction term p=0.03). The trends were consistent in the multivariable regression models, spline curves, and sensitivity analysis using post-interventional parameters. CONCLUSIONS RV-PA coupling affects the outcome correlation of TR in patients undergoing mitral TEER. The prognostic impact of TR is attenuated in patients with RV-PA uncoupling.
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Affiliation(s)
- Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Refik Kavsur
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Maximilian Spieker
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christos Iliadis
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Victor Mauri
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Tetsu Tanaka
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Marcel Weber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Malte Kelm
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Stephan Baldus
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Ralf Westenfeld
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Roman Pfister
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
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23
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Doldi P, Stolz L, Orban M, Karam N, Praz F, Kalbacher D, Lubos E, Braun D, Adamo M, Giannini C, Melica B, Näbauer M, Higuchi S, Wild M, Neuss M, Butter C, Kassar M, Petrescu A, Pfister R, Iliadis C, Unterhuber M, Thiele H, Baldus S, von Bardeleben RS, Schofer N, Hagl C, Petronio AS, Massberg S, Windecker S, Lurz P, Metra M, Hausleiter J. Transcatheter Mitral Valve Repair in Patients With Atrial Functional Mitral Regurgitation. JACC Cardiovasc Imaging 2022; 15:1843-1851. [PMID: 35842361 DOI: 10.1016/j.jcmg.2022.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 12/27/2021] [Revised: 05/02/2022] [Accepted: 05/19/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Among patients with severe functional mitral regurgitation (FMR), atrial functional mitral regurgitation (aFMR) represents an underrecognized entity. Data regarding outcomes after mitral valve transcatheter edge-to-edge repair (M-TEER) in aFMR remain scarce. OBJECTIVES The objective of this study was to analyze the outcome of aFMR patients undergoing M-TEER. METHODS Using patients from the international EuroSMR (European Registry of Transcatheter Repair for Secondary Mitral Regurgitation) registry undergoing M-TEER for FMR, the authors analyzed baseline characteristics and 2-year outcomes in aFMR in comparison to non-aFMR and ventricular FMR. Additionally, the impact of right ventricular dysfunction (RVD) (defined as right ventricular to pulmonary artery uncoupling) on outcome after M-TEER was assessed. RESULTS Among 1,608 FMR patients treated by M-TEER, 126 (7.8%) were categorized as aFMR. All 126 aFMR patients had preserved left ventricular function without regional wall motion abnormalities, left arterial dilatation and Carpentier leaflet motion type I. Procedural success (defined as mitral regurgitation ≤2+ at discharge) was 87.2% (P < 0.001) and New York Heart Association (NYHA) functional class significantly improved during follow-up (NYHA functional class III/IV: 86.5% at baseline to 36.6% at follow-up; P < 0.001). The estimated 2-year survival rate in aFMR patients was 70.4%. Two-year survival did not differ significantly between aFMR, non-aFMR, and ventricular FMR. Besides NYHA functional class IV, RVD was identified as a strong independent predictor for 2-year survival (HR: 2.82 [95% CI: 1.24-6.45]; P = 0.014). CONCLUSIONS aFMR is a frequent cause of FMR and can be effectively treated with M-TEER to improve symptoms at follow-up. Advanced heart failure symptoms and RVD were identified as important risk factors for survival in aFMR patients.
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Affiliation(s)
- Philipp Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Nicole Karam
- Paris University, PARCC, INSERM, F-75015, European Hospital Georges Pompidou, Paris, France
| | - Fabien Praz
- Universitätsklinik für Kardiologie, Bern University Hospital, Inselspital Bern, Switzerland
| | - Daniel Kalbacher
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany
| | - Edith Lubos
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Cristina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Bruno Melica
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia e Espinho, Portugal
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Satoshi Higuchi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Mirjam Wild
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Michael Neuss
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Christian Butter
- Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany
| | - Mohammad Kassar
- Universitätsklinik für Kardiologie, Bern University Hospital, Inselspital Bern, Switzerland
| | - Aniela Petrescu
- Zentrum für Kardiologie, Johannes Gutenberg-Universität, Mainz, Germany
| | - Roman Pfister
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Christos Iliadis
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Matthias Unterhuber
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Stephan Baldus
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | | | - Niklas Schofer
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Germany
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Stephan Windecker
- Universitätsklinik für Kardiologie, Bern University Hospital, Inselspital Bern, Switzerland
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany.
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24
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Doldi PM, Stolz L, Kalbacher D, Köll B, Geyer M, Ludwig S, Orban M, Braun D, Weckbach LT, Stocker TJ, Näbauer M, Higuchi S, Ruf T, Da Rocha E Silva J, Wild M, Tence N, Unterhuber M, Schofer N, Petrescu A, Thiele H, Lurz P, Lubos E, von Bardeleben S, Karam N, Samim D, Paradis JM, Iliadis C, Xhepa E, Hagl C, Massberg S, Hausleiter J. Right ventricular dysfunction predicts outcome after transcatheter mitral valve repair for primary mitral valve regurgitation. Eur J Heart Fail 2022; 24:2162-2171. [PMID: 36054557 DOI: 10.1002/ejhf.2661] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 07/18/2022] [Revised: 08/09/2022] [Accepted: 08/20/2022] [Indexed: 01/18/2023] Open
Abstract
AIMS Right ventricular dysfunction (RVD), as expressed by right ventricular to pulmonary artery coupling, has recently been identified as a strong outcome predictor in patients undergoing mitral valve edge-to-edge repair (M-TEER) for secondary mitral regurgitation (MR). The aim of this study was to define RVD in patients undergoing M-TEER for primary MR (PMR) and to evaluate its impact on procedural MR reduction, symptomatic development and 2-year all-cause mortality. METHODS AND RESULTS This multicentre study included patients undergoing M-TEER for symptomatic PMR at nine international centres. The study cohort was divided into a derivation (DC) and validation cohort (VC) for calculation and validation of the best discriminatory value for RVD. A total of 648 PMR patients were included in the study. DC and VC were comparable regarding procedural success and outcomes at follow-up. Sensitivity analysis identified RVD as an independent predictor for 2-year mortality in the DC (hazard ratio [HR] 2.37, 95% confidence interval [CI] 1.47-3.81, p < 0.001), which was confirmed in the VC (HR 2.06, 95% CI 1.36-3.13, p < 0.001). Procedural success (MR ≤2+) and symptomatic improvement at follow-up (New York Heart Association [NYHA] class ≤II) were lower in PMR patients with RVD (MR ≤2+: 82% vs. 93%, p = 0.002; NYHA class ≤II: 57.3% vs. 66.5%, p = 0.09 for with vs. without RVD). In all PMR patients, the presence of RVD significantly impaired 2-year survival after M-TEER (HR 2.23, 95% CI 1.63-3.05, p < 0.001). CONCLUSIONS Mitral valve edge-to-edge repair is an effective treatment option for PMR patients. The presence of RVD is associated with less MR reduction, less symptomatic improvement and increased 2-year mortality. Accordingly, RVD might be included into pre-procedural prognostic considerations.
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Affiliation(s)
- Philipp M Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Daniel Kalbacher
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany
| | - Benedikt Köll
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany
| | - Martin Geyer
- Zentrum für Kardiologie, Johannes Gutenberg-Universität, Mainz, Germany
| | - Sebastian Ludwig
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Ludwig T Weckbach
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Thomas J Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Satoshi Higuchi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Tobias Ruf
- Zentrum für Kardiologie, Johannes Gutenberg-Universität, Mainz, Germany
| | | | - Mirjam Wild
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Noemie Tence
- Paris University, PARCC, INSERM, F-75015, European Hospital Georges Pompidou, Paris, France
| | - Matthias Unterhuber
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Niklas Schofer
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany
| | - Aniela Petrescu
- Zentrum für Kardiologie, Johannes Gutenberg-Universität, Mainz, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Edith Lubos
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Nicole Karam
- Paris University, PARCC, INSERM, F-75015, European Hospital Georges Pompidou, Paris, France
| | - Daryoush Samim
- Universitätsklinik für Kardiologie, Bern University Hospital, Inselspital Bern, Switzerland
| | - Jean-Michel Paradis
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Christos Iliadis
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Erion Xhepa
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Christian Hagl
- Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany.,Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
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25
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Higuchi S, Orban M, Adamo M, Giannini C, Melica B, Karam N, Praz F, Kalbacher D, Koell B, Stolz L, Braun D, Näbauer M, Wild M, Doldi P, Neuss M, Butter C, Kassar M, Ruf T, Petrescu A, Ludwig S, Pfister R, Iliadis C, Unterhuber M, Sampaio F, Ferreira D, Thiele H, Baldus S, von Bardeleben RS, Massberg S, Windecker S, Lurz P, Petronio AS, Lindenfeld J, Abraham WT, Metra M, Hausleiter J. Guideline-directed medical therapy in patients undergoing transcatheter edge-to-edge repair for secondary mitral regurgitation. Eur J Heart Fail 2022; 24:2152-2161. [PMID: 35791663 DOI: 10.1002/ejhf.2613] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 04/25/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 01/18/2023] Open
Abstract
AIMS Guideline-directed medical therapy (GDMT), based on the combination of beta-blockers (BB), renin-angiotensin system inhibitors (RASI), and mineralocorticoid receptor antagonists (MRA), is known to have a major impact on the outcome of patients with heart failure with reduced ejection fraction (HFrEF). Although GDMT is recommended prior to mitral valve transcatheter edge-to-edge repair (M-TEER), not all patients tolerate it. We studied the association of GDMT prescription with survival in HFrEF patients undergoing M-TEER for secondary mitral regurgitation (SMR). METHODS AND RESULTS EuroSMR, a European multicentre registry, included SMR patients with left ventricular ejection fraction <50%. The outcome was 2-year all-cause mortality. Of 1344 patients, BB, RASI, and MRA were prescribed in 1169 (87%), 1012 (75%), and 765 (57%) patients at the time of M-TEER, respectively. Triple GDMT prescription was associated with a lower 2-year all-cause mortality compared to non-triple GDMT (hazard ratio [HR] 0.74; 95% confidence interval [CI] 0.60-0.91). The association persisted in patients with glomerular filtration rate <30 ml/min, ischaemic aetiology, or right ventricular dysfunction. Further, a positive impact of triple GDMT prescription on survival was observed in patients with residual mitral regurgitation of ≥2+ (HR 0.62; 95% CI 0.44-0.86), but not in patients with residual mitral regurgitation of ≤1+ (HR 0.83; 95% CI 0.64-1.08). CONCLUSION Triple GDMT prescription is associated with higher 2-year survival after M-TEER in HFrEF patients with SMR. This association was consistent also in patients with major comorbidities or non-optimal results after M-TEER.
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Affiliation(s)
- Satoshi Higuchi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Cristina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Bruno Melica
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Nicole Karam
- Paris University, PARCC, INSERM, F-75015, European Hospital Georges Pompidou, Paris, France
| | - Fabien Praz
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Daniel Kalbacher
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Benedikt Koell
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Mirjam Wild
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Philipp Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Michael Neuss
- Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany
| | - Christian Butter
- Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany
| | - Mohammad Kassar
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Tobias Ruf
- Zentrum für Kardiologie, Johannes Gutenberg-Universität, Mainz, Germany
| | - Aniela Petrescu
- Zentrum für Kardiologie, Johannes Gutenberg-Universität, Mainz, Germany
| | - Sebastian Ludwig
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany
| | - Roman Pfister
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Christos Iliadis
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Matthias Unterhuber
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Francisco Sampaio
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Diogo Ferreira
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Stephan Baldus
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | | | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Stephan Windecker
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - JoAnn Lindenfeld
- Department of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
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Lauder L, Bergmann M, Paitazoglou C, Ozdemir R, Iliadis C, Bartunek J, Lauten A, Keller T, Weber S, Sievert H, Anker SD, Mahfoud F. Impact of atrial flow regulator implantation on survival in patients with heart failure with reduced and preserved ejection fraction: a post-hoc analysis of the PRELIEVE study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.944] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Purpose
This analysis aims to assess the theoretical impact of atrial flow regulator implantation on mortality by comparing the observed survival rate with the median predicted probability for one-year survival.
Methods
The prospective, multicentre, open-label, non-randomised PRELIEVE study assessed the safety and efficacy of the atrial flow regulator in patients with symptomatic HFrEF (left ventricular ejection fraction (LVEF) ≥15% and <40%) or HFpEF (LVEF ≥40% and <70%) and elevated PCWP (≥15mmHg at rest or ≥25mmHg during exercise). In this analysis, after the first 60 patients completed twelve months of follow-up, the theoretical impact of atrial flow regulator implantation on survival was assessed by comparing the observed mortality rate with the median predicted probability for one-year mortality. Each subject's risk of mortality was predicted from individual baseline data using the Meta-Analysis Global Group in Chronic HF (MAGGIC) prognostic model.
Results
A total of 87 patients had undergone successful device implantation for the treatment of HFrEF (53%) and HFpEF (47%). Sixty patients had a complete twelve-month follow-up. The median follow-up was 351 days (interquartile range [IQR] 202–370). A total of six (7%) patients died during follow-up (8.6 deaths per 100 patient-years; 95% confidence interval [CI] 2.7 to 15.5), all of which had HFrEF. The median predicted mortality rate for the overall study population was 12.2 deaths per 100 patient-years (95% CI 10.2 to 14.7). While the observed mortality rate (0 deaths per 100 patient-years) was significantly lower than the median predicted mortality rate (9.3 deaths per 100 patient-years; 95% CI 8.4 to 11.1) in patients with HFpEF (−9.3 deaths per 100 patient-years; 95% CI −11.1 to −8.4), there was no difference in patients with HFrEF (−3.6 deaths per 100 patient-years; 95% CI −9.5 to 3.0) (Figure 1). Four deaths were HF-related deaths (5.7 HF-related deaths per 100 patient-years; 95% CI 1.4 to 11.9; 10.8 HF-related deaths per 100 patient-years; 95% CI 2.5 to 23.1 in the HFrEF subgroup).
Conclusion
In patients with HFpEF, the mortality rate following atrial flow regulator implantation was lower than the predicted mortality rate. These findings need to be confirmed by larger randomised, controlled trials.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Occlutech International AB
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Affiliation(s)
- L Lauder
- University hospital of Saarland (UKS) , Homburg , Germany
| | - M Bergmann
- Cardiologicum Hamburg , Hamburg , Germany
| | - C Paitazoglou
- Schleswig-Holstein University Clinic, Lubeck Campus, University Heart Center Lübeck , Luebeck , Germany
| | - R Ozdemir
- Bezmialem University, Department of Cardiology , Istanbul , Turkey
| | - C Iliadis
- Heart Center at the University of Cologne, Department of Cardiology, Pulmonology, Angiology and Intensive Care Medicine , Cologne , Germany
| | - J Bartunek
- Olv Hospital Aalst, Cardiovascular Center , Aalst , Belgium
| | - A Lauten
- HELIOS Clinic Erfurt, Department of General and Interventional Cardiology , Erfurt , Germany
| | - T Keller
- ACOMED statistik , Leipzig , Germany
| | - S Weber
- ACOMED statistik , Leipzig , Germany
| | - H Sievert
- CardioVascular Center Frankfurt , Frankfurt , Germany
| | - S D Anker
- Berlin Institute of Health Center for Regenerative Therapies , Berlin , Germany
| | - F Mahfoud
- University hospital of Saarland (UKS) , Homburg , Germany
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Iliadis C, Weber M, Horn P, Harr C, Gavazzoni M, Nickenig G, Westenfeld R, Alessandrini H, Taramasso M, Baldus S, Pfister R. Echocardiography and computed tomography predictors of successful transcatheter direct annuloplasty for mitral regurgitation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1640] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Secondary mitral regurgitation (SMR) is associated with adverse outcomes and the optimal treatment modality remains challenging due to extensive variety in the pathology of SMR. Percutaneous direct annuloplasty using the Cardioband system emerged as a promising treatment in selected patients. However, success predictors of this intervention and their association with prognosis remain unclear.
Purpose
To investigate the role of echocardiographic and computed tomography (CT) data in patients with SMR undergoing percutaneous direct annuloplasty.
Methods
We retrospectively analyzed patients who underwent catheter-based direct annuloplasty with the Cardioband system for SMR at five tertiary centres in Germany and Switzerland between 2013 and 2020. Patients with procedural success (defined as postprocedural MR grade ≤2+) were compared to those with MR >2+ with respect to baseline echocardiographic data and outcome.
Results
We included 130 patients (median age 75.5 [71–79], 37% female). Most patients were severely symptomatic (NYHA class III/IV 86.9%), had a median EF of 39 (29–52) with an ischaemic etiology in 39%. Procedural success was achieved in 68%. Procedural time was 178.5 (147.5–214.5) minutes. Patients with and without procedural success differed significantly in measures of MR severity (defined as postprocedural SMR severity (grade, vena contracta (VC), effective regurgitation orifice area and regurgitation volume), annular dilatation (leaflet length, LA sphericity index at end-systole and CT-derived intercommissural distance) and leaflet tethering (tenting area, regurgitation jet direction). In multivariable analysis of echocardiographic parameters including significant measures of annular dilatation and leaflet tethering, predictors of procedural treatment success were tenting area (OR 0.54; 95% CI 0.33–0.98 per mm2, p=0.016) and central regurgitation jet direction (OR 2.96; 95% CI 1.06–8.25, p=0.038). After adding CT data in the multivariable model, intercommissural distance proved to be the most significant predictor (OR 0.96; 0.92–0.99, p=0.009), whereas VC was the only echo predictor (OR 0.84; 0.73–0.98, p=0.03).
NYHA class III/IV at last follow up was significantly different between groups, with 34.1% vs. 55.2% of patients with vs. without procedural success, respectively (p=0.04). The combined endpoint of mortality or reintervention at 1 year was significantly lower in patients with procedural success (27% vs. 63%, p=0.002), whereas the association of procedural success with 1-year mortality was of borderline significance (13% vs. 32%, p=0.05).
Conclusion
Two thirds of patients undergoing transcatheter direct annuloplasty for SMR had procedural success. Careful patient selection by assessment of mitral valve anatomy is helpful to predict procedural success, which translates into less symptom burden and better clinical outcome.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Iliadis
- Cologne University Hospital - Heart Center, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne Germany , Cologne , Germany
| | - M Weber
- University Hospital Bonn, Heart Centre, Department of Medicine II, University Hospital Bonn , Bonn , Germany
| | - P Horn
- University Hospital Duesseldorf, Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty , Duesseldorf , Germany
| | - C Harr
- Asklepios St. Georg Clinic, Department of Cardiology , Hamburg , Germany
| | - M Gavazzoni
- Italian Auxological Institute San Luca Hospital, Istituto Auxologico Italiano , Milan , Italy
| | - G Nickenig
- University Hospital Bonn, Heart Centre, Department of Medicine II, University Hospital Bonn , Bonn , Germany
| | - R Westenfeld
- University Hospital Duesseldorf, Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty , Duesseldorf , Germany
| | - H Alessandrini
- Asklepios St. Georg Clinic, Department of Cardiology , Hamburg , Germany
| | - M Taramasso
- Hirslanden Heart Center, Herzzentrum Hirslanden , Zurich , Switzerland
| | - S Baldus
- Cologne University Hospital - Heart Center, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne Germany , Cologne , Germany
| | - R Pfister
- Cologne University Hospital - Heart Center, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne Germany , Cologne , Germany
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Metze C, Kavsur R, Sugiura A, Tanaka T, Becher U, Nickenig G, Baldus S, Koerber MI, Pfister R, Iliadis C. Validation of expert criteria proposed by the “German Cardiac Society” for predicting procedural complexity in transcatheter edge-to-edge mitral valve repair. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2123] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Following up on the original EVEREST criteria and several years of procedural experience, the German Cardiac Society (GCS) proposed refined criteria indicating morphological complexity in transcatheter edge-to-edge mitral valve repair (TEER) procedures which so far have not been validated.
Methods
In a retrospective analysis of transesophageal echocardiography images of consecutive patients undergoing TEER in two high-volume centres, complexity was classified according to GCS criteria as optimal (neither characteristics of “complex” nor “very complex', see Table 1), complex (any of the “complex” criteria but no “very complex” criteria) and very complex (any of the “very complex” criteria). Associations with the procedural outcome, reintervention, survival, and heart failure rehospitalization were tested.
Results
633 patients (mean age 79 years, range 50 to 96 years, 59% male) were included, with 35% having dominant primary and 65% having dominant secondary mitral regurgitation (MR). 19% of patients were classified as having optimal, 40% as complex, and 41% as very complex morphologies. Successful clip implantation and reduction in MR ≤2 at discharge were achieved in 100% and 97% in the optimal, in 96% and 88% in the complex, and in 95% and 88% in the very complex morphologies, respectively (p for difference 0.13 and 0.42). The rate of successful clip deployment was significantly lower and the rate of reintervention significantly higher in patients with a mitral valve orifice area ≤3 cm2, compared to patients with a mitral valve orifice area >3 cm2. Pathology extent of MR likely requiring >2 clips was significantly associated with a lower rate of MR reduction to grade ≤2. Midterm (median follow-up time 640 days) mortality or hospitalization due to heart failure was significantly higher in patients with a posterior mitral leaflet length of 7–10 mm.
Conclusion
In the setting of experienced heart valve centres only a few of the complexity criteria proposed by the GCS impact on procedural and clinical outcomes. Even in the case of complex or very complex mitral valve morphology, TEER can be performed effectively with reduction of MR to ≤2 in 88% of cases.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Metze
- Cologne University Hospital - Heart Center , Cologne , Germany
| | - R Kavsur
- Heartcenter Bonn, University Hospital Bonn , Bonn , Germany
| | - A Sugiura
- Heartcenter Bonn, University Hospital Bonn , Bonn , Germany
| | - T Tanaka
- Heartcenter Bonn, University Hospital Bonn , Bonn , Germany
| | - U Becher
- Municipal Clinic Solingen non-profit GmbH , Solingen , Germany
| | - G Nickenig
- Heartcenter Bonn, University Hospital Bonn , Bonn , Germany
| | - S Baldus
- Cologne University Hospital - Heart Center , Cologne , Germany
| | - M I Koerber
- Cologne University Hospital - Heart Center , Cologne , Germany
| | - R Pfister
- Cologne University Hospital - Heart Center , Cologne , Germany
| | - C Iliadis
- Cologne University Hospital - Heart Center , Cologne , Germany
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Iliadis C, Kavsur R, Spieker M, Zachoval C, Becher MU, Westenfeld R, Pfister R. Therapie der sekundären Mitralklappeninsuffizienz – Strategien eines interuniversitären Verbundes. Aktuelle Kardiologie 2022. [DOI: 10.1055/a-1912-4962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ZusammenfassungDie sekundäre Mitralinsuffizienz ist bei Patienten mit Herzinsuffizienz häufig und mit einem schlechten Verlauf assoziiert. Aufgrund des hohen OP-Risikos war die Therapie traditionell auf
eine Behandlung der Herzinsuffizienz beschränkt. Die Entwicklung von kathetergestützten Techniken ermöglicht nun die Behandlung mit geringem Risiko. Wenngleich die Studienevidenz immer noch
begrenzt ist, erfolgte in den aktuellen Leitlinien der europäischen Fachgesellschaften eine Aufwertung der kathetergestützten Therapie für ausgewählte Patienten mit hohem OP-Risiko und hoher
Wahrscheinlichkeit für ein Therapieansprechen. Dennoch bleiben viele Fragen offen, was die Rolle der chirurgischen Behandlung und auch die Patientenselektion für kathetergestützte
Therapieverfahren angeht. Hier beschreiben wir den aktuellen Stand der Behandlung der sekundären Mitralinsuffizienz und zeigen Strategien von transuniversitären Verbundprojekten mit dem
Ziel, Evidenz für die Behandlung dieser Patienten zu entwickeln.
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Affiliation(s)
- Christos Iliadis
- Klinik für Kardiologie, Angiologie, Pneumologie und internistische Intensivmedizin, Universitätsklinik Köln, Köln, Deutschland
| | - Refik Kavsur
- Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Universitätsklinik Bonn, Bonn, Deutschland
| | - Maximilian Spieker
- Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Christian Zachoval
- Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Universitätsklinik Bonn, Bonn, Deutschland
| | - Marc Ulrich Becher
- Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Universitätsklinik Bonn, Bonn, Deutschland
| | - Ralf Westenfeld
- Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Roman Pfister
- Klinik für Kardiologie, Angiologie, Pneumologie und internistische Intensivmedizin, Universitätsklinik Köln, Köln, Deutschland
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Omran H, Pfister R, Ehrenfels MA, Körber MI, Baldus S, Friedrichs K, Rudolph V, Iliadis C. Prognostic Performance of the Surgical TRI-SCORE Risk Score in Patients Undergoing Transcatheter Tricuspid Valve Treatment. JACC Cardiovasc Interv 2022; 15:1996-1998. [DOI: 10.1016/j.jcin.2022.05.031] [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: 05/15/2022] [Revised: 05/18/2022] [Accepted: 05/24/2022] [Indexed: 11/15/2022]
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Haurand JM, Kavsur R, Ochs L, Tanaka T, Iliadis C, Sugiura A, Kelm M, Nickenig G, Baldus S, Westenfeld R, Becher MU, Pfister R, Horn P. Deep sedation vs. general anesthesia for transcatheter tricuspid valve repair. Front Cardiovasc Med 2022; 9:976822. [PMID: 36119730 PMCID: PMC9471949 DOI: 10.3389/fcvm.2022.976822] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/10/2022] [Indexed: 12/01/2022] Open
Abstract
Background Transcatheter tricuspid valve repair (TTVr) is routinely performed under general anesthesia (GA). This study aimed to investigate whether TTVr procedures can be performed effectively and safely without GA but using deep sedation (DS). Methods We performed a retrospective analysis of 104 patients from three centers who underwent TTVr between 2020 and 2021. The primary performance endpoints were technical success and severity of TR assessed at the time of discharge. The safety outcome was a composite of in-hospital complications, including occurrence of death, conversion to surgery, major adverse cardiac and cerebrovascular events, major vascular complications, or occurrence of pneumonia. Results Sixty-four procedures were performed in GA and 40 procedures were performed in DS. The groups did not differ in age, EuroScore II, TR severity, ventricular function, or hemodynamic parameters. Technical success was achieved in 92.5% of the patients in the DS group and in 93.6% of the patients in the GA group (p = 0.805). In none of the patients intraprocedural conversion from DS to GA was required. There was no difference in total duration of the procedure, and number of devices implanted. The degree of TR was ≤2+ in 77.5% of the patients in the DS group and in 74.2% of the patients in the GA group (p = 0.705). The composite safety endpoint did not differ between the groups (2.5 vs. 6.3%, p = 0.384). The total duration of hospital stay was shorter in patients who underwent TTVr in DS compared to those who underwent TTVr in GA (6 [5, 9] days vs. 8 [6, 11] days; p = 0.011). Conclusion Performing TTVr in DS was effective with similar procedural results, and was safe with similar low complication rates compared to GA.
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Affiliation(s)
- Jean Marc Haurand
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Refik Kavsur
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Laurin Ochs
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, Heart Center of the University of Cologne, Cologne, Germany
| | - Tetsu Tanaka
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Christos Iliadis
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, Heart Center of the University of Cologne, Cologne, Germany
| | - Atsushi Sugiura
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Georg Nickenig
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Stephan Baldus
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, Heart Center of the University of Cologne, Cologne, Germany
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Marc Ulrich Becher
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Roman Pfister
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, Heart Center of the University of Cologne, Cologne, Germany
| | - Patrick Horn
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
- *Correspondence: Patrick Horn,
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Sialakis C, Antoniou Sialaki P, Frantzana A, Iliadis C, Ouzounakis P, Kourkouta L. House Dust Mite and Grass Pollen Allergen Extracts for Seasonal Allergic Rhinitis Treatment: A Systematic Review. Cureus 2022; 14:e27289. [PMID: 36039254 PMCID: PMC9407027 DOI: 10.7759/cureus.27289] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/05/2022] Open
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Tanaka T, Kavsur R, Spieker M, Iliadis C, Metze C, Brachtendorf BM, Horn P, Zachoval C, Sugiura A, Kelm M, Baldus S, Nickenig G, Westenfeld R, Pfister R, Becher MU. Guideline-directed medical therapy after transcatheter edge-to-edge mitral valve repair. Heart 2022; 108:1722-1728. [DOI: 10.1136/heartjnl-2022-320826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/27/2022] [Indexed: 11/04/2022]
Abstract
ObjectiveA sizeable proportion of patients with secondary mitral regurgitation (SMR) do not receive guideline-directed medical therapy (GDMT) for heart failure (HF). We investigated the association between the use of GDMT and mortality in patients with SMR who underwent transcatheter edge-to-edge repair (TEER).MethodsWe retrospectively analysed patients with SMR and a left ventricular ejection fraction of <50% who underwent TEER at three centres. According to current HF guidelines, GDMT was defined as triple therapy consisting of beta-blockers, renin–angiotensin system (RAS) inhibitors and mineralocorticoid receptor antagonists (MRAs). Patients were divided into two groups: GDMT and non-GDMT groups. We calculated the propensity scores and carried out inverse probability of treatment weighting (IPTW) analyses to compare 2-year mortality between the two groups.ResultsOf 463 patients, 228 (49.2%) were treated with GDMT upon discharge. IPTW-adjusted Kaplan-Meier curve showed patients with GDMT had a lower incidence of mortality than those without GDMT (19.8% vs 31.1%, p=0.011). In IPTW-adjusted Cox proportional hazards analysis, GDMT was associated with a reduced risk of 2-year mortality (HR: 0.58; 95% CI: 0.35 to 0.95; p=0.030), which was consistent among clinical subgroups. Moreover, patients with GDMT had a higher rate of left ventricular reverse remodelling at 1 year after TEER than those without GDMT.ConclusionGDMT, defined as triple therapy consisting of beta-blockers, RAS inhibitors and MRAs, was associated with a reduced risk of 2-year mortality after TEER for SMR. Optimisation of medical therapy is crucial to improve clinical outcomes in patients undergoing TEER for SMR.
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Iliadis C, Kalbacher D, Lurz P, Petrescu AM, Orban M, Puscas T, Lupi L, Stazzoni L, Pires-Morais G, Koell B, Besler C, Ruf TF, Stolz L, Tence N, Adamo M, Giannini C, Guerreiro C, Hellmich M, Baldus S, Schofer N, Thiele H, von Bardeleben RS, Hausleiter J, Karam N, Metra M, Petronio AS, Melica B, Pfister R. Left Atrial Volume Index and Outcome after Transcatheter Edge-to-edge Valve Repair for Secondary Mitral Regurgitation. Eur J Heart Fail 2022; 24:1282-1292. [PMID: 35642951 DOI: 10.1002/ejhf.2565] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/19/2022] [Accepted: 05/29/2022] [Indexed: 11/08/2022] Open
Abstract
AIMS To investigate the role of left atrial (LA) volume index in patients with secondary mitral regurgitation (SMR) undergoing transcatheter edge-to-edge mitral valve repair (TEER). METHODS Outcomes were evaluated in SMR patients of a European multicenter registry according to baseline left atrial volume index (LAVi). Main analysis was performed for all-cause mortality; residual MR and NYHA class improvement were analyzed for patients available. RESULTS 1,074 patients were included with a median LAVi (interquartile range) of 58 ml/m2 (46-73). Postprocedural reduction of MR grade to ≤2+ was similar across LAVi quintiles, ranging 91%-96% (p=0.26). Symptomatic benefit (≥1 NYHA class improvement) also did not differ by LAVi quintiles (61%-68% of patients) (p=0.66). The risk of mortality increased by 23% to 42% in the four upper quintiles compared to the bottom quintile (LAVi <42ml/m2 ). The hazard ratio of mortality was 1.35 (95%-CI 1.02-1.78, p=0.035) associated with a LAVi >42ml/m2 , which was attenuated after multivariable adjustment (1.18, 95%-CI 0.83-1.67, p=0.36). A significant interaction was found for MR severity and pulmonary hypertension, with an increased risk of death associated with enlarged LAVi in patients with inframedian effective regurgitation orifice area (EROA, HR 1.99, 95%-CI 1.06-3.74, p=0.032) and in patients with systolic pulmonary pressure ≤50 mmHg (HR 1.67, 95%-CI 1.02-2.75, p=0.042) in multivariable analysis. CONCLUSION Procedural success and symptomatic benefit were high throughout the whole range of LAVi. The prognostic impact of LA enlargement was relevant in patients with less severe SMR and without pulmonary hypertension, reinforcing the need to identify patients in the early course of backward congestion to achieve good long-term outcome after TEER.
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Affiliation(s)
- Christos Iliadis
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department III of Internal Medicine, Heart Center, Cologne, Germany
| | - Daniel Kalbacher
- Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, DZHK, Hamburg, Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Aniela Monica Petrescu
- Heart Valve Center Mainz, Center for Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg-Universität, Mainz, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Tania Puscas
- European Hospital Georges Pompidou (Department of Cardiology) and Paris Cardiovascular Research Center (INSERM U970), Paris, France
| | - Laura Lupi
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Laura Stazzoni
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | | | - Benedikt Koell
- Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, DZHK, Hamburg, Germany
| | - Christian Besler
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Tobias Friedrich Ruf
- Heart Valve Center Mainz, Center for Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg-Universität, Mainz, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Noemie Tence
- European Hospital Georges Pompidou (Department of Cardiology) and Paris Cardiovascular Research Center (INSERM U970), Paris, France
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Cristina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | | | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department III of Internal Medicine, Heart Center, Cologne, Germany
| | - Niklas Schofer
- Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Ralph Stephan von Bardeleben
- Heart Valve Center Mainz, Center for Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg-Universität, Mainz, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Nicole Karam
- European Hospital Georges Pompidou (Department of Cardiology) and Paris Cardiovascular Research Center (INSERM U970), Paris, France
| | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Bruno Melica
- Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
| | - Roman Pfister
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department III of Internal Medicine, Heart Center, Cologne, Germany
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Tichelbäcker T, Körber MI, Mauri V, Iliadis C, Metze C, Adler C, Baldus S, Rudolph V, Halbach M, Pfister R, Ten Freyhaus H. Prevalence of left ventricular thrombus formation after mitral valve edge-to-edge repair. Sci Rep 2022; 12:9096. [PMID: 35641530 PMCID: PMC9156712 DOI: 10.1038/s41598-022-12944-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/19/2022] [Indexed: 12/05/2022] Open
Abstract
The prevalence of left ventricular (LV) thrombus formation following percutaneous mitral valve edge-to-edge repair (TMVR) with the MitraClip system is unclear. Decreased total stroke volume and perfusion of the LV apex after mitral valve repair may facilitate thrombus formation especially in the context of reduced LV function. LV thrombus may cause disabling stroke or other thromboembolic events in this elderly and multimorbid patient cohort. Analyses of the prevalence of and risk factors for left ventricular thrombus formation in patients treated with the MitraClip system due to severe mitral valve regurgitation. All discharge and follow-up transthoracic echocardiographic examinations up to 6 months of 453 consecutive patients treated with the MitraClip system were screened for the presence of LV thrombus. Prevalence of LV thrombus formation was 1.1% (5/453). Importantly, LV thrombi were exclusively found in patients with severely depressed left ventricular systolic function (LV-EF < 30%), comprising a prevalence of 4.4% in this subgroup (5/113). Importantly, two of these patients were under active DOAC therapy with Rivaroxaban and Apixaban, respectively. Apart from LV-EF, we did not identify other factors that might have facilitated LV thrombus formation. LV thrombus formation following percutaneous mitral valve repair occurred exclusively in patients with severely depressed LV-EF. As two patients developed LV thrombus despite of DOAC therapy, anticoagulation with a Vitamin K antagonist should be considered in patients with an indication for oral anticoagulation following TMVR.
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Affiliation(s)
- Tobias Tichelbäcker
- Department of Cardiology, Heart Center of the University of Cologne, Kerpener Str. 62, 50939, Cologne, Germany
| | - Maria Isabel Körber
- Department of Cardiology, Heart Center of the University of Cologne, Kerpener Str. 62, 50939, Cologne, Germany
| | - Victor Mauri
- Department of Cardiology, Heart Center of the University of Cologne, Kerpener Str. 62, 50939, Cologne, Germany
| | - Christos Iliadis
- Department of Cardiology, Heart Center of the University of Cologne, Kerpener Str. 62, 50939, Cologne, Germany
| | - Clemens Metze
- Department of Cardiology, Heart Center of the University of Cologne, Kerpener Str. 62, 50939, Cologne, Germany
| | - Christoph Adler
- Department of Cardiology, Heart Center of the University of Cologne, Kerpener Str. 62, 50939, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center of the University of Cologne, Kerpener Str. 62, 50939, Cologne, Germany
| | - Volker Rudolph
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Marcel Halbach
- Department of Cardiology, Heart Center of the University of Cologne, Kerpener Str. 62, 50939, Cologne, Germany
| | - Roman Pfister
- Department of Cardiology, Heart Center of the University of Cologne, Kerpener Str. 62, 50939, Cologne, Germany
| | - Henrik Ten Freyhaus
- Department of Cardiology, Heart Center of the University of Cologne, Kerpener Str. 62, 50939, Cologne, Germany. .,Cologne Cardiovascular Research Center (CCRC), University of Cologne, Cologne, Germany.
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Shamekhi J, Sugiura A, Spieker M, Iliadis C, Weber M, Öztürk C, Becher MU, Tiyerili V, Zimmer S, Horn P, Westenfeld R, Pfister R, Mauri V, Sinning JM, Kelm M, Baldus S, Nickenig G. A staging classification of right heart remodelling for patients undergoing transcatheter edge-to-edge mitral valve repair. EUROINTERVENTION 2022; 18:43-49. [PMID: 34757918 PMCID: PMC9904371 DOI: 10.4244/eij-d-21-00667] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In patients with severe mitral regurgitation (MR) who are scheduled for transcatheter mitral valve repair (TMVR), risk stratification is predominantly based on surgical risk scores. AIMS We sought to characterise and define stages of right heart remodelling in patients undergoing TMVR and evaluate the impact of this staging classification on survival. METHODS According to echocardiographic parameters, 929 patients undergoing MitraClip treatment were classified into three stages: severe MR without right heart damage (stage 0), with moderate-to-severe tricuspid regurgitation (TR) (stage 1), with right ventricular dysfunction defined as a reduced fractional area change <35% and a tricuspid annular plane systolic excursion <17 mm, or with increased right atrial area >25 cm2 and/or indexed right ventricular volume >30 ml/m2 (stage 2). We compared clinical outcomes and performed a multivariate analysis to evaluate the predictive value of the extent of cardiac damage. RESULTS Rates of one-year all-cause mortality increased with more advanced stages of right heart remodelling (stage 0: 8% vs stage 1: 9.7% vs stage 2: 18.1%; p<0.001). In the multivariate analysis, advanced cardiac damage was an independent predictor of one-year all-cause mortality (stage 2: p=0.007). CONCLUSIONS A simple staging classification objectively characterises the extent of right heart remodelling caused by MR and allows risk prediction in patients undergoing a MitraClip procedure.
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Affiliation(s)
- Jasmin Shamekhi
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Atsushi Sugiura
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Maximilian Spieker
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christos Iliadis
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Marcel Weber
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Can Öztürk
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marc Ulrich Becher
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Vedat Tiyerili
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Patrick Horn
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Ralf Westenfeld
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Roman Pfister
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Victor Mauri
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Jan-Malte Sinning
- Department of Cardiology, St. Vinzenz-Hospital Cologne, Cologne, Germany
| | - Malte Kelm
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Stephan Baldus
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Georg Nickenig
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
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Sialakis C, Iliadis C, Frantzana A, Ouzounakis P, Kourkouta L. Intratympanic Versus Systemic Steroid Therapy for Idiopathic Sudden Hearing Loss: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e22887. [PMID: 35399426 PMCID: PMC8980198 DOI: 10.7759/cureus.22887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2022] [Indexed: 11/19/2022] Open
Abstract
Idiopathic sudden sensorineural hearing loss (ISSHL) is a common condition characterized by hearing threshold reduction, most often of unknown causes. The patient experiences a sudden reduction of the hearing threshold in one or both ears. Steroids are the mainstream of the treatment. This study aims to investigate the effectiveness of intratympanic steroid administration compared with systemic administration and the combination of the two steroid treatments in the hearing recovery of patients with idiopathic sudden sensorineural hearing loss. We searched electronic databases such as PubMed, ScienceDirect, CINAHL, Cochrane (Central), Ovid, and Medline from August 31, 2021, to November 31, 2021, and from February 5 to 10, 2022. We included 12 randomized controlled trials (RCTs) and performed a meta-analysis comparing the efficiency in the hearing recovery of intratympanic versus systemic steroid treatment, systemic versus combined, and intratympanic versus combined steroid treatment. The results of the intratympanic versus systemic steroid therapy comparison showed no actual difference in efficiency and no statistical significance (odds ratio: 1.07 (Mantel-Haenszel (M-H), fixed, 95% confidence interval (CI): 0.76-1.51)). Systemic steroid treatment was inferior to combined steroid treatment and was the only outcome with statistical significance (odds ratio: 0.55 (M-H, fixed, 95% CI: 0.38-0.80)). Intratympanic steroid treatment was inferior to combined steroid treatment, although the results were not statistically significant (odds ratio: 0.65 (M-H, fixed, 95% CI: 0.37-1.16)). In conclusion, systemic steroid therapy was inferior to combined steroid therapy. The comparison of intratympanic with systemic therapy and intratympanic with combined therapy showed no statistical significance. Further research is needed with more RCTs, and side effects should be considered.
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Sugiura A, Kavsur R, Spieker M, Iliadis C, Goto T, Öztürk C, Weber M, Tabata N, Zimmer S, Sinning JM, Mauri V, Horn P, Kelm M, Baldus S, Nickenig G, Westenfeld R, Pfister R, Becher MU. Recurrent Mitral Regurgitation After MitraClip: Predictive Factors, Morphology, and Clinical Implication. Circ Cardiovasc Interv 2022; 15:e010895. [PMID: 35193380 DOI: 10.1161/circinterventions.121.010895] [Citation(s) in RCA: 28] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recurrent mitral regurgitation (MR) following MitraClip has not been thoroughly investigated. We aimed to examine the predictive factors, morphology, and long-term outcome of recurrent MR after MitraClip. METHODS We assessed data from the Heart Failure Network Rhineland registry from August 2010 to October 2018. Competing risk analyses were performed using the Fine and Gray model to assess the risk of recurrent MR. RESULTS Among 685 MitraClip patients with a reduction in MR to ≤2+, 61 patients developed recurrent MR within the first 12 months. Flail leaflet (hazard ratio, 3.68; P=0.002) and residual MR (MR grade 2+ versus ≤1+: hazard ratio, 2.56; P=0.03) were the predictors of recurrent MR in primary MR patients, while left atrial volume (per 10 mL increase: hazard ratio, 1.11; P<0.001) and residual MR (hazard ratio, 2.45; P=0.01) were independently associated with recurrent MR in secondary MR patients. In primary MR patients, loss of leaflet insertion or leaflet tear were the predominant morphologies with recurrent MR. In secondary MR patients, more than half of the patients with recurrent MR did not show any disorder of the clip or leaflets. Patients with recurrent MR were more likely to experience unplanned heart failure hospitalization or heart failure symptom with New York Heart Association scale III/IV (54.1% versus 37.8%; P=0.018) and undergo a repeat mitral valve intervention (9.8% versus 2.2%; P=0.005) during the follow-up. In the landmark survival analysis, patients with recurrent MR tended to have lower long-term survival (58.7% versus 83.9%; P=0.08) than patients without recurrent MR. CONCLUSIONS Flail leaflet and residual MR were the predictors of recurrent MR in primary MR patients, while a larger left atrial volume and residual MR were associated with recurrent MR in secondary MR patients, which may be associated with long-term clinical outcomes of patients after MitraClip.
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Affiliation(s)
- Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.S., R.K., C.O., M.W., S.Z., G.N., M.U.B.)
| | - Refik Kavsur
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.S., R.K., C.O., M.W., S.Z., G.N., M.U.B.)
| | - Maximilian Spieker
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Germany (M.S., P.H., M.K., R.W.)
| | - Christos Iliadis
- Heart Center, Department of Cardiology, University Hospital Cologne, Germany (C.I., V.M., S.B., R.P.)
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Japan (T.G.)
| | - Can Öztürk
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.S., R.K., C.O., M.W., S.Z., G.N., M.U.B.)
| | - Marcel Weber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.S., R.K., C.O., M.W., S.Z., G.N., M.U.B.)
| | - Noriaki Tabata
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (N.T.)
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.S., R.K., C.O., M.W., S.Z., G.N., M.U.B.)
| | - Jan-Malte Sinning
- Department of Cardiology, St Vinzenz-Hospital Cologne, Germany (J.-M.S.)
| | - Victor Mauri
- Heart Center, Department of Cardiology, University Hospital Cologne, Germany (C.I., V.M., S.B., R.P.)
| | - Patrick Horn
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Germany (M.S., P.H., M.K., R.W.)
| | - Malte Kelm
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Germany (M.S., P.H., M.K., R.W.)
| | - Stephan Baldus
- Heart Center, Department of Cardiology, University Hospital Cologne, Germany (C.I., V.M., S.B., R.P.)
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.S., R.K., C.O., M.W., S.Z., G.N., M.U.B.)
| | - Ralf Westenfeld
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Germany (M.S., P.H., M.K., R.W.)
| | - Roman Pfister
- Heart Center, Department of Cardiology, University Hospital Cologne, Germany (C.I., V.M., S.B., R.P.)
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.S., R.K., C.O., M.W., S.Z., G.N., M.U.B.)
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Hohmann C, Ludwig M, Walker J, Iliadis C, Schipper JH, Baldus S, Pfister R. Real-world anticoagulatory treatment after percutaneous mitral valve repair using MitraClip: a retrospective, observational study on 1300 patients. Clin Res Cardiol 2022; 111:889-899. [PMID: 35220447 PMCID: PMC9334399 DOI: 10.1007/s00392-022-01988-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/02/2022] [Indexed: 11/22/2022]
Abstract
Aims This study sought to investigate current anticoagulatory treatment patterns and clinical outcome in patients undergoing transcatheter mitral valve repair (MitraClip). Methods and results In a retrospective study of a German claims database (InGef research database), anticoagulatory treatment regimens were assessed using any drug prescription post discharge within the first 90 days after MitraClip procedure. Clinical events between 30 days and 6 months were examined by treatment regime. The study population comprised 1342 patients undergoing MitraClip procedure between 2014 and 2018. 22.4% received antiplatelet monotherapy, 20.8% oral anticoagulation (OAC) plus antiplatelet therapy, 19.4% OAC monotherapy, 11.7% dual antiplatelet therapy, 2.8% triple therapy and 21.0% did not receive any anticoagulatory drugs. 63% of patients with OAC received non-vitamin-K antagonist oral anticoagulants (NOAC). A total of 168 patients were newly prescribed OAC after MitraClip, of whom 12 patients (7.1%) had no diagnosis of atrial fibrillation or venous thromboembolism. 40% of patients with OAC prior to MitraClip did not have any OAC after MitraClip. The adjusted risk of all-cause mortality was significantly increased in patients with no anticoagulatory treatment (HR 3.84, 95% CI 2.33–6.33, p < 0.0001) when compared to antiplatelet monotherapy whereas the other regimes were not significantly different. Conclusions This large real-world data analysis demonstrates a heterogeneous spectrum of prescriptions for anticoagulant therapies after MitraClip. Considering relevant differences in clinical outcome across treatment groups, major effort is warranted for controlled trials in order to establish evidence-based recommendations on anticoagulatory treatment after percutaneous mitral valve repair. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-022-01988-2.
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Iliadis C, Kourkouta L, Bountas D, Tsaloglidou A, Koukourikos K, Frantzana A, Doumas A. The Quality of Health Services Provided to Patients Undergoing Myocardial Perfusion Imaging by a Nuclear Medicine Department. Acta Inform Med 2022; 30:29-35. [PMID: 35800908 PMCID: PMC9226786 DOI: 10.5455/aim.2022.30.29-35] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/02/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Nuclear medicine procedures can be delivered in different healthcare settings, such as outpatient centers, medical clinics, mobile units, and hospitals. The process of providing care to the patient can be modified according to the provision arrangement; however, the basic level of quality of service should be maintained, and continuous improvement should be pursued. Objective: The objective of this research study is to investigate the quality of health services provided to patients undergoing myocardial perfusion imaging by a nuclear medicine department. Methods: The data collected through the questionnaires were saved in an Excel sheet, and then, they were analyzed by using the SPSS 24 statistical software platform. Firstly, the demographic data of the sample are presented by using a frequency table. In terms of the main questions, for those of them that were not answered in the Likert scale, frequency charts were used to present their results. Results: From the analysis, it emerged that 75% (n=75) of the sample was composed of male patients, and 25% (n=25) was composed of female patients. Regarding the age distribution of the patients of the survey, it was observed that 39% (n=39) were between 45 and 64 years old, 35% (n=35) were over 65 years old, and 26% (n=26) were between 18 and 44 years old. Moreover, it was observed that 17% (n=17) of the sample were Secondary School graduates, 17% (n=17) were Technological Education graduates, 16% (n=16) were Primary School graduates, 16% (n=16) were High School graduates, and 14% (n=14) were University graduates. Conclusion: The levels of satisfaction ranged were moderate regarding access to the clinics, and were lower regarding the time required between the date of making the appointment and the date of performing the examination.
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Affiliation(s)
| | - Lambrini Kourkouta
- Nursing Department, International University of Greece, Thessaloniki, Greece
| | | | - Areti Tsaloglidou
- Nursing Department, International Hellenic University Thessaloniki, Greece
| | | | | | - Argirios Doumas
- Department of Nuclear Medicine, Aristotelio University of Thessaloniki, Thessaloniki, Greece
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Kavsur R, Iliadis C, Spieker M, Brachtendorf B, Tiyerili V, Metze C, Horn P, Baldus S, Kelm M, Nickenig G, Pfister R, Westenfeld R, Becher M. Predictors and prognostic relevance of tricuspid alterations in patients undergoing transcatheter edge-to-edge mitral valve repair. EUROINTERVENTION 2021; 17:827-834. [PMID: 33646125 PMCID: PMC9724950 DOI: 10.4244/eij-d-20-01094] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mitral valve repair may lead to alterations of tricuspid regurgitation (TR). AIMS We aimed to investigate alterations, predictors and prognostic relevance of TR evolution in a large-scale multicentre population of patients undergoing transcatheter mitral valve repair (TMVR) via the MitraClip. METHODS In total, we included 531 TMVR patients with at least one available follow-up echocardiography. TR improvement was defined as a TR ≥II at baseline, which showed a decline of at least one TR categorisation. RESULTS Distribution of preprocedural TR severity was TR 0/I 41% (220/531), TR II 39% (209/531) and TR ≥III 19% (102/531), respectively. Follow-up echocardiography was at 308±187 days. TR severity improved to TR 0/I 49% (259/531), TR II 35% (183/531) and TR III 17% (89/531), p=0.003. Out of 311 patients with TR ≥II at baseline, 41% (127/311) showed TR improvement. Atrial fibrillation (AF), residual mitral regurgitation ≥II (rMR) and tricuspid annular diameter (TAD) remained variables which prevented TR improvement (odds ratio 0.49 [0.29-0.84], 0.47 [0.27-0.81] and 0.97 [0.93-0.997], respectively). TR improvement was associated with better event-free survival regarding post-procedural heart failure hospitalisation (HHF) (hazard ratio 0.6 [0.38-0.94]). The main changes of TR severity occurred within 3 months post TMVR (p=0.006), while there were only minor TR changes between 3 and 12 months of follow-up (p=0.813). CONCLUSIONS TR improvement was frequent after TMVR. Predictors preventing TR improvement were AF, post-procedural rMR, and TAD. Furthermore, TR improvement was an early phenomenon occurring primarily within the first three months post TMVR and served as a suitable marker of reduced HHF.
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Affiliation(s)
- Refik Kavsur
- Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Christos Iliadis
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, Heart Center of the University of Cologne, Cologne, Germany
| | - Maximilian Spieker
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Vedat Tiyerili
- Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Clemens Metze
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, Heart Center of the University of Cologne, Cologne, Germany
| | - Patrick Horn
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Hospital Düsseldorf, Düsseldorf, Germany
| | - Stephan Baldus
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, Heart Center of the University of Cologne, Cologne, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Hospital Düsseldorf, Düsseldorf, Germany
| | - Georg Nickenig
- Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Roman Pfister
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, Heart Center of the University of Cologne, Cologne, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Hospital Düsseldorf, Düsseldorf, Germany
| | - Marc Becher
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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Sugiura A, Shamekhi J, Goto T, Spieker M, Iliadis C, Kavsur R, Mauri V, Kelm M, Baldus S, Tanaka T, Tabata N, Sinning JM, Weber M, Zimmer S, Nickenig G, Westenfeld R, Pfister R, Becher MU. Early response of right-ventricular function to percutaneous mitral valve repair. Clin Res Cardiol 2021; 111:859-868. [PMID: 34669015 PMCID: PMC9334433 DOI: 10.1007/s00392-021-01951-7] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022]
Abstract
Background The change in right-ventricular function (RVF) after transcatheter mitral valve repair is still poorly understood. We assessed the early response of RVF to the MitraClip procedure and its clinical relevance. Methods We analyzed consecutive patients who underwent a MitraClip procedure to treat MR between August 2010 and March 2019 in the Heart Failure Network Rhineland registry. RVF was assessed before and after the procedure. Impaired RVF was defined as an RV fractional area change (RVFAC) < 35% or tricuspid annular plane systolic excursion (TAPSE) < 16 mm. Results 816 eligible patients (77 ± 9 years, 58.5% male) were included in the analysis. Baseline values of RVF were: RVFAC 38.6 (IQR 29.7–46.7) % and TAPSE 17.0 (IQR 14.0–21.0) mm. At a median time of 3 (IQR 2–5) days after the procedure, the RVF remained normal in 34% (n = 274), normalized in 17% (n = 140), deteriorated in 15% (n = 125), and was persistently impaired in 34% (n = 277) of patients. The RVF response was significantly associated with a composite outcome of all-cause mortality and hospitalization due to heart failure within a 2-year follow-up. Compared to stable/normal RVF, the adjusted hazard ratios for the outcome were 1.78 (95% CI 1.10–2.86) for normalized RVF, 1.89 (95% CI 1.34–3.15) for deteriorated RVF, and 2.25 (95% CI 1.47–3.44) for persistently impaired RVF. Changes in TAPSE and RVFAC as continuous variables were significantly correlated with the outcome. Conclusion An early change in RVF following transcatheter mitral valve repair is predictive of mortality and hospitalization due to heart failure during follow-up. Graphic abstract Early response of RVF after MitraClip and its clinical significance. An acute, early change in RVF can be observed following the MitraClip procedure, which is associated with the risk of mortality and hospitalization for HF. ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-021-01951-7.
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Affiliation(s)
- Atsushi Sugiura
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Jasmin Shamekhi
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Maximilian Spieker
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christos Iliadis
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Refik Kavsur
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Victor Mauri
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Malte Kelm
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Tetsu Tanaka
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Noriaki Tabata
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Jan-Malte Sinning
- Department of Cardiology, St. Vinzenz-Hospital Cologne, Cologne, Germany
| | - Marcel Weber
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Zimmer
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Georg Nickenig
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Roman Pfister
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Marc Ulrich Becher
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Iliadis C, Kalbacher D, Lurz P, Petrescu A, Orban M, Karam N, Lubos E, Thiele H, Von Bardeleben S, Hausleiter J, Pfister R. Association of left atrial volume index with outcomes after transcatheter mitral valve repair for secondary mitral regurgitation: results from the EuroSMR registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1695] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The benefit of transcatheter edge-to-edge mitral valve repair (TMVr) in heart failure patients with secondary mitral regurgitation (SMR) shows large heterogeneity. A potential explanation might be the burden and chronicity of left-ventricular backward failure which is reflected by left atrial (LA) size.
Purpose
To investigate the role of LA volume index (LAVi) in real-world SMR patients undergoing TMVr.
Methods
SMR patients in a European multicenter registry were evaluated. Outcomes were evaluated according to LAVi at baseline. Main analysis was performed for all-cause mortality; residual mitral regurgitation, improvement of NYHA class and heart failure hospitalization were analyzed for patients available.
Results
823 included patients were divided according to LAVi into quintiles (≤42, 43–52, 53–62, 63–78, ≥79). A higher hazard for mortality occurred in the four upper quintiles compared to the lower quintile (HR [95% CI] 1.61 [1.08–2.4], 1.65 [1.11–2.46], 1.52 [1.02–2.26] and 1.35 [0.89–2.05]). The incidence of all-cause mortality per 100 patient-years was 14.6, 23, 23.9, 21.7 and 19.5, respectively. Consequently, a cut-off of 42ml/m2 was adopted, which was associated with a significantly higher hazard for mortality after a mean of 589 days (HR 1.54 [95%-CI 1.1–2.1], p=0.01). Technical success rate (postprocedural MR ≤2+) was higher in large LAVi group (95% vs. 91%, p=0.045). The endpoints of heart failure hospitalization, improvement of NYHA class were not different among groups. Multivariable Cox regression analysis including age, EF<30%, diabetes mellitus and NTproBNP showed LAVi >42ml/m2 to be an independent predictor of mortality.
Conclusion
LA dilatation defined by LAVi>42 ml/m2 was associated with higher mortality hazard in SMR patients undergoing TMVr after multivariable adjustment. Our findings warrant further study on whether timely TMVr intervention in patients with SMR and small LAVi can modify outcome.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Iliadis
- Cologne University Hospital - Heart Center, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne Germany, Cologne, Germany
| | - D Kalbacher
- University Heart Center Hamburg, University Heart Center Eppendorf, Hamburg, Department of Cardiology, Hamburg, Germany
| | - P Lurz
- University of Leipzig, Department of Cardiology, Heart Center Leipzig, Leipzig, Germany
| | - A Petrescu
- Johannes Gutenberg University Mainz (JGU), Cardiology Center, Mainz, Germany
| | - M Orban
- Ludwig-Maximilians University, Medical Clinic and Policlinic I, University Clinic Munich, Munich, Germany
| | - N Karam
- Georges Pompidou APHP Site of Paris Ouest University Hospital, Department of Cardiology and Paris Cardiovascular Research Center, Paris, France
| | - E Lubos
- University Heart Center Hamburg, University Heart Center Eppendorf, Hamburg, Department of Cardiology, Hamburg, Germany
| | - H Thiele
- University of Leipzig, Department of Cardiology, Heart Center Leipzig, Leipzig, Germany
| | - S Von Bardeleben
- Johannes Gutenberg University Mainz (JGU), Cardiology Center, Mainz, Germany
| | - J Hausleiter
- Ludwig-Maximilians University, Medical Clinic and Policlinic I, University Clinic Munich, Munich, Germany
| | - R Pfister
- Cologne University Hospital - Heart Center, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne Germany, Cologne, Germany
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Zweck E, Spieker M, Horn P, Iliadis C, Metze C, Kavsur R, Tiyerili V, Nickenig G, Baldus S, Kelm M, Becher MU, Pfister R, Westenfeld R. Machine learning identifies clinical parameters to predict mortality in patients undergoing transcatheter mitral valve repair. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2221] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Transcatheter Mitral Valve Repair (TMVR) with MitraClip is an important treatment option for patients with severe mitral regurgitation. The lack of appropriate, validated and specific means to risk stratify TMVR patients complicates the evaluation of prognostic benefits of TMVR in clinical trials and practice.
Purpose
We aimed to develop an optimized risk stratification model for TMVR patients using machine learning (ML).
Methods
We included a total of 1009 TMVR patients from three large university hospitals, of which one (n=317) served as an external validation cohort. The primary endpoint was all-cause 1-year mortality, which was known in 95% of patients. Model performance was assessed using receiver operating characteristics. In the derivation cohort, different ML algorithms, including random forest, logistic regression, support vectors machines, k nearest neighbors, multilayer perceptron, and extreme gradient boosting (XGBoost) were tested using 5-fold cross-validation in the derivation cohort. The final model (Transcatheter MITral Valve Repair MortALIty PredicTion SYstem; MITRALITY) was tested in the validation cohort with respect to existing clinical scores.
Results
XGBoost was selected as the final algorithm for the MITRALITY Score, using only six baseline clinical features for prediction (in order of predictive importance): blood urea nitrogen, hemoglobin, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), mean arterial pressure, body mass index, and creatinine. In the external validation cohort, the MITRALITY Score's area under the curve (AUC) was 0.783, outperforming existing scores which yielded AUCs of 0.721 and 0.657 at best. 1-year mortality in the MITRALITY Score quartiles across the total cohort was 0.8%, 1.3%, 10.5%, and 54.6%, respectively. Odds of mortality in MITRALITY Score quartile 4 as compared to quartile 1 were 143.02 [34.75; 588.57]. Survival analyses showed that the differences in outcomes between the MITRALITY Score quartiles remained even over a timeframe of 3 years post intervention (log rank: p<0.005). With each increase by 1% in the MITRALITY score, the respective proportional hazard ratio for 3-year survival was 1.06 [1.05, 1.07] (Cox regression, p<0.05).
Conclusion
The MITRALITY Score is a novel, internally and externally validated ML-based tool for risk stratification of patients prior to TMVR. These findings may potentially allow for more precise design of future clinical trials, may enable novel treatment strategies tailored to populations of specific risk and thereby serve future daily clinical practice.
Funding Acknowledgement
Type of funding sources: None. Summary Figure
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Affiliation(s)
- E Zweck
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - M Spieker
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - P Horn
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - C Iliadis
- University of Cologne, Medical Faculty, Department of Cardiology, Cologne, Germany
| | - C Metze
- University of Cologne, Medical Faculty, Department of Cardiology, Cologne, Germany
| | - R Kavsur
- University Hospital Bonn, Department of Cardiology, Bonn, Germany
| | - V Tiyerili
- University Hospital Bonn, Department of Cardiology, Bonn, Germany
| | - G Nickenig
- University Hospital Bonn, Department of Cardiology, Bonn, Germany
| | - S Baldus
- University of Cologne, Medical Faculty, Department of Cardiology, Cologne, Germany
| | - M Kelm
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - M U Becher
- University Hospital Bonn, Department of Cardiology, Bonn, Germany
| | - R Pfister
- University of Cologne, Medical Faculty, Department of Cardiology, Cologne, Germany
| | - R Westenfeld
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
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Fortmeier V, Lachmann M, Gercek M, Roder F, Friedrichs KP, Rudolph TK, Iliadis C, Koerber MI, Pfister R, Baldus S, Rudolph V. Predicting procedural success in patients treated with Cardioband system for severe tricuspid regurgitation by employing a random forest algorithm. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1705] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Severe tricuspid regurgitation (TR) is associated with high morbidity and mortality despite optimal medical treatment. Transcatheter tricuspid valve intervention (TTVI) is therefore emerging as a novel treatment option, fueling the hope to prolong survival and reduce rehospitalization for heart failure. Obviously, procedural success of TTVI is an important determinant of survival, but predictors for procedural success in patients treated with Cardioband system, which mimics the surgical approach by implanting an annular reduction system and hence targets tricuspid annulus dilatation as the central pathology in most patients, are largely elusive.
Purpose
This study aims to refine prediction of procedural success in patients with severe TR undergoing TTVI with Cardioband system by employing a random forest algorithm.
Methods
Procedural success was evaluated in 72 patients enrolled at two tertiary centers in Germany between 2018 and 2020. Key inclusion criterion was TR ≥ III/V° with high symptomatic burden despite optimal medical treatment. Procedural success war defined as patient alive at the end of the procedure, successful Cardioband implantation, and TR reduction ≥ II/V° as assessed on transthoracic echocardiography before discharge. Since 66.7% of patients were classified as “success”, a synthetic minority over-sampling technique was applied in order to train the random forest algorithm on a balanced data set.
Results
A random forest algorithm reached 85.4% accuracy (AUC: 0.923) in predicting procedural success in a balanced data set using eight parameters from pre-procedural echocardiography as input variables. Partial dependence analysis revealed that enlargement of the tricuspid valve (TV) anteroseptal diameter was most important for model accuracy. Applied to the real-world data set (24 patients classified as “failure” and 48 patients classified as “success”), the now trained random forest algorithm predicted procedural success with high sensitivity (70.8%) and specificity (100.0%), significantly outperforming the no information rate (p-value: 0.0069). Patients with low probability for success were characterized by impaired right ventricular function (TAPSE: 15.5±3.63 mm) and enlarged right sided cardiac diameters (basal right ventricular diameter: 51.6±3.79 mm; TV anteroseptal diameter: 45.0±5.10 mm). Notably, systolic pulmonary artery pressure (sPAP) and TV effective regurgitant orifice area were negatively correlated (R: −0.3004, p-value: 0.0322), and elevation in sPAP was attenuated in patients with low probability for procedural success (sPAP: 34.0±11.7 mmHg).
Conclusion
A random forest algorithm enables precise prediction of procedural success in patients treated with Cardioband system. TR reduction ≥ II/V° appears less achievable in patients with advanced stages of right heart failure, emphasizing the importance of adequate patient selection and timing of intervention.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- V Fortmeier
- Heart- and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Department of General and Interventional Cardiology, Bad Oeynhausen, Germany
| | - M Lachmann
- Klinikum rechts der Isar, Technical University of Munich, First Department of Medicine, Munich, Germany
| | - M Gercek
- Heart- and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Department of General and Interventional Cardiology, Bad Oeynhausen, Germany
| | - F Roder
- Heart- and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Department of General and Interventional Cardiology, Bad Oeynhausen, Germany
| | - K P Friedrichs
- Heart- and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Department of General and Interventional Cardiology, Bad Oeynhausen, Germany
| | - T K Rudolph
- Heart- and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Department of General and Interventional Cardiology, Bad Oeynhausen, Germany
| | - C Iliadis
- Heart Center, University of Cologne, Department of Cardiology, Cologne, Germany
| | - M I Koerber
- Heart Center, University of Cologne, Department of Cardiology, Cologne, Germany
| | - R Pfister
- Heart Center, University of Cologne, Department of Cardiology, Cologne, Germany
| | - S Baldus
- Heart Center, University of Cologne, Department of Cardiology, Cologne, Germany
| | - V Rudolph
- Heart- and Diabetes Center Northrhine-Westfalia, Ruhr University Bochum, Department of General and Interventional Cardiology, Bad Oeynhausen, Germany
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Tanaka T, Kavsur R, Spieker M, Iliadis C, Metze C, Horn P, Sugiura A, Kelm M, Baldus S, Nickenig G, Westenfeld R, Pfister R, Becher MU. Periprocedural changes in natriuretic peptide levels and clinical outcome after transcatheter mitral valve repair. ESC Heart Fail 2021; 8:5237-5247. [PMID: 34519444 PMCID: PMC8712850 DOI: 10.1002/ehf2.13603] [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: 06/23/2021] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 11/06/2022] Open
Abstract
Aims This multicentre study investigated the association of periprocedural changes in the levels of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) with clinical outcomes after transcatheter edge‐to‐edge mitral valve repair (TMVR). Methods and results Patients were retrospectively analysed who underwent TMVR with the MitraClip system (Abbott Vascular, Santa Clara, CA, USA) and had available sequential NT‐proBNP testing at baseline and 2 months after TMVR. Periprocedural changes in NT‐proBNP following TMVR were assessed as the percent change in NT‐proBNP between baseline and the 2 month follow‐up, and the significant reduction in NT‐proBNP was defined as a decrease of >30% in the follow‐up NT‐proBNP compared with the pre‐procedural NT‐proBNP level. Primary outcome was defined as a composite outcome consisting of all‐cause mortality and hospitalization due to heart failure from 2 months to 2 years after TMVR. Additionally, we identified the cut‐off value of pre‐procedural NT‐proBNP to predict the composite outcome using a receiver operating characteristic analysis (cut‐off: 2485 pg/mL). Of 485 patients undergoing TMVR (age: 76.2 ± 9.2 years, female: 42.1%, secondary mitral regurgitation: 67.2%), 150 patients (30.9%) had the significant reduction in NT‐proBNP (>30%) following the procedure. Patients with the NT‐proBNP reduction had a lower incidence of the composite outcome, compared with those without the reduction in NT‐proBNP (31.4% vs. 40.2%; log‐rank P = 0.03). The significant reduction in NT‐proBNP was also associated with a lower risk of the composite outcome [adjusted hazard ratio (HR): 0.67; 95% confidence interval (CI): 0.45–0.97; P = 0.04], independently of pre‐procedural NT‐proBNP levels and other clinical parameters. The percent change in NT‐proBNP was associated with a linear trend of the incidence of the composite outcome (adjusted HR per 10% decrease: 0.96; 95% CI: 0.94–0.98; P < 0.001). A stratified analysis revealed that the prognostic impact of the significant reduction in NT‐proBNP was consistent among clinical subgroups, including aetiology of mitral regurgitation (P for interaction = 0.99). Higher pre‐procedural NT‐proBNP level (>2485 pg/mL) was associated with the increased risk of the composite outcome (adjusted HR: 1.50; 95% CI: 1.03–2.17; P = 0.03); however, patients with a higher pre‐procedural NT‐proBNP who achieved the significant reduction in NT‐proBNP had a similar risk of the composite outcome to those with a lower pre‐procedural NT‐proBNP. Conclusions Changes in sequential NT‐proBNP measurements were associated with clinical outcomes within 2 years after TMVR. The assessment of NT‐proBNP dynamics may be valuable to assess the residual risk for patients undergoing TMVR and could assist with post‐procedural management after TMVR.
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Affiliation(s)
- Tetsu Tanaka
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg Campus 1, Bonn, 53127, Germany
| | - Refik Kavsur
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg Campus 1, Bonn, 53127, Germany
| | - Maximilian Spieker
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christos Iliadis
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Clemens Metze
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Patrick Horn
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg Campus 1, Bonn, 53127, Germany
| | - Malte Kelm
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Stephan Baldus
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg Campus 1, Bonn, 53127, Germany
| | - Ralf Westenfeld
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Roman Pfister
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg Campus 1, Bonn, 53127, Germany
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Schäfer M, Körber MI, Vimalathasan R, Mauri V, Iliadis C, Metze C, Ten Freyhaus H, Baldus S, Polidori MC, Pfister R. Risk Stratification of Patients Undergoing Percutaneous Repair of Mitral and Tricuspid Valves Using a Multidimensional Geriatric Assessment. Circ Cardiovasc Qual Outcomes 2021; 14:e007624. [PMID: 34325515 DOI: 10.1161/circoutcomes.120.007624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/13/2023]
Abstract
BACKGROUND Given their advanced age and high comorbidity, individual risk assessment is crucial in patients undergoing transcatheter mitral and tricuspid valve repair. Therefore, we evaluated the use of a comprehensive geriatric assessment score, the multidimensional prognostic index (MPI), for risk stratification in these patients. METHODS We conducted a prospective, observational single-center study, including 226 patients undergoing percutaneous repair for mitral or tricuspid regurgitation. The MPI was calculated preprocedural and covers 8 domains (activities of daily living, instrumental activities of daily living, mental status, nutrition, risk of pressure ulcers, comorbidity, medication, and marital/cohabitation status). We sought to identify an association of MPI score with procedural outcomes and 6-month mortality. RESULTS A total of 53.1% of patients were stratified as low risk according to MPI (MPI-1 group), 44.2% as medium risk (MPI-2 group), and 2.7% as high risk (MPI-3 group). Procedural efficacy and safety were similar between groups. The estimated survival rate at 6 months was 97±2% in MPI-1 group, 79±4% in MPI-2 group (hazard ratio, 6.90 [95% CI, 2.36-12.2]; P≤0.001) and 50±20% in MPI-3 group (hazard ratio, 20.3 [95% CI, 4.51-91.3]; P<0.001). An increase in 1 SD of the MPI score (0.14 points, possible range of MPI score 0-1) was associated with a hazard ratio of 2.13 (95% CI, 1.58-2.73; P≤0.001) for death after 6 months. The risk association of the MPI with mortality remained significant in multivariate analysis including risk factors, such as peripheral artery disease and NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels. CONCLUSIONS A comprehensive geriatric assessment with the MPI score provides additional information on mortality risk beyond established cardiovascular risk factors.
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Affiliation(s)
- Matthieu Schäfer
- Division of Cardiology, Pneumology, Angiology, and Intensive Care, Department III of Internal Medicine (M.S., M.I.K., R.V., V.M., C.I., C.M., H.t.F., S.B., R.P.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Maria I Körber
- Division of Cardiology, Pneumology, Angiology, and Intensive Care, Department III of Internal Medicine (M.S., M.I.K., R.V., V.M., C.I., C.M., H.t.F., S.B., R.P.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Rakave Vimalathasan
- Division of Cardiology, Pneumology, Angiology, and Intensive Care, Department III of Internal Medicine (M.S., M.I.K., R.V., V.M., C.I., C.M., H.t.F., S.B., R.P.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Victor Mauri
- Division of Cardiology, Pneumology, Angiology, and Intensive Care, Department III of Internal Medicine (M.S., M.I.K., R.V., V.M., C.I., C.M., H.t.F., S.B., R.P.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Christos Iliadis
- Division of Cardiology, Pneumology, Angiology, and Intensive Care, Department III of Internal Medicine (M.S., M.I.K., R.V., V.M., C.I., C.M., H.t.F., S.B., R.P.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Clemens Metze
- Division of Cardiology, Pneumology, Angiology, and Intensive Care, Department III of Internal Medicine (M.S., M.I.K., R.V., V.M., C.I., C.M., H.t.F., S.B., R.P.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Henrik Ten Freyhaus
- Division of Cardiology, Pneumology, Angiology, and Intensive Care, Department III of Internal Medicine (M.S., M.I.K., R.V., V.M., C.I., C.M., H.t.F., S.B., R.P.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Stephan Baldus
- Division of Cardiology, Pneumology, Angiology, and Intensive Care, Department III of Internal Medicine (M.S., M.I.K., R.V., V.M., C.I., C.M., H.t.F., S.B., R.P.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - M Cristina Polidori
- Ageing Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne (M.C.P.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress-Responses in Ageing-Associated Diseases (CECAD) (M.C.P.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | - Roman Pfister
- Division of Cardiology, Pneumology, Angiology, and Intensive Care, Department III of Internal Medicine (M.S., M.I.K., R.V., V.M., C.I., C.M., H.t.F., S.B., R.P.), Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
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Kavsur R, Spieker M, Iliadis C, Metze C, Transier M, Tiyerili V, Horn P, Baldus S, Kelm M, Nickenig G, Westenfeld R, Pfister R, Becher MU. Mitral Regurgitation International Database (MIDA) Score Predicts Outcome in Patients With Heart Failure Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair. J Am Heart Assoc 2021; 10:e019548. [PMID: 34187184 PMCID: PMC8403297 DOI: 10.1161/jaha.120.019548] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Optimizing risk stratification in patients undergoing transcatheter mitral valve repair is an ongoing challenge. The Mitral Regurgitation International Database (MIDA) score represents a user-friendly mortality risk stratification tool that is validated on a large-scale registry of patients with degenerative mitral regurgitation (MR). We here assessed the potential benefit of the MIDA risk score for patients with functional or degenerative MR undergoing transcatheter mitral valve repair. Methods and Results In total, 680 patients undergoing MitraClip implantation were stratified according to MIDA score tertiles into a low (0-7), intermediate (8-9), and a high (10-12) MIDA score group. MR was assessed in follow-up echocardiograms in 416 patients at 323±169 days after transcatheter mitral valve repair. During 2-year follow-up, 8.2% (15/182) of patients with low, 21.3% (64/300) with intermediate, and 26.3% (52/198) with high MIDA score died (log-rank test P<0.001). Hazard of all-cause mortality increased by 13% (95% CI, 3%-25%) with every additional point of the MIDA score. Subanalysis of 431 patients with functional MR showed similar results. Furthermore, rates of a combined end point of mortality and hospitalization for heart failure were higher with increasing MIDA score (30% [54/182], 38% [113/300] and 48% [94/198], respectively, log-rank test P=0.001). Frequency of residual MR ≥II at follow-up increased with increasing MIDA score group (33%, 44%, and 59%, respectively, P<0.001). Conclusions The MIDA mortality risk score maintains its predictive utility in patients undergoing transcatheter mitral valve repair, regardless of MR cause. Moreover, it was predictive of worse event-free survival regarding a combined end point of mortality and hospitalization for heart failure, and was associated with postprocedural residual MR ≥II and MR recurrence.
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Affiliation(s)
- Refik Kavsur
- Department of Internal Medicine II University Hospital Bonn Bonn Germany
| | - Maximilian Spieker
- Department of Cardiology, Pulmonology and Vascular Medicine Heinrich-Heine University Hospital Duesseldorf Duesseldorf Germany
| | - Christos Iliadis
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care Heart Center of the University of Cologne Cologne Germany
| | - Clemens Metze
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care Heart Center of the University of Cologne Cologne Germany
| | - Moritz Transier
- Department of Internal Medicine II University Hospital Bonn Bonn Germany
| | - Vedat Tiyerili
- Department of Internal Medicine II University Hospital Bonn Bonn Germany
| | - Patrick Horn
- Department of Cardiology, Pulmonology and Vascular Medicine Heinrich-Heine University Hospital Duesseldorf Duesseldorf Germany
| | - Stephan Baldus
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care Heart Center of the University of Cologne Cologne Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine Heinrich-Heine University Hospital Duesseldorf Duesseldorf Germany
| | - Georg Nickenig
- Department of Internal Medicine II University Hospital Bonn Bonn Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine Heinrich-Heine University Hospital Duesseldorf Duesseldorf Germany
| | - Roman Pfister
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care Heart Center of the University of Cologne Cologne Germany
| | - Marc Ulrich Becher
- Department of Internal Medicine II University Hospital Bonn Bonn Germany
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Higuchi S, Orban M, Stolz L, Karam N, Praz F, Kalbacher D, Ludwig S, Braun D, Näbauer M, Wild MG, Neuss M, Butter C, Kassar M, Petrescu A, Pfister R, Iliadis C, Unterhuber M, Park SD, Thiele H, Baldus S, von Bardeleben RS, Schofer N, Massberg S, Windecker S, Lurz P, Hausleiter J. Impact of Residual Mitral Regurgitation on Survival After Transcatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation. JACC Cardiovasc Interv 2021; 14:1243-1253. [PMID: 33992551 DOI: 10.1016/j.jcin.2021.03.050] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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: 01/05/2021] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The aim of this study was to assess the impact of residual mitral regurgitation (resMR) on mortality with respect to left ventricular dilatation (LV-Dil) or right ventricular dysfunction (RV-Dys) in patients with secondary mitral regurgitation (SMR) who underwent mitral valve transcatheter edge-to-edge repair (TEER). BACKGROUND The presence of LV-Dil and RV-Dys correlates with advanced stages of heart failure in SMR patients, which may impact the outcome after TEER. METHODS SMR patients in a European multicenter registry were evaluated. Investigated outcomes were 2-year all-cause mortality and improvement in New York Heart Association functional class with respect to MR reduction, LV-Dil (defined as LV end-diastolic volume ≥159 ml), and RV-Dys (defined as tricuspid annular plane systolic excursion-to-systolic pulmonary artery pressure ratio of <0.274 mm/mm Hg). RESULTS Among 809 included patients, resMR ≤1+ was achieved in 546 (67%) patients. Overall estimated 2-year mortality rate was 32%. Post-procedural resMR was significantly associated with mortality (p = 0.031). Although the improvement in New York Heart Association functional class persisted regardless of either LV-Dil or RV-Dys, the beneficial treatment effect of resMR ≤1+ on 2-year mortality was observed only in patients without LV-Dil and RV-Dys (hazard ratio: 1.75; 95% confidence interval: 1.03 to 3.00). CONCLUSIONS Achieving optimal MR reduction by TEER is associated with improved survival in SMR patients, especially if the progress in heart failure is not too advanced. In SMR patients with advanced stages of heart failure, as evidenced by LV-Dil or RV-Dys, the treatment effect of TEER on symptomatic improvement is maintained, but the survival benefit appears to be reduced.
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Affiliation(s)
- Satoshi Higuchi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease, Munich, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Nicole Karam
- Department of Cardiology, European Hospital Georges Pompidou, Paris, France; INSERM U970, Paris Cardiovascular Research Center, Paris, France
| | - Fabien Praz
- Universitätsklinik für Kardiologie, Inselspital, Bern, Switzerland
| | - Daniel Kalbacher
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany
| | - Sebastian Ludwig
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Mirjam G Wild
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Universitätsklinik für Kardiologie, Inselspital, Bern, Switzerland
| | - Michael Neuss
- Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany
| | - Christian Butter
- Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany
| | - Mohammad Kassar
- Universitätsklinik für Kardiologie, Inselspital, Bern, Switzerland
| | - Aniela Petrescu
- Zentrum für Kardiologie, Johannes Gutenberg-Universität, Mainz, Germany
| | - Roman Pfister
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Christos Iliadis
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Matthias Unterhuber
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Sang-Don Park
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Stephan Baldus
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | | | - Niklas Schofer
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease, Munich, Germany
| | | | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease, Munich, Germany.
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50
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Park SD, Orban M, Karam N, Lubos E, Kalbacher D, Braun D, Stolz L, Neuss M, Butter C, Praz F, Kassar M, Petrescu A, Pfister R, Iliadis C, Unterhuber M, Lurz P, Thiele H, Baldus S, von Bardeleben RS, Blankenberg S, Massberg S, Windecker S, Hausleiter J. Sex-Related Clinical Characteristics and Outcomes of Patients Undergoing Transcatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation. JACC Cardiovasc Interv 2021; 14:819-827. [PMID: 33812815 DOI: 10.1016/j.jcin.2020.12.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 10/20/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The authors sought to assess sex-based differences in characteristics and outcomes of patients undergoing transcatheter edge-to-edge mitral valve repair (TMVR) for secondary mitral regurgitation (SMR). BACKGROUND Subgroup analysis from the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial indicated potential sex-related differences in outcomes after TMVR. The impact of sex on results after TMVR in a real-world setting is unknown. METHODS The authors assessed clinical outcomes and echocardiographic parameters in women and men undergoing TMVR for SMR between 2008 and 2018 who were included in the large, international, multicenter real-world EuroSMR registry (European Registry of Transcatheter Repair for Secondary Mitral Regurgitation). RESULTS A total of 1,233 patients, including 445 women (36%) and 788 men (64%), were analyzed. Although women were significantly older and had fewer comorbidities than men, TMVR was equally effective in women and men (mitral regurgitation [MR] grade ≤2+ at discharge: 93.2% vs. 94.6% for women vs. men; p = 0.35). All-cause mortality at 1 year (17.9% vs. 18.9%, adjusted hazard ratio: 0.806; p = 0.46) and at 2-year follow-up (26.5% vs. 26.4%, adjusted hazard ratio: 0.757; p = 0.26) were similar in women versus men after multivariate regression analysis. Durability of MR reduction, improvement in symptoms, quality of life, and functional capacity did also not differ during follow-up. CONCLUSIONS Results from the EuroSMR registry confirmed effective and similar MR reduction with TMVR in women and men. There were no sex-related differences in clinical outcomes up to 2 years of follow-up.
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Affiliation(s)
- Sang-Don Park
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Department of Cardiology, Inha University Hospital, Incheon, Korea Republic
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Nicole Karam
- Department of Cardiology, European Hospital Georges Pompidou, and INSERM U970, Paris Cardiovascular Research Center, Paris, France
| | - Edith Lubos
- Universitäres Herz und Gefäßzentrum UKE Hamburg, Klinik für Kardiologie, Hamburg, Germany
| | - Daniel Kalbacher
- Universitäres Herz und Gefäßzentrum UKE Hamburg, Klinik für Kardiologie, Hamburg, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Michael Neuss
- Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany
| | - Christian Butter
- Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany
| | - Fabien Praz
- Universitätsklinik für Kardiologie, Inselspital Bern, Switzerland
| | - Mohammad Kassar
- Universitätsklinik für Kardiologie, Inselspital Bern, Switzerland
| | - Aniela Petrescu
- Zentrum für Kardiologie, Johannes Gutenberg-Universität, Mainz, Germany
| | - Roman Pfister
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Christos Iliadis
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Matthias Unterhuber
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Stephan Baldus
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | | | - Stefan Blankenberg
- Universitäres Herz und Gefäßzentrum UKE Hamburg, Klinik für Kardiologie, Hamburg, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | | | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany.
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