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Amaral PHF, Macret JZ, Dias ERM, Carvalho JPV, Pivetta LGA, Ribeiro HB, Franciss MY, Silva RA, Malheiros CA, Roll S. Volumetry after botulinum toxin A: the impact on abdominal wall compliance and endotracheal pressure. Hernia 2024; 28:53-61. [PMID: 37563426 DOI: 10.1007/s10029-023-02848-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/23/2023] [Indexed: 08/12/2023]
Abstract
PURPOSE Botulinum toxin type A (BTA) is an adjuvant tool used in the preoperative optimization of complex hernias before abdominal wall reconstruction (AWR). This study aims to investigate changes in the abdominal cavity and hernia sac dimensions after BTA application. METHOD A prospective study with 27 patients with a hernia defect of ≥ 10 cm and loss of domain (LOD) ≥ 20% underwent AWR. Computed tomography (CT) measurements and volumetry before and after the application of BTA were performed. Intraoperative and postoperative outcomes were evaluated. RESULTS Imaging post-BTA revealed hernia width reduction of 1.9 cm (p = 0.002), lateral abdominal wall muscle elongation of 3.1 cm (p < 0.001), hernia volume reduction (HV) from 2.9 ± 0.9L to 2.4 ± 0.8L (p < 0.001), increase in abdominal cavity volume (ACV) from 9.7 ± 2.5L to 10.3L ± 2.4L (p = 0.003), and a reduction in the HV/ACV ratio from 30.2 ± 5% to 23.4 ± 6% (p < 0.001). Fascial closure was achieved in 92.6% of cases and component separation was required in 78%. The average variation in pulmonary plateau pressure was 3.53 cmH2O, and there were no postoperative respiratory failure recorded. At the 90-day follow-up, the wound morbidity rate was 25%, unplanned readmissions were 11%, and hernia recurrence 7.4%. CONCLUSION BTA produces measurable volumetric changes in abdominal wall and appears to facilitate fascial closure. Further studies are required to determine the role of BTA in the surgical armamentarium for complex hernia repair.
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Affiliation(s)
- P H F Amaral
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil.
- Hospital Alemão Oswaldo Cruz, Hernia Center, São Paulo, SP, Brazil.
| | - J Z Macret
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
- Hospital Alemão Oswaldo Cruz, Hernia Center, São Paulo, SP, Brazil
| | - E R M Dias
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
- Hospital Alemão Oswaldo Cruz, Hernia Center, São Paulo, SP, Brazil
| | - J P V Carvalho
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
- Hospital Alemão Oswaldo Cruz, Hernia Center, São Paulo, SP, Brazil
| | - L G A Pivetta
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
- Hospital Alemão Oswaldo Cruz, Hernia Center, São Paulo, SP, Brazil
| | - H B Ribeiro
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
| | - M Y Franciss
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
| | - R A Silva
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
| | - C A Malheiros
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
| | - S Roll
- Santa Casa de Sao Paulo - Abdominal Wall Surgery Unit, Rua Cesário Mota Júnior, 112 - Vila Buarque, São Paulo, SP, Brazil
- Hospital Alemão Oswaldo Cruz, Hernia Center, São Paulo, SP, Brazil
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Wu Y, Wang BY, Yu Y, Li Y, Ribeiro HB, Wang J, Xu R, Liu Y, Ye Y, Zhou J, Ke F, Harbola V, Heinz TF, Hwang HY, Cui Y. Interlayer engineering of Fe 3GeTe 2: From 3D superlattice to 2D monolayer. Proc Natl Acad Sci U S A 2024; 121:e2314454121. [PMID: 38232283 PMCID: PMC10823236 DOI: 10.1073/pnas.2314454121] [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: 08/21/2023] [Accepted: 12/05/2023] [Indexed: 01/19/2024] Open
Abstract
The discoveries of ferromagnetism down to the atomically thin limit in van der Waals (vdW) crystals by mechanical exfoliation have enriched the family of magnetic thin films [C. Gong et al., Nature 546, 265-269 (2017) and B. Huang et al., Nature 546, 270-273 (2017)]. However, compared to the study of traditional magnetic thin films by physical deposition methods, the toolbox of the vdW crystals based on mechanical exfoliation and transfer suffers from low yield and ambient corrosion problem and now is facing new challenges to study magnetism. For example, the formation of magnetic superlattice is difficult in vdW crystals, which limits the study of the interlayer interaction in vdW crystals [M. Gibertini, M. Koperski, A. F. Morpurgo, K. S. Novoselov, Nat. Nanotechnol. 14, 408-419 (2019)]. Here, we report a strategy of interlayer engineering of the magnetic vdW crystal Fe3GeTe2 (FGT) by intercalating quaternary ammonium cations into the vdW spacing. Both three-dimensional (3D) vdW superlattice and two-dimensional (2D) vdW monolayer can be formed by using this method based on the amount of intercalant. On the one hand, the FGT superlattice shows a strong 3D critical behavior with a decreased coercivity and increased domain wall size, attributed to the co-engineering of the anisotropy, exchange interaction, and electron doping by intercalation. On the other hand, the 2D vdW few layers obtained by over-intercalation are capped with organic molecules from the bulk crystal, which not only enhances the ferromagnetic transition temperature (TC), but also substantially protects the thin samples from degradation, thus allowing the preparation of large-scale FGT ink in ambient environment.
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Affiliation(s)
- Yecun Wu
- Stanford Institute for Materials and Energy Sciences, SLAC National Accelerator Laboratory, Menlo Park, CA94025
- Department of Electrical Engineering, Stanford University, Stanford, CA94305
- Department of Physics, Stanford University, Stanford, CA94305
| | - Bai Yang Wang
- Stanford Institute for Materials and Energy Sciences, SLAC National Accelerator Laboratory, Menlo Park, CA94025
- Department of Physics, Stanford University, Stanford, CA94305
| | - Yijun Yu
- Department of Applied Physics, Stanford University, Stanford, CA94305
| | - Yanbin Li
- Department of Materials Science and Engineering, Stanford University, Stanford, CA94305
| | - Henrique B. Ribeiro
- Stanford PULSE Institute, SLAC National Accelerator Laboratory, Menlo Park, CA94025
| | - Jierong Wang
- Department of Applied Physics, Stanford University, Stanford, CA94305
| | - Rong Xu
- Department of Materials Science and Engineering, Stanford University, Stanford, CA94305
| | - Yunzhi Liu
- Department of Materials Science and Engineering, Stanford University, Stanford, CA94305
| | - Yusheng Ye
- Department of Materials Science and Engineering, Stanford University, Stanford, CA94305
| | - Jiawei Zhou
- Department of Materials Science and Engineering, Stanford University, Stanford, CA94305
| | - Feng Ke
- Department of Geological Science, Stanford University, Stanford, CA94305
| | - Varun Harbola
- Department of Physics, Stanford University, Stanford, CA94305
| | - Tony F. Heinz
- Department of Applied Physics, Stanford University, Stanford, CA94305
- Stanford PULSE Institute, SLAC National Accelerator Laboratory, Menlo Park, CA94025
| | - Harold Y. Hwang
- Stanford Institute for Materials and Energy Sciences, SLAC National Accelerator Laboratory, Menlo Park, CA94025
- Department of Applied Physics, Stanford University, Stanford, CA94305
| | - Yi Cui
- Stanford Institute for Materials and Energy Sciences, SLAC National Accelerator Laboratory, Menlo Park, CA94025
- Department of Materials Science and Engineering, Stanford University, Stanford, CA94305
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3
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Simonato M, Whisenant BK, Unbehaun A, Kempfert J, Ribeiro HB, Kornowski R, Erlebach M, Bleiziffer S, Windecker S, Pilgrim T, Tomii D, Guerrero M, Ahmad Y, Forrest JK, Montorfano M, Ancona M, Adam M, Wienemann H, Finkelstein A, Villablanca P, Codner P, Hildick-Smith D, Ferrari E, Petronio AS, Shamekhi J, Presbitero P, Bruschi G, Rudolph T, Cerillo A, Attias D, Nejjari M, Abizaid A, Felippi de Sá Marchi M, Horlick E, Wijeysundera H, Andreas M, Thukkani A, Agrifoglio M, Iadanza A, Baer LM, Nanna MG, Dvir D. Clinical and Hemodynamic Outcomes of Balloon-Expandable Mitral Valve-in-Valve Positioning and Asymmetric Deployment: The VIVID Registry. JACC Cardiovasc Interv 2023; 16:2615-2627. [PMID: 37968032 DOI: 10.1016/j.jcin.2023.08.047] [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: 05/07/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND Mitral valve-in-valve (ViV) is associated with suboptimal hemodynamics and rare left ventricular outflow tract (LVOT) obstruction. OBJECTIVES This study aimed to determine whether device position and asymmetry are associated with these outcomes. METHODS Patients undergoing SAPIEN 3 (Edwards Lifesciences) mitral ViV included in the VIVID (Valve-in-Valve International Data) Registry were studied. Clinical endpoints are reported according to Mitral Valve Academic Research Consortium definitions. Residual mitral valve stenosis was defined as mean gradient ≥5 mm Hg. Depth of implantation (percentage of transcatheter heart valve [THV] atrial to the bioprosthesis ring) and asymmetry (ratio of 2 measures of THV height) were evaluated. RESULTS A total of 222 patients meeting the criteria for optimal core lab evaluation were studied (age 74 ± 11.6 years; 61.9% female; STS score = 8.3 ± 7.1). Mean asymmetry was 6.2% ± 4.4%. Mean depth of implantation was 19.0% ± 10.3% atrial. Residual stenosis was common (50%; mean gradient 5.0 ± 2.6 mm Hg). LVOT obstruction occurred in 7 cases (3.2%). Implantation depth was not a predictor of residual stenosis (OR: 1.19 [95% CI: 0.92-1.55]; P = 0.184), but more atrial implantation was protective against LVOT obstruction (0.7% vs 7.1%; P = 0.009; per 10% atrial, OR: 0.48 [95% CI: 0.24-0.98]; P = 0.044). Asymmetry was found to be an independent predictor of residual stenosis (per 10% increase, OR: 2.30 [95% CI: 1.10-4.82]; P = 0.027). CONCLUSIONS Valve stenosis is common after mitral ViV. Asymmetry was associated with residual stenosis. Depth of implantation on its own was not associated with residual stenosis but was associated with LVOT obstruction. Technical considerations to reduce postdeployment THV asymmetry should be considered.
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Affiliation(s)
- Matheus Simonato
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | | | - Axel Unbehaun
- Deutsches Herzzentrum der Charité, Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung, Berlin, Germany; Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Henrique B Ribeiro
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Sabine Bleiziffer
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | | | | | | | | | - Yousif Ahmad
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - John K Forrest
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | | | - Marco Ancona
- IRCCS Ospedale San Raffaele, Milan, Italy; School of Medicine, Vita Salute San Raffaele University, Milan, Italy
| | - Matti Adam
- Universitätsklinikum Köln, Cologne, Germany
| | | | | | | | | | | | | | | | | | | | | | - Tanja Rudolph
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | | | - David Attias
- Centre Cardiologique du Nord, Saint-Denis, France
| | | | - Alexandre Abizaid
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Eric Horlick
- Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| | | | | | | | | | | | | | - Michael G Nanna
- Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Danny Dvir
- Department of Cardiology, Shaare Zedek Medical Centre, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
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Avvedimento M, Campelo-Parada F, Munoz-Garcia E, Nombela-Franco L, Fischer Q, Donaint P, Serra V, Veiga G, Gutiérrez E, Esposito G, Vilalta V, Alperi A, Regueiro A, Asmarats L, Ribeiro HB, Matta A, Munoz-Garcia A, Tirado-Conte G, Urena M, Metz D, Rodenas-Alesina E, de la Torre Hernandez JM, Fernandez-Nofrerias E, Pascual I, Vidal-Cales P, Arzamendi D, Campanha-Borges DC, Trinh KH, Côté M, Faroux L, Rodés-Cabau J. Late Bleeding Events in Patients Undergoing Percutaneous Coronary Intervention in the Workup Pre-TAVR. JACC Cardiovasc Interv 2023; 16:2153-2164. [PMID: 37704301 DOI: 10.1016/j.jcin.2023.06.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND In patients undergoing percutaneous coronary intervention (PCI) in the work-up pre-transcatheter aortic valve replacement (TAVR), the incidence and clinical impact of late bleeding events (LBEs) remain largely unknown. OBJECTIVES This study sought to determine the incidence, clinical characteristics, associated factors, and outcomes of LBEs in patients undergoing PCI in the work-up pre-TAVR. METHODS This was a multicenter study including 1,457 consecutive patients (mean age 81 ± 7 years; 41.5% women) who underwent TAVR and survived beyond 30 days. LBEs (>30 days post-TAVR) were defined according to the Valve Academic Research Consortium-2 criteria. RESULTS LBEs occurred in 116 (7.9%) patients after a median follow-up of 23 (IQR: 12-40) months. Late bleeding was minor, major, and life-threatening or disabling in 21 (18.1%), 63 (54.3%), and 32 (27.6%) patients, respectively. Periprocedural (<30 days post-TAVR) major bleeding and the combination of antiplatelet and anticoagulation therapy at discharge were independent factors associated with LBEs (P ≤ 0.02 for all). LBEs conveyed an increased mortality risk at 4-year follow-up compared with no bleeding (43.9% vs 36.0; P = 0.034). Also, LBE was identified as an independent predictor of all-cause mortality after TAVR (HR: 1.39; 95% CI: 1.05-1.83; P = 0.020). CONCLUSIONS In TAVR candidates with concomitant significant coronary artery disease requiring percutaneous treatment, LBEs after TAVR were frequent and associated with increased mortality. Combining antiplatelet and anticoagulation regimens and the occurrence of periprocedural bleeding determined an increased risk of LBEs. Preventive strategies should be pursued for preventing late bleeding after TAVR, and further studies are needed to provide more solid evidence on the most safe and effective antithrombotic regimen post-TAVR in this challenging group of patients.
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Affiliation(s)
- Marisa Avvedimento
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Erika Munoz-Garcia
- Cardiology Department, Hospital Universitario Virgen de la Victoria, Málaga, CIBERCV, Spain
| | - Luis Nombela-Franco
- Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico de San Carlos, Madrid, Spain
| | - Quentin Fischer
- Cardiology Department, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Donaint
- Cardiology Department, Reims University Hospital, Reims, France
| | - Vicenç Serra
- Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Gabriela Veiga
- Cardiology Department, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | | | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Victoria Vilalta
- Cardiology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Alberto Alperi
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ander Regueiro
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - Lluis Asmarats
- Cardiology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Henrique B Ribeiro
- Cardiology Department, Heart Institute, University of São Paulo, São Paulo, Brazil
| | - Anthony Matta
- Cardiology Department, Hôpital Rangueil, CHU Toulouse, Toulouse, France
| | - Antonio Munoz-Garcia
- Cardiology Department, Hospital Universitario Virgen de la Victoria, Málaga, CIBERCV, Spain
| | - Gabriela Tirado-Conte
- Cardiology Department, Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico de San Carlos, Madrid, Spain
| | - Marina Urena
- Cardiology Department, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Damien Metz
- Cardiology Department, Reims University Hospital, Reims, France
| | | | | | | | - Isaac Pascual
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Pablo Vidal-Cales
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain
| | - Dabit Arzamendi
- Cardiology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Kim Hoang Trinh
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mélanie Côté
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Laurent Faroux
- Cardiology Department, Reims University Hospital, Reims, France
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Spain.
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Ramos SLLM, Carvalho BR, Monteiro Lobato RL, Ribeiro-Soares J, Fantini C, Ribeiro HB, Molino L, Plumadore R, Heinz T, Luican-Mayer A, Pimenta MA. Selective Electron-Phonon Coupling in Dimerized 1T-TaS 2 Revealed by Resonance Raman Spectroscopy. ACS Nano 2023; 17:15883-15892. [PMID: 37556765 DOI: 10.1021/acsnano.3c03902] [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] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
The layered transition-metal dichalcogenide material 1T-TaS2 possesses successive phase transitions upon cooling, resulting in strong electron-electron correlation effects and the formation of charge density waves (CDWs). Recently, a dimerized double-layer stacking configuration was shown to form a Peierls-like instability in the electronic structure. To date, no direct evidence for this double-layer stacking configuration using optical techniques has been reported, in particular through Raman spectroscopy. Here, we employ a multiple excitation and polarized Raman spectroscopy to resolve the behavior of phonons and electron-phonon interactions in the commensurate CDW lattice phase of dimerized 1T-TaS2. We observe a distinct behavior from what is predicted for a single layer and probe a richer number of phonon modes that are compatible with the formation of double-layer units (layer dimerization). The multiple-excitation results show a selective coupling of each Raman-active phonon with specific electronic transitions hidden in the optical spectra of 1T-TaS2, suggesting that selectivity in the electron-phonon coupling must also play a role in the CDW order of 1T-TaS2.
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Affiliation(s)
- Sergio L L M Ramos
- Centro de Tecnologia em Nanomateriais e Grafeno (CTNano), Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 30123-970, Brazil
| | - Bruno R Carvalho
- Departamento de Física, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte 59078-970, Brazil
| | | | - Jenaina Ribeiro-Soares
- Departamento de Física, Universidade Federal de Lavras, Campus Universitário, PO Box 3037, Lavras, Minas Gerais 37200-000, Brazil
| | - Cristiano Fantini
- Departamento de Física, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 30123-970, Brazil
| | - Henrique B Ribeiro
- Department of Applied Physics, Stanford University, Stanford, California 94305, United States
| | - Laurent Molino
- Department of Physics, University of Ottawa, Ottawa, Ontario K1N6N5, Canada
| | - Ryan Plumadore
- Department of Physics, University of Ottawa, Ottawa, Ontario K1N6N5, Canada
| | - Tony Heinz
- Department of Applied Physics, Stanford University, Stanford, California 94305, United States
| | - Adina Luican-Mayer
- Department of Physics, University of Ottawa, Ottawa, Ontario K1N6N5, Canada
| | - Marcos A Pimenta
- Centro de Tecnologia em Nanomateriais e Grafeno (CTNano), Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 30123-970, Brazil
- Departamento de Física, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 30123-970, Brazil
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Kanhouche G, Ribeiro HB. The Forgotten Valve is not to be Forgiven: Tricuspid Regurgitation Impact on Clinical Outcomes after Transcatheter Aortic Valve Implantation. Arq Bras Cardiol 2023; 120:e20230410. [PMID: 37585899 PMCID: PMC10421601 DOI: 10.36660/abc.20230410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Affiliation(s)
- Gabriel Kanhouche
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
| | - Henrique B. Ribeiro
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasilInstituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP – Brasil
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7
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Calomeni PAKB, Carvalho LVR, Melo P, Gauza MDM, Silva RRE, Cardoso R, Ribeiro HB. IMPACT OF TRICUSPID REGURGITATION ON MORTALITY: A META-ANALYSIS OF KAPLAN-MEIERDERIVED INDIVIDUAL PATIENT DATA. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02447-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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8
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Fukui M, Annabi MS, Rosa VEE, Ribeiro HB, Stanberry LI, Clavel MA, Rodés-Cabau J, Tarasoutchi F, Schelbert EB, Bergler-Klein J, Bartko PE, Dona C, Mascherbauer J, Dahou A, Rochitte CE, Pibarot P, Cavalcante JL. Comprehensive myocardial characterization using cardiac magnetic resonance associates with outcomes in low gradient severe aortic stenosis. Eur Heart J Cardiovasc Imaging 2022; 24:46-58. [PMID: 35613021 DOI: 10.1093/ehjci/jeac089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 12/24/2022] Open
Abstract
AIMS This study sought to compare cardiac magnetic resonance (CMR) characteristics according to different flow/gradient patterns of aortic stenosis (AS) and to evaluate their prognostic value in patients with low-gradient AS. METHODS AND RESULTS This international prospective multicentric study included 147 patients with low-gradient moderate to severe AS who underwent comprehensive CMR evaluation of left ventricular global longitudinal strain (LVGLS), extracellular volume fraction (ECV), and late gadolinium enhancement (LGE). All patients were classified as followings: classical low-flow low-gradient (LFLG) [mean gradient (MG) < 40 mmHg and left ventricular ejection fraction (LVEF) < 50%]; paradoxical LFLG [MG < 40 mmHg, LVEF ≥ 50%, and stroke volume index (SVi) < 35 ml/m2]; and normal-flow low-gradient (MG < 40 mmHg, LVEF ≥ 50%, and SVi ≥ 35 ml/m2). Patients with classical LFLG (n = 90) had more LV adverse remodelling including higher ECV, and higher LGE and volume, and worst LVGLS. Over a median follow-up of 2 years, 43 deaths and 48 composite outcomes of death or heart failure hospitalizations occurred. Risks of adverse events increased per tertile of LVGLS: hazard ratio (HR) = 1.50 [95% CI, 1.02-2.20]; P = 0.04 for mortality; HR = 1.45 [1.01-2.09]; P < 0.05 for composite outcome; per tertile of ECV, HR = 1.63 [1.07-2.49]; P = 0.02 for mortality; HR = 1.54 [1.02-2.33]; P = 0.04 for composite outcome. LGE presence also associated with higher mortality, HR = 2.27 [1.01-5.11]; P < 0.05 and composite outcome, HR = 3.00 [1.16-7.73]; P = 0.02. The risk of mortality and the composite outcome increased in proportion to the number of impaired components (i.e. LVGLS, ECV, and LGE) with multivariate adjustment. CONCLUSIONS In this international prospective multicentric study of low-gradient AS, comprehensive CMR assessment provides independent prognostic value that is cumulative and incremental to clinical and echocardiographic characteristics.
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Affiliation(s)
- Miho Fukui
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, 920 E 28th Street, Suite 100, 55407 Minneapolis, MN, USA
| | - Mohamed-Salah Annabi
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Québec, Canada
| | - Vitor E E Rosa
- Heart Institute of Sao Paulo (InCor), University of Sao Paulo, Sao Paulo, Brazil
| | - Henrique B Ribeiro
- Heart Institute of Sao Paulo (InCor), University of Sao Paulo, Sao Paulo, Brazil
| | - Larissa I Stanberry
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, 920 E 28th Street, Suite 100, 55407 Minneapolis, MN, USA
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Québec, Canada
| | - Josep Rodés-Cabau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Québec, Canada
| | - Flavio Tarasoutchi
- Heart Institute of Sao Paulo (InCor), University of Sao Paulo, Sao Paulo, Brazil
| | - Erik B Schelbert
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jutta Bergler-Klein
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Philipp E Bartko
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Carolina Dona
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Julia Mascherbauer
- Department of Internal Medicine 3, Karl Landsteiner University of Health Sciences, University Hospital St. Pölten, Krems, Austria
| | | | - Carlos E Rochitte
- Heart Institute of Sao Paulo (InCor), University of Sao Paulo, Sao Paulo, Brazil
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, Québec, Canada
| | - João L Cavalcante
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, 920 E 28th Street, Suite 100, 55407 Minneapolis, MN, USA
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9
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Chiang HP, Aguiar MOD, Tavares BG, Rosa VEE, Gomes SB, Oliveira MT, Soeiro A, Nicolau JC, Ribeiro HB, Sbano JC, Rochitte CE, Filho RK, Ramires JAF, Porter TR, Mathias W, Tsutsui JM. The Impact of Sonothrombolysis on Left Ventricular Diastolic Function and Left Atrial Mechanics Preventing Left Atrial Remodeling in Patients With ST Elevation Acute Myocardial Infarction. J Am Soc Echocardiogr 2022; 36:504-513. [PMID: 36535625 DOI: 10.1016/j.echo.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 12/01/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The diagnostic ultrasound-guided high mechanical index impulses during an intravenous microbubble infusion (sonothrombolysis) improve myocardial perfusion in acute ST segment elevation myocardial infarction, but its effect on left ventricular diastolic dysfunction (DD), left atrial (LA) mechanics and remodeling is unknown. We assessed the effect of sonothrombolysis on DD grade and LA mechanics. METHODS One hundred patients (59 ± 10 years; 34% women) were randomized to receive either high mechanical index impulses plus percutaneous coronary intervention (PCI) (therapy group) or PCI only (control group) (n = 50 in each group). Diastolic dysfunction grade and LA mechanics were assessed immediately before and after PCI and at 48 to 72 hours, 1 month, and 6 months of follow-up. Diastolic dysfunction grades were classified as grades I, II, and III. The LA mechanics was obtained by two-dimensional speckle-tracking echocardiography-derived global longitudinal strain (GLS). RESULTS As follow-up time progressed, increased DD grade was observed more frequently in the control group than in the therapy group at 1 month and 6 months of follow-up (all P < .05). The LA-GLS values were incrementally higher in the therapy group when compared with the control group at 48 to 72 hours, 24.0% ± 7.3% in the therapy group versus 19.6% ± 7.2% in the control group, P = .005; at 1 month, 25.3% ± 6.3% in the therapy group versus 21.5% ± 8.3% in the control group, P = .020; and at 6 months, 26.2% ± 8.7% in the therapy group versus 21.6% ± 8.5% in the control group, P = .015. The therapy group was less likely to experience LA remodeling (odds ratio, 2.91 [1.10-7.73]; P = .03). LA-GLS was the sole predictor of LA remodeling (odds ratio, 0.79 [0.67-0.94]; P = .006). CONCLUSION Sonothrombolysis is associated with better DD grade and LA mechanics, reducing LA remodeling.
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Affiliation(s)
- Hsu Po Chiang
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; Fleury Group, São Paulo, Brazil.
| | - Miguel O D Aguiar
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; Fleury Group, São Paulo, Brazil
| | - Bruno G Tavares
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; Fleury Group, São Paulo, Brazil
| | - Vitor E E Rosa
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Sergio Barros Gomes
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Mucio T Oliveira
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Alexandre Soeiro
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Jose C Nicolau
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Henrique B Ribeiro
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - João C Sbano
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; Fleury Group, São Paulo, Brazil
| | - Carlos E Rochitte
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Roberto Kalil Filho
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Jose A F Ramires
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | | | - Wilson Mathias
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; Fleury Group, São Paulo, Brazil
| | - Jeane M Tsutsui
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; Fleury Group, São Paulo, Brazil
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10
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Nicz P, Freire AFD, Filippini FB, Kanhouche G, Accorsi TAD, Ribeiro HB, Liberato G, Nomura CH, Cassar RS, Vieira ML, Mathias Jr W, Pomerantzeff PMA, Tarasoutchi F, Abizaid A, De Brito Jr FS. Transcatheter aortic valve implantation without contrast media technique in chronic kidney disease population – pilot study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2102] [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/Introduction
Acute Kidney Injury (AKI) is frequently observed after Transcatheter aortic valve implantation (TAVI), with rates ranging from 3% to 50%. In the Brazilian TAVI Registry, the incidence of AKI following TAVI was 18%, with 4.5% requiring dialysis. Its occurrence is associated with an increase in 3-fold all-cause and cardiac death. Since AKI is related to the volume of contrast media, avoiding contrast during TAVI procedure is advisable, especially in chronic kidney disease (CKD) patients.
Purpose
The aims of the proposed study are to: (1) evaluate the feasibility and safety of a zero-contrast technique for CKD patients undergoing TAVI and (2) define the role of each of the non-contrast imaging modalities in the preoperative assessment for TAVI and (3) evaluate the incidence of AKI post-TAVI in this population.
Methods
Patients with severe symptomatic aortic stenosis (AS) and CKD stage ≥3a where evaluated for TAVI with four preoperative exams: transesophageal echocardiogram (TEE), cardiac magnetic resonance, contrast and noncontrast computed tomography (MDCT) and aortoiliac co2 angiography. After safety measures of transfemoral (TF) viability and aortic valve favorable anatomy, patients were submitted to TF-TAVI with self-expandable Evolut R/Pro. The contrast MDCT was blinded to the operators and it is checked before the procedure, at a safety checkpoint, to exclude high-risk conditions not detected by non-contrast methods. During the procedure, another safety checkpoint was accomplished. Clinical and echocardiographic outcomes were assessed at 30 days.
Results
Between december 2020 to december 2021, a total of 25 patients underwent TF TAVI with zero-contrast technique. Mean age of 79.9±6.1 years, 52% male, 18 patients (72%) NYHA functional class III or IV, mean STS-PROM 3.0±1.5%, 12% had severe systolic dysfunction (left ventricle ejection fraction <35%) and mean creatinine clearance of 49.1±7 mL/min. Self-expandable Evolut R was implanted in 80% of patients and Evolut Pro in 20% of them, the most frequent THV size was 29 mm (52%) and the mean implant depth was 6 mm in fluoroscopy and 4.5 mm in TEE. The mean procedural time was 138±56 minutes, with a median radiation dose of 6.6 mGy/cm2 [IQR, 2–6 mGy]. Definitive pacemaker was implanted in 17% of patients and AKI was seen in 6 patients (24%), with stage I (20%), stage II (4%) and no case needed hemodialysis. At 30 days, 84% were at functional class I, there was no death, one embolization requiring a second valve and the rate of device success (VARC-2) was 92%.
Conclusion
The proposed pilot study for transfemoral TAVI in CKD population with zero contrast technique was safe, with promising results and similar rates of success and complication, compared with the conventional TAVI approach.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): MedtronicAngiodroid
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Affiliation(s)
- P Nicz
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - A F D Freire
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - F B Filippini
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - G Kanhouche
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - T A D Accorsi
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - H B Ribeiro
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - G Liberato
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - C H Nomura
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - R S Cassar
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - M L Vieira
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - W Mathias Jr
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - P M A Pomerantzeff
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - F Tarasoutchi
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - A Abizaid
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - F S De Brito Jr
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
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11
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McInerney A, Rodés-Cabau J, Veiga G, López-Otero D, Muñoz-García E, Campelo-Parada F, Oteo JF, Carnero M, Tafur Soto JD, Amat-Santos IJ, Travieso A, Mohammadi S, Barbanti M, Cheema AN, Toggweiler S, Saia F, Dabrowski M, Serra V, Alfonso F, Ribeiro HB, Regueiro A, Alpieri A, Gil Ongay A, Martinez-Cereijo JM, Muñoz-García A, Matta A, Arellano Serrano C, Barrero A, Tirado-Conte G, Gonzalo N, Sanmartin XC, de la Torre Hernandez JM, Kalavrouziotis D, Maroto L, Forteza-Gil A, Cobiella J, Escaned J, Nombela-Franco L. Transcatheter versus surgical aortic valve replacement in patients with morbid obesity: a multicentre propensity score-matched analysis. EUROINTERVENTION 2022; 18:e417-e427. [PMID: 35321860 PMCID: PMC10241265 DOI: 10.4244/eij-d-21-00891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Morbidly obese (MO) patients are increasingly undergoing transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS). However, the best therapeutic strategy for these patients remains a matter for debate. AIMS Our aim was to compare the periprocedural and mid-term outcomes in MO patients undergoing TAVR versus SAVR. METHODS A multicentre retrospective study including consecutive MO patients (body mass index ≥40 kg/m2, or ≥35 kg/m2 with obesity-related comorbidities) from 18 centres undergoing either TAVR (n=860) or biological SAVR (n=696) for severe AS was performed. Propensity score matching resulted in 362 pairs. RESULTS After matching, periprocedural complications, including blood transfusion (14.1% versus 48.1%; p<0.001), stage 2-3 acute kidney injury (3.99% versus 10.1%; p=0.002), hospital-acquired pneumonia (1.7% versus 5.8%; p=0.005) and access site infection (1.5% versus 5.5%; p=0.013), were more common in the SAVR group, as was moderate to severe patient-prosthesis mismatch (PPM; 9.9% versus 39.4%; p<0.001). TAVR patients more frequently required permanent pacemaker implantation (14.4% versus 5.6%; p<0.001) and had higher rates of ≥moderate residual aortic regurgitation (3.3% versus 0%; p=0.001). SAVR was an independent predictor of moderate to severe PPM (hazard ratio [HR] 1.80, 95% confidence interval [CI]: 1.25-2.59; p=0.002), while TAVR was not. In-hospital mortality was not different between groups (3.9% for TAVR versus 6.1% for SAVR; p=0.171). Two-year outcomes (including all-cause and cardiovascular mortality, and readmissions) were similar in both groups (log-rank p>0.05 for all comparisons). Predictors of all-cause 2-year mortality differed between the groups; moderate to severe PPM was a predictor following SAVR (HR 1.78, 95% CI: 1.10-2.88; p=0.018) but not following TAVR (p=0.737). CONCLUSIONS SAVR and TAVR offer similar mid-term outcomes in MO patients with severe AS, however, TAVR offers some advantages in terms of periprocedural morbidity.
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Affiliation(s)
- Angela McInerney
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Gabriela Veiga
- Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - Diego López-Otero
- Hospital Clínico Universitario de Santiago, CIBERCV, Santiago, Spain
| | - Erika Muñoz-García
- CIBERCV Cardiology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | | | - Juan F Oteo
- Department of Cardiology and Cardiac Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Manuel Carnero
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - José D Tafur Soto
- The Ochsner Clinical School, Ochsner Medical Center, New Orleans, LA, USA
| | - Ignacio J Amat-Santos
- CIBERCV, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Alejandro Travieso
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Asim N Cheema
- Division of Cardiology, St. Michael's Hospital, Toronto University, Toronto, Ontario, Canada
| | | | - Francesco Saia
- Cardiology Unit, Cardio-Thoracic-Vascular Department, University Hospital of Bologna, Bologna, Italy
| | - Maciej Dabrowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Vicenç Serra
- Hospital General Universitari Vall d'Hebrón, Barcelona, Spain
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario La Princesa, IIS-IP, CIBER-CV, Madrid, Spain
| | | | - Ander Regueiro
- Cardiology Department, Cardiovascular Institute, Hospital Clínic, Universidad de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Alberto Alpieri
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Aritz Gil Ongay
- Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | | | - Antonio Muñoz-García
- CIBERCV Cardiology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Anthony Matta
- Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - Carlos Arellano Serrano
- Department of Cardiology and Cardiac Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Alejandro Barrero
- CIBERCV, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Nieves Gonzalo
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Xoan C Sanmartin
- Hospital Clínico Universitario de Santiago, CIBERCV, Santiago, Spain
| | | | | | - Luis Maroto
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Alberto Forteza-Gil
- Department of Cardiology and Cardiac Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Javier Cobiella
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Javier Escaned
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
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12
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Panagides V, del Val D, Abdel-Wahab M, Mangner N, Durand E, Ihlemann N, Urena M, Pellegrini C, Giannini F, Scislo P, Huczek Z, Landt M, Auffret V, Sinning JM, Cheema AN, Nombela-Franco L, Chamandi C, Campelo-Parada F, Munoz-Garcia E, Herrmann HC, Testa L, Kim WK, Castillo JC, Alperi A, Tchetche D, Bartorelli AL, Kapadia S, Stortecky S, Amat-Santos I, Wijeysundera HC, Lisko J, Gutiérrez-Ibanes E, Serra V, Salido L, Alkhodair A, Livi U, Chakravarty T, Lerakis S, Vilalta V, Regueiro A, Romaguera R, Kappert U, Barbanti M, Masson JB, Maes F, Fiorina C, Miceli A, Kodali S, Ribeiro HB, Mangione JA, Brito FSD, Dato GMA, Rosato F, Ferreira MC, de Lima VC, Colafranceschi AS, Abizaid A, Marino MA, Esteves V, Andrea J, Godinho RR, Alfonso F, Eltchaninoff H, Søndergaard L, Himbert D, Husser O, Latib A, Breton HL, Servoz C, Pascual I, Siddiqui S, Olivares P, Hernandez-Antolin R, Webb JG, Sponga S, Makkar R, Kini AS, Boukhris M, Gervais P, Linke A, Crusius L, Holzhey D, Rodés-Cabau J. Mitral Valve Infective Endocarditis after Trans-Catheter Aortic Valve Implantation. Am J Cardiol 2022; 172:90-97. [PMID: 35387738 DOI: 10.1016/j.amjcard.2022.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/01/2022] [Accepted: 02/08/2022] [Indexed: 11/01/2022]
Abstract
Scarce data exist on mitral valve (MV) infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI). This multicenter study included a total of 579 patients with a diagnosis of definite IE after TAVI from the IE after TAVI International Registry and aimed to evaluate the incidence, characteristics, management, and outcomes of MV-IE after TAVI. A total of 86 patients (14.9%) had MV-IE. These patients were compared with 284 patients (49.1%) with involvement of the transcatheter heart valve (THV) only. Two factors were found to be associated with MV-IE: the use of self-expanding valves (adjusted odds ratio 2.49, 95% confidence interval [CI] 1.23 to 5.07, p = 0.012), and the presence of an aortic regurgitation ≥2 at discharge (adjusted odds ratio 3.33; 95% CI 1.43 to 7.73, p <0.01). There were no differences in IE timing and causative microorganisms between groups, but surgical management was significantly lower in patients with MV-IE (6.0%, vs 21.6% in patients with THV-IE, p = 0.001). All-cause mortality rates at 2-year follow-up were high and similar between patients with MV-IE (51.4%, 95% CI 39.8 to 64.1) and patients with THV-IE (51.5%, 95% CI 45.4 to 58.0) (log-rank p = 0.295). The factors independently associated with increased mortality risk in patients with MV-IE were the occurrence of heart failure (adjusted p <0.001) and septic shock (adjusted p <0.01) during the index hospitalization. One of 6 IE episodes after TAVI is localized on the MV. The implantation of a self-expanding THV and the presence of an aortic regurgitation ≥2 at discharge were associated with MV-IE. Patients with MV-IE were rarely operated on and had a poor prognosis at 2-year follow-up.
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13
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Barré E, Karni O, Liu E, O'Beirne AL, Chen X, Ribeiro HB, Yu L, Kim B, Watanabe K, Taniguchi T, Barmak K, Lui CH, Refaely-Abramson S, da Jornada FH, Heinz TF. Optical absorption of interlayer excitons in transition-metal dichalcogenide heterostructures. Science 2022; 376:406-410. [PMID: 35446643 DOI: 10.1126/science.abm8511] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Interlayer excitons, electron-hole pairs bound across two monolayer van der Waals semiconductors, offer promising electrical tunability and localizability. Because such excitons display weak electron-hole overlap, most studies have examined only the lowest-energy excitons through photoluminescence. We directly measured the dielectric response of interlayer excitons, which we accessed using their static electric dipole moment. We thereby determined an intrinsic radiative lifetime of 0.40 nanoseconds for the lowest direct-gap interlayer exciton in a tungsten diselenide/molybdenum diselenide heterostructure. We found that differences in electric field and twist angle induced trends in exciton transition strengths and energies, which could be related to wave function overlap, moiré confinement, and atomic reconstruction. Through comparison with photoluminescence spectra, this study identifies a momentum-indirect emission mechanism. Characterization of the absorption is key for applications relying on light-matter interactions.
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Affiliation(s)
- Elyse Barré
- SLAC National Accelerator Laboratory, Menlo Park, CA 94025, USA.,Department of Electrical Engineering, Stanford University, Stanford, CA 94305, USA
| | - Ouri Karni
- SLAC National Accelerator Laboratory, Menlo Park, CA 94025, USA.,Department of Applied Physics, Stanford University, Stanford, CA 94305, USA
| | - Erfu Liu
- Department of Physics and Astronomy, University of California, Riverside, CA 92521, USA
| | - Aidan L O'Beirne
- SLAC National Accelerator Laboratory, Menlo Park, CA 94025, USA.,Department of Physics, Stanford University, Stanford, CA 94305, USA
| | - Xueqi Chen
- Department of Physics, Stanford University, Stanford, CA 94305, USA
| | | | - Leo Yu
- Department of Applied Physics, Stanford University, Stanford, CA 94305, USA
| | - Bumho Kim
- Department of Mechanical Engineering, Columbia University, New York, NY 10027, USA
| | - Kenji Watanabe
- Research Center for Functional Materials, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan
| | - Takashi Taniguchi
- International Center for Materials Nanoarchitectonics, National Institute for Materials Science, 1-1 Namiki, Tsukuba, Ibaraki 305-0044, Japan
| | - Katayun Barmak
- Department of Applied Physics and Applied Mathematics, Columbia University, New York, NY 10027, USA
| | - Chun Hung Lui
- Department of Physics and Astronomy, University of California, Riverside, CA 92521, USA
| | - Sivan Refaely-Abramson
- Department of Molecular Chemistry and Materials Science, Weizmann Institute of Science, Rehovot 7610001, Israel
| | - Felipe H da Jornada
- Department of Materials Science and Engineering, Stanford University, Stanford, CA 94305, USA
| | - Tony F Heinz
- SLAC National Accelerator Laboratory, Menlo Park, CA 94025, USA.,Department of Applied Physics, Stanford University, Stanford, CA 94305, USA
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14
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Schué L, Goudreault FA, Righi A, Resende GC, Lefebvre V, Godbout É, Tie M, Ribeiro HB, Heinz TF, Pimenta MA, Côté M, Francœur S, Martel R. Visible Out-of-plane Polarized Luminescence and Electronic Resonance in Black Phosphorus. Nano Lett 2022; 22:2851-2858. [PMID: 35311277 DOI: 10.1021/acs.nanolett.1c04998] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Black phosphorus (BP) is unique among layered materials because of its homonuclear lattice and strong structural anisotropy. While recent investigations on few-layer BP have extensively explored the in-plane (a, c) anisotropy, much less attention has been given to the out-of-plane direction (b). Here, the optical response from bulk BP is probed using polarization-resolved photoluminescence (PL), photoluminescence excitation (PLE), and resonant Raman scattering along the zigzag, out-of-plane, and armchair directions. An unexpected b-polarized luminescence emission is detected in the visible, far above the fundamental gap. PLE indicates that this emission is generated through b-polarized excitation at 2.3 eV. The same electronic resonance is observed in resonant Raman with the enhancement of the Ag phonon modes scattering efficiency. These experimental results are fully consistent with DFT calculations of the permittivity tensor elements and demonstrate the remarkable extent to which the anisotropy influences the optical properties and carrier dynamics in black phosphorus.
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Affiliation(s)
- Léonard Schué
- Département de Chimie, Université de Montréal, Montréal, Québec H3C 3J7, Canada
- Département de Physique, Université de Montréal, Montréal, Québec H3C 3J7, Canada
| | - Félix A Goudreault
- Département de Physique, Université de Montréal, Montréal, Québec H3C 3J7, Canada
| | - Ariete Righi
- Departamento de Fìsica, Universidade Federal de Minas Gerais, Belo Horizonte 30123-970, Brazil
| | - Geovani C Resende
- Departamento de Fìsica, Universidade Federal de Minas Gerais, Belo Horizonte 30123-970, Brazil
| | - Valérie Lefebvre
- Département de Chimie, Université de Montréal, Montréal, Québec H3C 3J7, Canada
| | - Émile Godbout
- Département de Chimie, Université de Montréal, Montréal, Québec H3C 3J7, Canada
| | - Monique Tie
- Department of Applied Physics, Stanford University, Stanford, California 94305, United States
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, United States
| | - Henrique B Ribeiro
- Department of Applied Physics, Stanford University, Stanford, California 94305, United States
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, United States
| | - Tony F Heinz
- Department of Applied Physics, Stanford University, Stanford, California 94305, United States
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, United States
| | - Marcos A Pimenta
- Departamento de Fìsica, Universidade Federal de Minas Gerais, Belo Horizonte 30123-970, Brazil
| | - Michel Côté
- Département de Physique, Université de Montréal, Montréal, Québec H3C 3J7, Canada
| | - Sébastien Francœur
- Département de Génie Physique, École Polytechnique de Montréal, Montréal, Québec H3C 3A7, Canada
| | - Richard Martel
- Département de Chimie, Université de Montréal, Montréal, Québec H3C 3J7, Canada
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15
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Karni O, Barré E, Pareek V, Georgaras JD, Man MKL, Sahoo C, Bacon DR, Zhu X, Ribeiro HB, O'Beirne AL, Hu J, Al-Mahboob A, Abdelrasoul MMM, Chan NS, Karmakar A, Winchester AJ, Kim B, Watanabe K, Taniguchi T, Barmak K, Madéo J, da Jornada FH, Heinz TF, Dani KM. Structure of the moiré exciton captured by imaging its electron and hole. Nature 2022; 603:247-252. [PMID: 35264760 DOI: 10.1038/s41586-021-04360-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/14/2021] [Indexed: 11/09/2022]
Abstract
Interlayer excitons (ILXs) - electron-hole pairs bound across two atomically thin layered semiconductors - have emerged as attractive platforms to study exciton condensation1-4, single-photon emission and other quantum information applications5-7. Yet, despite extensive optical spectroscopic investigations8-12, critical information about their size, valley configuration and the influence of the moiré potential remains unknown. Here, in a WSe2/MoS2 heterostructure, we captured images of the time-resolved and momentum-resolved distribution of both of the particles that bind to form the ILX: the electron and the hole. We thereby obtain a direct measurement of both the ILX diameter of around 5.2 nm, comparable with the moiré-unit-cell length of 6.1 nm, and the localization of its centre of mass. Surprisingly, this large ILX is found pinned to a region of only 1.8 nm diameter within the moiré cell, smaller than the size of the exciton itself. This high degree of localization of the ILX is backed by Bethe-Salpeter equation calculations and demonstrates that the ILX can be localized within small moiré unit cells. Unlike large moiré cells, these are uniform over large regions, allowing the formation of extended arrays of localized excitations for quantum technology.
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Affiliation(s)
- Ouri Karni
- Department of Applied Physics, Stanford University, Stanford, CA, USA.,SLAC National Accelerator Laboratory, Menlo Park, CA, USA
| | - Elyse Barré
- SLAC National Accelerator Laboratory, Menlo Park, CA, USA.,Department of Electrical Engineering, Stanford University, Stanford, CA, USA
| | - Vivek Pareek
- Femtosecond Spectroscopy Unit, Okinawa Institute of Science and Technology Graduate University, Onna-son, Okinawa, Japan
| | - Johnathan D Georgaras
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA
| | - Michael K L Man
- Femtosecond Spectroscopy Unit, Okinawa Institute of Science and Technology Graduate University, Onna-son, Okinawa, Japan
| | - Chakradhar Sahoo
- Femtosecond Spectroscopy Unit, Okinawa Institute of Science and Technology Graduate University, Onna-son, Okinawa, Japan.,Tata Institute of Fundamental Research, Hyderabad, Gopanpally, Serlingampalli, Telangana, India
| | - David R Bacon
- Femtosecond Spectroscopy Unit, Okinawa Institute of Science and Technology Graduate University, Onna-son, Okinawa, Japan
| | - Xing Zhu
- Femtosecond Spectroscopy Unit, Okinawa Institute of Science and Technology Graduate University, Onna-son, Okinawa, Japan
| | | | - Aidan L O'Beirne
- SLAC National Accelerator Laboratory, Menlo Park, CA, USA.,Department of Physics, Stanford University, Stanford, CA, USA
| | - Jenny Hu
- Department of Applied Physics, Stanford University, Stanford, CA, USA
| | - Abdullah Al-Mahboob
- Femtosecond Spectroscopy Unit, Okinawa Institute of Science and Technology Graduate University, Onna-son, Okinawa, Japan
| | - Mohamed M M Abdelrasoul
- Femtosecond Spectroscopy Unit, Okinawa Institute of Science and Technology Graduate University, Onna-son, Okinawa, Japan
| | - Nicholas S Chan
- Femtosecond Spectroscopy Unit, Okinawa Institute of Science and Technology Graduate University, Onna-son, Okinawa, Japan
| | - Arka Karmakar
- Femtosecond Spectroscopy Unit, Okinawa Institute of Science and Technology Graduate University, Onna-son, Okinawa, Japan
| | - Andrew J Winchester
- Femtosecond Spectroscopy Unit, Okinawa Institute of Science and Technology Graduate University, Onna-son, Okinawa, Japan
| | - Bumho Kim
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| | - Kenji Watanabe
- Research Center for Functional Materials, National Institute for Materials Science, Tsukuba, Japan
| | - Takashi Taniguchi
- International Center for Materials Nanoarchitectonics, National Institute for Materials Science, Tsukuba, Japan
| | - Katayun Barmak
- Department of Applied Physics and Applied Mathematics, Columbia University, New York, NY, USA
| | - Julien Madéo
- Femtosecond Spectroscopy Unit, Okinawa Institute of Science and Technology Graduate University, Onna-son, Okinawa, Japan
| | - Felipe H da Jornada
- Department of Materials Science and Engineering, Stanford University, Stanford, CA, USA
| | - Tony F Heinz
- Department of Applied Physics, Stanford University, Stanford, CA, USA.,SLAC National Accelerator Laboratory, Menlo Park, CA, USA
| | - Keshav M Dani
- Femtosecond Spectroscopy Unit, Okinawa Institute of Science and Technology Graduate University, Onna-son, Okinawa, Japan.
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16
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Teixeira PS, Campos C, de Ribamar Costa J, Ribeiro HB, Mangione JA, Oliveira M, Freitas B, Cade JR, Fiorotto WB, Da Silva A, Da Costa DS, Zuwoski C, de Carvalho Cantarelli MJ, Rocha G, Lemos P, Franken M, Almeida B. SPONTANEOUS CORONARY ARTERY DISSECTION. DEMOGRAPHIC AND ANGIOGRAPHIC CHARACTERISTICS FINDINGS IN THE SCALIBUR BRAZILIAN REGISTRY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)04464-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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17
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Mangner N, del Val D, Abdel-Wahab M, Crusius L, Durand E, Ihlemann N, Urena M, Pellegrini C, Giannini F, Gasior T, Wojakowski W, Landt M, Auffret V, Sinning JM, Cheema AN, Nombela-Franco L, Chamandi C, Campelo-Parada F, Munoz-Garcia E, Herrmann HC, Testa L, Kim WK, Castillo JC, Alperi A, Tchetche D, Bartorelli AL, Kapadia S, Stortecky S, Amat-Santos I, Wijeysundera HC, Lisko J, Gutiérrez-Ibanes E, Serra V, Salido L, Alkhodair A, Livi U, Chakravarty T, Lerakis S, Vilalta V, Regueiro A, Romaguera R, Kappert U, Barbanti M, Masson JB, Maes F, Fiorina C, Miceli A, Kodali S, Ribeiro HB, Mangione JA, Sandoli de Brito F, Actis Dato GM, Rosato F, Ferreira MC, Correia de Lima V, Colafranceschi AS, Abizaid A, Marino MA, Esteves V, Andrea J, Godinho RR, Alfonso F, Eltchaninoff H, Søndergaard L, Himbert D, Husser O, Latib A, Le Breton H, Servoz C, Pascual I, Siddiqui S, Olivares P, Hernandez-Antolin R, Webb JG, Sponga S, Makkar R, Kini AS, Boukhris M, Gervais P, Côté M, Holzhey D, Linke A, Rodés-Cabau J. Surgical Treatment of Patients With Infective Endocarditis After Transcatheter Aortic Valve Implantation. J Am Coll Cardiol 2022; 79:772-785. [PMID: 35210032 DOI: 10.1016/j.jacc.2021.11.056] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 10/18/2021] [Accepted: 11/22/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The optimal treatment of patients developing infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is uncertain. OBJECTIVES The goal of this study was to investigate the clinical characteristics and outcomes of patients with TAVI-IE treated with cardiac surgery and antibiotics (IE-CS) compared with patients treated with antibiotics alone (IE-AB). METHODS Crude and inverse probability of treatment weighting analyses were applied for the treatment effect of cardiac surgery vs medical therapy on 1-year all-cause mortality in patients with definite TAVI-IE. The study used data from the Infectious Endocarditis after TAVI International Registry. RESULTS Among 584 patients, 111 patients (19%) were treated with IE-CS and 473 patients (81%) with IE-AB. Compared with IE-AB, IE-CS was not associated with a lower in-hospital mortality (HRunadj: 0.85; 95% CI: 0.58-1.25) and 1-year all-cause mortality (HRunadj: 0.88; 95% CI: 0.64-1.22) in the crude cohort. After adjusting for selection and immortal time bias, IE-CS compared with IE-AB was also not associated with lower mortality rates for in-hospital mortality (HRadj: 0.92; 95% CI: 0.80-1.05) and 1-year all-cause mortality (HRadj: 0.95; 95% CI: 0.84-1.07). Results remained similar when patients with and without TAVI prosthesis involvement were analyzed separately. Predictors for in-hospital and 1-year all-cause mortality included logistic EuroSCORE I, Staphylococcus aureus, acute renal failure, persistent bacteremia, and septic shock. CONCLUSIONS In this registry, the majority of patients with TAVI-IE were treated with antibiotics alone. Cardiac surgery was not associated with an improved all-cause in-hospital or 1-year mortality. The high mortality of patients with TAVI-IE was strongly linked to patients' characteristics, pathogen, and IE-related complications.
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Affiliation(s)
- Norman Mangner
- Herzzentrum Dresden, Technische Universität Dresden, Germany. https://twitter.com/NormanMangner
| | - David del Val
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada. https://twitter.com/David_delVal_
| | - Mohamed Abdel-Wahab
- Heart Center, Leipzig University, Leipzig, Germany; Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Lisa Crusius
- Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Eric Durand
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | | | | | | | - Francesco Giannini
- Ospedale San Raffaele, Milan, Italy; Maria Cecilia Hospital, GVM Care and Research, Cotignola RA, Italy
| | - Tomasz Gasior
- Herzzentrum Dresden, Technische Universität Dresden, Germany
| | | | - Martin Landt
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Vincent Auffret
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR1099, F 35000 Rennes, France
| | | | - Asim N Cheema
- St. Michaels Hospital, Toronto, Ontario, Canada; Southlake Hospital, Newmarket, Ontario, Canada
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | | | | | - Howard C Herrmann
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Won-Keun Kim
- Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | | | - Alberto Alperi
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Milan, Italy
| | | | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (on behalf of Swiss TAVI)
| | | | | | - John Lisko
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Enrique Gutiérrez-Ibanes
- Instituto de Investigación Universitaria Gregorio Marañon, Hospital Gregorio Marañon, Madrid, Spain
| | | | - Luisa Salido
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Stamatios Lerakis
- Emory University School of Medicine, Atlanta, Georgia, USA; Mount Sinai Hospital, New York, New York, USA
| | | | | | | | - Utz Kappert
- Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Marco Barbanti
- A.O.U. Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | | | - Frédéric Maes
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Antonio Miceli
- Istituto Clinico Sant'Ambrogio, Milan, Italy; University Hospital Galway, Galway, Ireland
| | - Susheel Kodali
- Columbia University Medical Center, New York, New York, USA
| | - Henrique B Ribeiro
- InCor, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil; Hospital Samaritano Paulista, São Paulo, Brazil
| | | | | | | | | | | | | | | | - Alexandre Abizaid
- InCor, Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | | | | | | | | | | | - Helene Eltchaninoff
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | | | | | - Oliver Husser
- Deutsches Herzzentrum München, Munich, Germany; St.-Johannes Hospital, Dortmund, Germany
| | - Azeem Latib
- Ospedale San Raffaele, Milan, Italy; Montefiore Medical Center, New York, New York, USA
| | - Hervé Le Breton
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR1099, F 35000 Rennes, France
| | | | - Isaac Pascual
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Paolo Olivares
- Centro Cardiologico Monzino, IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Milan, Italy
| | | | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Raj Makkar
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | | | - Marouane Boukhris
- Centre Hospitalier de l'Université de Montreal, Montreal, Quebec, Canada
| | - Philippe Gervais
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mélanie Côté
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Axel Linke
- Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada; Hospital Clinic Barcelona, Barcelona, Spain.
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18
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de Azevedo Filho AF, Accorsi TA, Ribeiro HB. Coronary Artery Disease in Patients with Aortic Stenosis and Transcatheter Aortic Valve Implantation: Implications for Management. Eur Cardiol 2021; 16:e49. [PMID: 34950245 PMCID: PMC8674631 DOI: 10.15420/ecr.2021.27] [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] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/16/2021] [Indexed: 01/09/2023] Open
Abstract
Aortic valve stenosis (AS) is the most common valvular heart disease among elderly patients. Since the pathophysiology of degenerative AS shares common pathways with atherosclerotic disease, the severity of AS in the elderly population is often concurrent to the presence of coronary artery disease (CAD). Although surgical aortic valve replacement has been the standard treatment for severe AS, the high operative morbidity and mortality in complex and fragile patients was the trigger to develop less invasive techniques. Transcatheter aortic valve implantation (TAVI) has been posed as the standard of care for elderly patients with severe AS with various risk profiles, which has meant that the concomitant management of CAD has become a crucial issue in such patients. Given the lack of randomised controlled trials evaluating the management of CAD in TAVI patients, most of the recommendations are based on retrospective cohort studies so that the Heart Team approach – together with an assessment of multiple parameters including symptoms and clinical characteristics, invasive and non-invasive ischaemic burden and anatomy – are crucial for the proper management of these patients. This article provides a review of current knowledge about assessment and therapeutic approaches for CAD and severe AS in patients undergoing TAVI.
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Affiliation(s)
| | - Tarso Ad Accorsi
- Department of Valvular Heart Disease, Heart Institute (InCor), University of São Paulo São Paulo, Brazil.,Samaritano Paulista Hospital São Paulo, Brazil
| | - Henrique B Ribeiro
- Samaritano Paulista Hospital São Paulo, Brazil.,Interventional Cardiology Department, Heart Institute (InCor), University of São Paulo São Paulo, Brazil
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19
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Pimenta MA, Resende GC, Ribeiro HB, Carvalho BR. Polarized Raman spectroscopy in low-symmetry 2D materials: angle-resolved experiments and complex number tensor elements. Phys Chem Chem Phys 2021; 23:27103-27123. [PMID: 34859800 DOI: 10.1039/d1cp03626b] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
In this perspective review, we discuss the power of polarized Raman spectroscopy to study optically anisotropic 2D materials, belonging to the orthorhombic, monoclinic and triclinic crystal families. We start by showing that the polarization dependence of the peak intensities is described by the Raman tensor that is unique for each phonon mode, and then we discuss how to determine the tensor elements from the angle-resolved polarized measurements by analyzing the intensities in both the parallel- and cross-polarized scattering configurations. We present specific examples of orthorhombic black phosphorus and monoclinic 1T'-MoTe2, where the Raman tensors have null elements and their principal axes coincide with the crystallographic ones, followed by a discussion on the results for triclinic ReS2 and ReSe2, where the axes of the Raman tensor do not coincide with the crystallographic axes and all elements are non-zero. We show that the Raman tensor elements are, in general, given by complex numbers and that phase differences between tensor elements are needed to describe the experimental results. We discuss the dependence of the Raman tensors on the excitation laser energy and thickness of the sample within the framework of the quantum model for the Raman intensities. We show that the wavevector dependence of the electron-phonon interaction is essential for explaining the distinct Raman tensor for each phonon mode. Finally, we close with our concluding remarks and perspectives to be explored using angle-resolved polarized Raman spectroscopy in optically anisotropic 2D materials.
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Affiliation(s)
- Marcos A Pimenta
- Departamento de Física, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 30123-970, Brazil.
| | - Geovani C Resende
- Departamento de Física, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 30123-970, Brazil.
| | - Henrique B Ribeiro
- Department of Applied Physics, Stanford University, Stanford, California, 94305, USA
| | - Bruno R Carvalho
- Departamento de Física, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte 59078-970, Brazil.
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20
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Panagides V, Del Val D, Abdel-Wahab M, Mangner N, Durand E, Ihlemann N, Urena M, Pellegrini C, Giannini F, Gasior T, Wojakowski W, Landt M, Auffret V, Sinning JM, Cheema AN, Nombela-Franco L, Chamandi C, Campelo-Parada F, Munoz-Garcia E, Herrmann HC, Testa L, Won-Keun K, Castillo JC, Alperi A, Tchetche D, Bartorelli AL, Kapadia S, Stortecky S, Amat-Santos I, Wijeysundera HC, Lisko J, Gutiérrez-Ibanes E, Serra V, Salido L, Alkhodair A, Livi U, Chakravarty T, Lerakis S, Vilalta V, Regueiro A, Romaguera R, Kappert U, Barbanti M, Masson JB, Maes F, Fiorina C, Miceli A, Kodali S, Ribeiro HB, Mangione JA, Sandoli de Brito F, Actis Dato GM, Rosato F, Ferreira MC, Correia de Lima V, Colafranceschi AS, Abizaid A, Marino MA, Esteves V, Andrea J, Godinho RR, Alfonso F, Eltchaninoff H, Søndergaard L, Himbert D, Husser O, Latib A, Le Breton H, Servoz C, Pascual I, Siddiqui S, Olivares P, Hernandez-Antolin R, Webb JG, Sponga S, Makkar R, Kini AS, Boukhris M, Gervais P, Linke A, Crusius L, Holzhey D, Rodés-Cabau J. Perivalvular Extension of Infective Endocarditis after Transcatheter Aortic Valve Replacement. Clin Infect Dis 2021; 75:638-646. [PMID: 34894124 DOI: 10.1093/cid/ciab1004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Infective endocarditis (IE) following transcatheter aortic valve replacement (TAVR) has been associated with a dismal prognosis. However, scarce data exist on IE perivalvular extension (PEE) in such patients. METHODS This multicenter study included a total of 579 patients who had the diagnosis of definite IE at a median of 171 (53-421) days following TAVR. PEE was defined as the presence of an intracardiac abscess, pseudoaneurysm or fistula confirmed by transthoracic/transophageal echocardiography, computed tomography or peri-operative findings. RESULTS A total of 105 patients (18.1%) were diagnosed with PEE (perivalvular abscess, pseudoaneurysm, fistula, or a combination in 87, 7, 7, and 4 patients, respectively). A history of chronic kidney disease (ORadj: 2.08; 95% CI: [1.27-3.41], p=0.003) and IE secondary to coagulase-negative staphylococci (ORadj: 2.71; 95% CI: [1.57-4.69], p<0.001) was associated with an increased risk of PEE. Surgery was performed at index IE episode in 34 patients (32.4%) with PEE (vs. 15.2% in patients without PEE, p<0.001). In-hospital and 2-year mortality rates among PEE-IE patients were 36.5% and 69.4%, respectively. Factors independently associated with an increased mortality risk were the occurrence of other complications (stroke post-TAVR, acute renal failure, septic shock) and the lack of surgery at index IE hospitalization (padj<0.05 for all). CONCLUSION PEE occurred in about one fifth of IE post-TAVR patients, with the presence of coagulase-negative staphylococci and chronic kidney disease determining an increased risk. Patients with PEE-IE exhibited very high early and late mortality rates, and surgery during IE hospitalization seemed to be associated with better outcomes.
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Affiliation(s)
- Vassili Panagides
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - David Del Val
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mohamed Abdel-Wahab
- Heart Center, Leipzig University, Leipzig, Germany.,Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Norman Mangner
- Heart Center, Leipzig University, Leipzig, Germany.,Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Eric Durand
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | | | | | | | - Francesco Giannini
- Ospedale San Raffaele, Milan, Italy.,Maria Cecilia Hospital, GVM Care and Research, Cotignola RA, Italy
| | - Tomasz Gasior
- Herzzentrum Dresden, Technische Universität Dresden, Germany
| | | | - Martin Landt
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Vincent Auffret
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, F 35000 Rennes, France
| | | | - Asim N Cheema
- St Michaels Hospital, Toronto, Canada.,Southlake Hospital, Newmarket, Ontario, Canada
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | | | | | | | | | - Kim Won-Keun
- Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | | | - Alberto Alperi
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | | | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - John Lisko
- Emory University School of Medicine, Atlanta, USA
| | - Enrique Gutiérrez-Ibanes
- Instituto de Investigación Universitaria Gregorio Marañon, Hospital Gregorio Marañon, Madrid, Spain
| | | | - Luisa Salido
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Stamatios Lerakis
- Emory University School of Medicine, Atlanta, USA.,Mount Sinai Hospital, New York, NY, USA
| | | | | | | | - Utz Kappert
- Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Marco Barbanti
- A.O.U. Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | | | - Frédéric Maes
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Antonio Miceli
- Istituto Clinico Sant'Ambrogio, Milan, Italy.,University Hospital Galway, Galway, Ireland
| | | | - Henrique B Ribeiro
- InCor, Heart Institute, University of São Paulo Medical School, Sao Paulo, Brazil.,Hospital Samaritano Paulista, Sao Paulo, Brazil
| | | | | | | | | | | | | | | | - Alexandre Abizaid
- InCor, Heart Institute, University of São Paulo Medical School, Sao Paulo, Brazil
| | | | | | | | | | | | - Helene Eltchaninoff
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | | | | | - Oliver Husser
- Deutsches Herzzentrum München, Munich, Germany.,St.-Johannes Hospital, Dortmund, Germany
| | - Azeem Latib
- Ospedale San Raffaele, Milan, Italy.,Montefiore Medical Center, New York, NY, USA
| | - Hervé Le Breton
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, F 35000 Rennes, France
| | | | - Isaac Pascual
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Paolo Olivares
- Centro Cardiologico Monzino, IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | | | | | | | - Raj Makkar
- Cedars-Sinai Heart Institute, Los Angeles, USA
| | | | | | - Philippe Gervais
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Axel Linke
- Heart Center, Leipzig University, Leipzig, Germany.,Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Lisa Crusius
- Heart Center, Leipzig University, Leipzig, Germany.,Herzzentrum Dresden, Technische Universität Dresden, Germany
| | | | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
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21
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Alperi A, Mohammadi S, Campelo-Parada F, Munoz-Garcia E, Nombela-Franco L, Faroux L, Veiga G, Serra V, Fischer Q, Pascual I, Asmarats L, Gutiérrez E, Regueiro A, Vilalta V, Ribeiro HB, Matta A, Munoz-Garcia A, Armijo G, Metz D, De la Torre Hernandez JM, Rodenas-Alesina E, Urena M, Moris C, Arzamendi D, Perez-Fuentes P, Fernandez-Nofrerias E, Campanha-Borges DC, Mesnier J, Voisine P, Dumont E, Kalavrouziotis D, Rodés-Cabau J. Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Complex Coronary Artery Disease. JACC Cardiovasc Interv 2021; 14:2490-2499. [PMID: 34794656 DOI: 10.1016/j.jcin.2021.08.073] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to compare, in a cohort of patients with complex coronary artery disease (CAD) and severe aortic stenosis (AS), the clinical outcomes associated with transfemoral transcatheter aortic valve replacement (TAVR) (plus percutaneous coronary intervention [PCI]) versus surgical aortic valve replacement (SAVR) (plus coronary artery bypass grafting [CABG]). BACKGROUND Patients with complex CAD were excluded from the main randomized trials comparing TAVR with SAVR, and no data exist comparing TAVR + PCI vs SAVR + CABG in such patients. METHODS A multicenter study was conducted including consecutive patients with severe AS and complex CAD (SYNTAX [Synergy Between PCI with Taxus and Cardiac Surgery] score >22 or unprotected left main disease). A 1:1 propensity-matched analysis was performed to account for unbalanced covariates. The rates of major adverse cardiac and cerebrovascular events (MACCE), including all-cause mortality, nonprocedural myocardial infarction, need for new coronary revascularization, and stroke, were evaluated. RESULTS A total of 800 patients (598 undergoing SAVR + CABG and 202 undergoing transfemoral TAVR + PCI) were included, and after propensity matching, a total of 156 pairs of patients were generated. After a median follow-up period of 3 years (interquartile range: 1-6 years), there were no significant differences between groups for MACCE (HR for transfemoral TAVR vs SAVR: 1.33; 95% CI: 0.89-1.98), all-cause mortality (HR: 1.25; 95% CI: 0.81-1.94), myocardial infarction (HR: 1.16; 95% CI: 0.41-3.27), and stroke (HR: 0.42; 95% CI: 0.13-1.32), but there was a higher rate of new coronary revascularization in the TAVR + PCI group (HR: 5.38; 95% CI: 1.73-16.7). CONCLUSIONS In patients with severe AS and complex CAD, TAVR + PCI and SAVR + CABG were associated with similar rates of MACCE after a median follow-up period of 3 years, but TAVR + PCI recipients exhibited a higher risk for repeat coronary revascularization. Future trials are warranted.
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Affiliation(s)
- Alberto Alperi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | | | - Vicenç Serra
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Quentin Fischer
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Isaac Pascual
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | | | - Henrique B Ribeiro
- Instituto do Coração (InCor), Heart Institute, University of Sao Paulo, Sao Paulo, Brazil
| | | | | | - German Armijo
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | | | | | - Marina Urena
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Cesar Moris
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | | | - Jules Mesnier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Pierre Voisine
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Eric Dumont
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Hospital Clinic de Barcelona, Barcelona, Spain.
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22
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Val DD, Abdel-Wahab M, Mangner N, Durand E, Ihlemann N, Urena M, Pellegrini C, Giannini F, Gasior T, Wojakowski W, Landt M, Auffret V, Sinning JM, Cheema AN, Nombela-Franco L, Chamandi C, Campelo-Parada F, Munoz-Garcia E, Herrmann HC, Testa L, Won-Keun K, Castillo JC, Alperi A, Tchetche D, Bartorelli AL, Kapadia S, Stortecky S, Amat-Santos I, Wijeysundera HC, Lisko J, Gutiérrez-Ibanes E, Serra V, Salido L, Alkhodair A, Vendramin I, Chakravarty T, Lerakis S, Vilalta V, Regueiro A, Romaguera R, Kappert U, Barbanti M, Masson JB, Maes F, Fiorina C, Miceli A, Kodali S, Ribeiro HB, Mangione JA, Sandoli de Brito F, Actis Dato GM, Rosato F, Ferreira MC, Corriea de Lima V, Colafranceschi AS, Abizaid A, Marino MA, Esteves V, Andrea J, Godinho RR, Alfonso F, Eltchaninoff H, Søndergaard L, Himbert D, Husser O, Latib A, Le Breton H, Servoz C, Pascual I, Siddiqui S, Olivares P, Hernandez-Antolin R, Webb JG, Sponga S, Makkar R, Kini AS, Boukhris M, Gervais P, Linke A, Crusius L, Holzhey D, Rodés-Cabau J. Infective Endocarditis Caused by Staphylococcus Aureus after Transcatheter Aortic Valve Replacement. Can J Cardiol 2021; 38:102-112. [PMID: 34688853 DOI: 10.1016/j.cjca.2021.10.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/17/2021] [Accepted: 10/17/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Staphylococcus aureus (S aureus) has been extensively studied as causative microorganism of surgical prosthetic-valve infective endocarditis (IE). However, scarce evidence exists on S aureus IE after transcatheter aortic valve replacement (TAVR). METHODS Data was obtained from the Infectious Endocarditis after TAVR International Registry including patients with definite IE following TAVR from 59 centers in 11 countries. Patients were divided into two groups according to microbiological etiology (non-S aureus-IE, non-SA-IE vs. S aureus-IE, SA-IE). RESULTS SA-IE was identified in 141 out of 573 (24.6%) patients, methicillin-sensitive S aureus in most cases (115/141, 81.6%). SEV were more common than BEV in patients with early SA-IE. Major bleeding and sepsis complicating TAVR, neurological symptoms or systemic embolism at admission and IE with cardiac device involvement other than the TAVR prosthesis were associated with SA-IE (p<0.05 for all). Among IE post-TAVR patients, the likelihood of SA-IE increased from 19% in the absence of those risk factors to 84.6% if ≥3 risk factors were present. In-hospital (47.8% vs. 26.9%, p<0.001) and 2-year mortality (71.5% vs. 49.6%, p<0.001) rates were higher among SA-IE (vs. non-SA-IE) patients. Surgery at the time of index SA-IE was associated with a lower mortality rate at follow-up (HRadj: 0.46, 95% CI: 0.22-0.96, p=0.038). CONCLUSIONS SA-IE represented ∼ 25% of IE cases after TAVR and was associated with a very high in-hospital and late mortality. The presence of some features determined a higher likelihood of SA-IE and could help to orientate early antibiotic regimen selection. Surgery at index SA-IE was associated with improved outcomes, and its role should be evaluated in future studies.
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Affiliation(s)
- David Del Val
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mohamed Abdel-Wahab
- Heart Center, Leipzig University, Leipzig, Germany; Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Norman Mangner
- Heart Center, Leipzig University, Leipzig, Germany; Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Eric Durand
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | | | | | | | - Francesco Giannini
- Ospedale San Raffaele, Milan, Italy; Maria Cecilia Hospital, GVM Care and Research, Cotignola RA, Italy
| | - Tomasz Gasior
- Herzzentrum Dresden, Technische Universität Dresden, Germany
| | | | - Martin Landt
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Vincent Auffret
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, F 35000 Rennes, France
| | | | - Asim N Cheema
- St Michaels Hospital, Toronto, Canada; Southlake Hospital, Newmarket, Ontario, Canada
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | | | | | | | | | - Kim Won-Keun
- Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | | | - Alberto Alperi
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | | | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (on behalf of Swiss TAVI)
| | | | | | - John Lisko
- Emory University School of Medicine, Atlanta, USA
| | - Enrique Gutiérrez-Ibanes
- Instituto de Investigación Universitaria Gregorio Marañon, Hospital Gregorio Marañón, Madrid, Spain
| | | | - Luisa Salido
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Stamatios Lerakis
- Emory University School of Medicine, Atlanta, USA; Mount Sinai Hospital, New York, NY, USA
| | | | | | | | - Utz Kappert
- Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Marco Barbanti
- A.O.U. Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | | | - Frédéric Maes
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Antonio Miceli
- Istituto Clinico Sant'Ambrogio, Milan, Italy; University Hospital Galway, Galway, Ireland
| | | | - Henrique B Ribeiro
- InCor, Heart Institute, University of São Paulo Medical School, Sao Paulo, Brazil; Hospital Samaritano Paulista, Sao Paulo, Brazil
| | | | | | | | | | | | | | | | - Alexandre Abizaid
- InCor, Heart Institute, University of São Paulo Medical School, Sao Paulo, Brazil
| | | | | | | | | | | | - Helene Eltchaninoff
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | | | | | - Oliver Husser
- Deutsches Herzzentrum München, Munich, Germany; St.-Johannes-Hospital, Dortmund, Germany
| | - Azeem Latib
- Ospedale San Raffaele, Milan, Italy; Montefiore Medical Center, New York, NY, USA
| | - Hervé Le Breton
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, F 35000 Rennes, France
| | | | - Isaac Pascual
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Paolo Olivares
- Centro Cardiologico Monzino, IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | | | | | | | - Raj Makkar
- Cedars-Sinai Heart Institute, Los Angeles, USA
| | | | | | - Philippe Gervais
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Axel Linke
- Heart Center, Leipzig University, Leipzig, Germany; Herzzentrum Dresden, Technische Universität Dresden, Germany
| | - Lisa Crusius
- Heart Center, Leipzig University, Leipzig, Germany
| | | | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.
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23
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Lopes MP, Emer Egypto Rosa V, Palma JH, Fernandes JRC, De Santis ASAL, Spina GS, Abizaid AC, De Brito Jr FS, Tarasoutchi F, Sampaio RO, Ribeiro HB. Valve-in-valve procedure for bioprosthesis dysfunction in rheumatic patients: a new procedure for an old disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1664] [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
Bioprosthetic heart valve has a limited durability and lower long-term performance especially in rheumatic patients. The standard treatment for degenerated bioprosthesis involves redo open-heart surgery, which is associated with significant morbidity and mortality, particularly in high-risk patients. Minimally invasive procedures, as valve-in-valve (ViV) implantation, may offer an attractive therapy alternative.
Methods
The aim of this study was to evaluate the characteristics and short-term post-procedure data of rheumatic and non-rheumatic patients undergoing aortic, mitral or tricuspid ViV procedure.
Results
Single centre data-base analysis study, with prospective data collection, during the period of May 2015 to September 2020. Among 106 patients included, 69 had rheumatic etiology and 37 were non-rheumatic. Rheumatic patients had higher incidence of female sex (73.9% vs 43.2%, respectively; p=0.004) and atrial fibrillation (82.6% vs 45.9%, respectively; p<0.001). There were no statistical difference regarding number of previous surgeries (2 [3–1] vs 1 [2–1], respectively; p=0.103). There was a tendency towards higher 30-day mortality in rheumatic patients (21.7% vs 5.4%, respectively; p=0.057) and device success rate was low, but similar between groups (78.3% vs 72.0%, respectively; p=0.710). Transapical access rate was also higher in rheumatic group (92.6% vs 70.3%, respectively; p=0.008);
Conclusion
Rheumatic patients tend to have a higher mortality when undergoing ViV procedures, although not statistically significant. Rheumatic patients underwent a greater number of previous valve surgeries than reported in literature, and also had high rate of transapical ViV procedure, which may have contributed to higher 30-day mortality and a lower device success rate.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M P Lopes
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - V Emer Egypto Rosa
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - J H Palma
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - J R C Fernandes
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - A S A L De Santis
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - G S Spina
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - A C Abizaid
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - F S De Brito Jr
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - F Tarasoutchi
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - R O Sampaio
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
| | - H B Ribeiro
- Heart Institute of the University of Sao Paulo (InCor), Valvular Heart Disease Unit, Sao Paulo, Brazil
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24
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Fukui M, Annabi MS, Rosa VEE, Ribeiro HB, Tarasoutchi F, Shelbert EB, Bergler-Klein J, Mascherbauer J, Rochitte CE, Pibarot P, Cavalcante JL. Impact of left ventricular fibrosis and longitudinal systolic strain on outcomes in low gradient aortic stenosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0233] [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: 11/15/2022] Open
Abstract
Abstract
Background
The clinical utility of comprehensive cardiac magnetic resonance (CMR) for the assessment of myocardial structure and function remains unknown in patients with low gradient (LG) aortic stenosis (AS).
Purpose
This study sought to compare CMR characteristics of myocardial structure and function according to different flow / gradient patterns of AS: classical low flow LG (LFLG); paradoxical LFLG; normal flow LG; and high gradient, and to evaluate their impact on the outcomes of these patients.
Methods
International multicentric prospective study included 147 patients with LG moderate to severe AS and 18 patients with high gradient severe AS who underwent comprehensive CMR evaluation of left ventricular global longitudinal strain (LVGLS), extracellular volume fraction (ECV), and late gadolinium enhancement (LGE).
Results
Patients with classical LFLG (n=90) had more LV adverse remodeling and impaired longitudinal function including higher ECV, and higher LGE and volume, and worst LVGLS, compared to other patterns of AS. Over a median follow-up of 2-years, 43 deaths and 48 composite outcomes of death or heart failure hospitalization occurred in LG AS patients. As LVGLS or ECV worsened, risks of adverse events also increased (per tertile of LVGLS: HR [95% CI] for mortality, 1.50 [1.02–2.20]; p=0.04; HR [95% CI] for composite outcome, 1.45 [1.01–2.09]; p<0.05) (per tertile of ECV: HR [95% CI] for mortality, 1.63 [1.07–2.49]; p=0.02; HR [95% CI] for composite outcome, 1.54 [1.02–2.33]; p=0.04). LGE presence was also associated with higher mortality (HR [95% CI], 2.27 [1.01–5.11]; p<0.05) and risk of the composite outcome (HR [95% CI], 3.00 [1.16–7.73]; p=0.02). The risk of all-cause death and of the composite outcome increased in proportion to the number of impaired components (i.e. LVGLS, ECV and LGE) (Figure) with and without adjustment for age, true severe AS, classical LFLG, and aortic valve replacement as a time-varying covariate.
Conclusions
In this international multicentric study of LG AS, comprehensive CMR assessment of myocardial structure and function provides independent prognostic value that is cumulative and incremental to clinical and echocardiographic characteristics.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Fukui
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - M S Annabi
- University Institute of Cardiology and Respirology of Quebec (IUCPQ), Quebec, Canada
| | - V E E Rosa
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - H B Ribeiro
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - F Tarasoutchi
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - E B Shelbert
- University of Pittsburgh, Pittsburgh, United States of America
| | - J Bergler-Klein
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | | | - C E Rochitte
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - P Pibarot
- University Institute of Cardiology and Respirology of Quebec (IUCPQ), Quebec, Canada
| | - J L Cavalcante
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
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25
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Guimarães PO, de Souza FR, Lopes RD, Bittar C, Cardozo FA, Caramelli B, Calderaro D, Albuquerque CP, Drager LF, Feres F, Baracioli L, Feitosa Filho G, Barbosa RR, Ribeiro HB, Ribeiro E, Alves RJ, Soeiro A, Faillace B, Figueiredo E, Damiani LP, do Val RM, Huemer N, Nicolai LG, Hajjar LA, Abizaid A, Kalil Filho R. High risk coronavirus disease 2019: The primary results of the CoronaHeart multi-center cohort study. Int J Cardiol Heart Vasc 2021; 36:100853. [PMID: 34345648 PMCID: PMC8321709 DOI: 10.1016/j.ijcha.2021.100853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Patients with Coronavirus Disease 2019 (COVID-19) may present high risk features during hospitalization, including cardiovascular manifestations. However, less is known about the factors that may further increase the risk of death in these patients. METHODS We included patients with COVID-19 and high risk features according to clinical and/or laboratory criteria at 21 sites in Brazil from June 10th to October 23rd of 2020. All variables were collected until hospital discharge or in-hospital death. RESULTS A total of 2546 participants were included (mean age 65 years; 60.3% male). Overall, 70.8% were admitted to intensive care units and 54.2% had elevated troponin levels. In-hospital mortality was 41.7%. An interaction among sex, age and mortality was found (p = 0.007). Younger women presented higher rates of death than men (30.0% vs 22.9%), while older men presented higher rates of death than women (57.6% vs 49.2%). The strongest factors associated with in-hospital mortality were need for mechanical ventilation (odds ratio [OR] 8.2, 95% confidence interval [CI] 5.4-12.7), elevated C-reactive protein (OR 2.3, 95% CI 1.7-2.9), cancer (OR 1.8, 95 %CI 1.2-2.9), and elevated troponin levels (OR 1.8, 95% CI 1.4-2.3). A risk score was developed for risk assessment of in-hospital mortality. CONCLUSIONS This cohort showed that patients with COVID-19 and high risk features have an elevated rate of in-hospital mortality with differences according to age and sex. These results highlight unique aspects of this population and might help identifying patients who may benefit from more careful initial surveillance and potential subsequent interventional therapies.
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Affiliation(s)
- Patrícia O. Guimarães
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Francis R. de Souza
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Renato D. Lopes
- Duke University Medical Center – Duke Clinical Research Institute, Duke Health, Durham, United States
| | - Cristina Bittar
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Francisco A. Cardozo
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Bruno Caramelli
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Daniela Calderaro
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Cícero P. Albuquerque
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luciano F. Drager
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
| | - Fausto Feres
- Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - Luciano Baracioli
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Lucas P. Damiani
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Renata M. do Val
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Natassja Huemer
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Lisiê G. Nicolai
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ludhmila A. Hajjar
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alexandre Abizaid
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Roberto Kalil Filho
- Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
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26
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Bernardi FLM, Rodés-Cabau J, Tirado-Conte G, Amat Santos IJ, Plachtzik C, Cura F, Sztejfman M, Mangione FM, Tumeleiro R, Esteves VBC, Pessoa de Melo EF, Alcocer Chauvet A, Fuchs F, Sarmento-Leite R, de Campos Martins EC, Nombela-Franco L, Delgado-Arana JR, Bocksch W, Lamelas P, Giuliani C, Campanha-Borges DC, Mangione JA, de Brito FS, Abizaid AC, Ribeiro HB. Incidence, Predictor, and Clinical Outcomes of Multiple Resheathing With Self-Expanding Valves During Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2021; 10:e020682. [PMID: 34546114 PMCID: PMC8649510 DOI: 10.1161/jaha.120.020682] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background No study has evaluated the impact of the additional manipulation demanded by multiple resheathing (MR) in patients undergoing transcatheter aortic valve replacement with repositionable self‐expanding valves. Methods and Results This study included a real‐world, multicenter registry involving 16 centers from Canada, Germany, Latin America, and Spain. All consecutive patients who underwent transcatheter aortic valve replacement with the Evolut R, Evolut PRO, and Portico valves were included. Patients were divided according to the number of resheathing: no resheathing, single resheathing (SR), and MR. The primary end point was device success. Secondary outcomes included procedural complications, early safety events, and 1‐year mortality. In 1026 patients, the proportion who required SR and MR was 23.9% and 9.3%, respectively. MR was predicted by the use of Portico and moderate/severe aortic regurgitation at baseline (both with P<0.01). Patients undergoing MR had less device success (no resheathing=89.9%, SR=89.8%, and MR=80%; P=0.01), driven by more need for a second prosthesis and device embolization. At 30 days, there were no differences in safety events. At 1 year, more deaths occurred with MR (no resheathing=10.5%, SR=8.0%, and MR=18.8%; P=0.014). After adjusting for baseline differences and center experience by annual volume, MR associated with less device success (odds ratio, 0.42; P=0.003) and increased 1‐year mortality (hazard ratio, 2.06; P=0.01). When including only the Evolut R/PRO cases (N=837), MR continued to have less device success (P<0.001) and a trend toward increased mortality (P=0.05). Conclusions Repositioning a self‐expanding valve is used in a third of patients, being multiple in ≈10%. MR, but not SR, was associated with more device failure and higher 1‐year mortality, regardless of the type of valve implanted.
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Affiliation(s)
- Fernando L M Bernardi
- Instituto do Coração Hospital das Clinicas HCFMUSP Faculdade de MedicinaUniversidade de Sao Paulo Sao Paulo Brazil
| | - Josep Rodés-Cabau
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada.,Hospital Clínic de Barcelona Barcelona Spain
| | | | - Ignacio J Amat Santos
- Centro de Investigación Biomédica en Red de Enfermedades CardiovascularesHospital Clínico Universitario de Valladolid Valladolid Spain
| | | | - Fernando Cura
- Instituto Cardiovascular de Buenos Aires Buenos Aires Argentina
| | | | | | | | | | | | | | - Felipe Fuchs
- Hospital de Clínicas de Porto Alegre Porto Alegre Brazil
| | | | | | | | - José Raul Delgado-Arana
- Centro de Investigación Biomédica en Red de Enfermedades CardiovascularesHospital Clínico Universitario de Valladolid Valladolid Spain
| | | | - Pablo Lamelas
- Instituto Cardiovascular de Buenos Aires Buenos Aires Argentina
| | | | - Diego Carter Campanha-Borges
- Instituto do Coração Hospital das Clinicas HCFMUSP Faculdade de MedicinaUniversidade de Sao Paulo Sao Paulo Brazil.,Hospital Samaritano Paulista São Paulo Brazil
| | | | - Fábio Sandoli de Brito
- Instituto do Coração Hospital das Clinicas HCFMUSP Faculdade de MedicinaUniversidade de Sao Paulo Sao Paulo Brazil
| | - Alexandre C Abizaid
- Instituto do Coração Hospital das Clinicas HCFMUSP Faculdade de MedicinaUniversidade de Sao Paulo Sao Paulo Brazil
| | - Henrique B Ribeiro
- Instituto do Coração Hospital das Clinicas HCFMUSP Faculdade de MedicinaUniversidade de Sao Paulo Sao Paulo Brazil.,Hospital Samaritano Paulista São Paulo Brazil
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de A Chaud MS, Agostinho CA, Malafaia FL, Sampaio MC, Chaccur P, de Barros E Silva PGM, Ribeiro EE, Garcia JCT, Furlan V, Ribeiro HB. A Coronary Artery Anomaly Presenting as Acute Coronary Syndrome: A Case Report. Am J Case Rep 2021; 22:e931561. [PMID: 34465715 PMCID: PMC8420673 DOI: 10.12659/ajcr.931561] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND Coronary artery anomalies (CAAs) are rare congenital malformations with different clinical presentations and pathophysiological mechanisms. These anomalies are frequently the cause of sudden death in young patients. Most CAAs are incidental findings owing to the lack of symptoms; however, they may be associated with acute coronary syndrome in rare cases. CASE REPORT We describe the case of a 47-year-old man who presented with a 1-day history of progressive typical chest pain and elevated troponin levels. The patient underwent a coronary angiography, which unveiled the anomalous origin of the left main coronary artery arising from the right coronary artery, with an interarterial course between the ascending aorta and the pulmonary artery, without coronary artery disease. Coronary computed tomography angiography confirmed the CAA and its relationship with the symptoms. An uneventful coronary artery bypass graft was undertaken, and at the 1-year follow-up, the patient was asymptomatic, with a normal stress test. CONCLUSIONS This case depicts the presentation of atypical acute coronary syndrome in a young patient with a rare CAA. In such patients, coronary angiography and coronary computed tomography angiography are essential tools to confirm the diagnosis and to determine treatment. Although controversial, in young individuals presenting CAA with an interarterial course, such as the left main coronary artery arising from the right coronary artery, coronary artery bypass graft may be an important treatment option to avoid sudden death in the future.
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Lemes da Silva MV, Nunes Filho ACB, Rosa VEE, Caixeta A, Lemos Neto PA, Ribeiro HB, Almeida BO, Mariani J, Campos CM, Abizaid AAC, Mangione JA, Sampaio RO, Caramori P, Sarmento-Leite R, Tarasoutchi F, Franken M, de Brito FS. Improvement of renal function after transcatheter aortic valve replacement in patients with chronic kidney disease. PLoS One 2021; 16:e0251066. [PMID: 33984005 PMCID: PMC8118303 DOI: 10.1371/journal.pone.0251066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 04/19/2021] [Indexed: 12/29/2022] Open
Abstract
Background Chronic kidney disease is commonly found in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) and has marked impact in their prognosis. It has been shown however that TAVR may improve renal function by alleviating the hemodynamic barrier imposed by AS. Nevertheless, the predictors of and clinical consequences of renal function improvement are not well established. Our aim was to assess the predictors of improvement of renal function after TAVR. Methods The present work is an analysis of the Brazilian Registry of TAVR, a national non-randomized prospective study with 22 Brazilian centers. Patients with baseline renal dysfunction (estimated glomerular filtration rate [eGFR] < 60mL/min/1.73m2) were stratified according to renal function after TAVR: increase >10% in eGFR were classified as TAVR induced renal function improvement (TIRFI); decrease > 10% in eGFR were classified as acute kidney injury (AKI) and stable renal function (neither criteria). Results A total of 819 consecutive patients with symptomatic severe AS were included. Of these, baseline renal dysfunction (estimated glomerular filtration rate [eGFR] < 60mL/min/1.73m2) was present in 577 (70%) patients. Considering variance in renal function between baseline and at discharge after TAVR procedure, TIRFI was seen in 197 (34.1%) patients, AKI in 203 (35.2%), and stable renal function in 177 (30.7%). The independent predictors of TIRFI were: absence of coronary artery disease (OR: 0.69; 95% CI 0.48–0.98; P = 0.039) and lower baseline eGFR (OR: 0.98; 95% CI 0.97–1.00; P = 0.039). There was no significant difference in 30-day and 1-year all-cause mortality between patients with stable renal function or TIRFI. Nonetheless, individuals that had AKI after TAVR presented higher mortality compared with TIRFI and stable renal function groups (29.3% vs. 15.4% vs. 9.5%, respectively; p < 0.001). Conclusions TIRFI was frequently found among baseline impaired renal function individuals but was not associated with improved 1-year outcomes.
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Affiliation(s)
- Michel V. Lemes da Silva
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Antonio C. B. Nunes Filho
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
- * E-mail:
| | - Vitor E. E. Rosa
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Adriano Caixeta
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
| | - Pedro A. Lemos Neto
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
| | - Henrique B. Ribeiro
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Breno O. Almeida
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
| | - José Mariani
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Carlos M. Campos
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
- Department of Cardiology, Instituto Prevent Senior, Sao Paulo, Brazil
| | - Alexandre A. C. Abizaid
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - José A. Mangione
- Department of Interventional Cardiology, Hospital Beneficiência Portuguesa, Sao Paulo, Brazil
| | - Roney O. Sampaio
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Paulo Caramori
- Department of Interventional Cardiology, Hospital São Lucas – PUCRS, Porto Alegre, Brazil
| | - Rogério Sarmento-Leite
- Department of Interventional Cardiology, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil
| | - Flávio Tarasoutchi
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Marcelo Franken
- Department of Cardiology, Hospital Israelita Albert Einstein (Albert Einstein Hospital), Sao Paulo, Brazil
| | - Fábio S. de Brito
- Department of Cardiology, Heart Institute (InCor), Clinical Hospital, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
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Alperi A, Rodés-Cabau J, Simonato M, Tchetche D, Charbonnier G, Ribeiro HB, Latib A, Montorfano M, Barbanti M, Bleiziffer S, Redfors B, Abdel-Wahab M, Allali A, Bruschi G, Napodano M, Agrifoglio M, Petronio AS, Giannini C, Chan A, Kornowski R, Pravda NS, Adam M, Iadanza A, Noble S, Chatfield A, Erlebach M, Kempfert J, Ubben T, Wijeysundera H, Seiffert M, Pilgrim T, Kim WK, Testa L, Hildick-Smith D, Nerla R, Fiorina C, Brinkmann C, Conzelmann L, Champagnac D, Saia F, Nissen H, Amrane H, Whisenant B, Shamekhi J, Søndergaard L, Webb JG, Dvir D. Permanent Pacemaker Implantation Following Valve-in-Valve Transcatheter Aortic Valve Replacement: VIVID Registry. J Am Coll Cardiol 2021; 77:2263-2273. [PMID: 33958122 DOI: 10.1016/j.jacc.2021.03.228] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Permanent pacemaker implantation (PPI) remains one of the main drawbacks of transcatheter aortic valve replacement (TAVR), but scarce data exist on PPI after valve-in-valve (ViV) TAVR, particularly with the use of newer-generation transcatheter heart valves (THVs). OBJECTIVES The goal of this study was to determine the incidence, factors associated with, and clinical impact of PPI in a large series of ViV-TAVR procedures. METHODS Data were obtained from the multicenter VIVID Registry and included the main baseline and procedural characteristics, in-hospital and late (median follow-up: 13 months [interquartile range: 3 to 41 months]) outcomes analyzed according to the need of periprocedural PPI. All THVs except CoreValve, Cribier-Edwards, Sapien, and Sapien XT were considered to be new-generation THVs. RESULTS A total of 1,987 patients without prior PPI undergoing ViV-TAVR from 2007 to 2020 were included. Of these, 128 patients (6.4%) had PPI after TAVR, with a significant decrease in the incidence of PPI with the use of new-generation THVs (4.7% vs. 7.4%; p = 0.017), mainly related to a reduced PPI rate with the Evolut R/Pro versus CoreValve (3.7% vs. 9.0%; p = 0.002). There were no significant differences in PPI rates between newer-generation balloon- and self-expanding THVs (6.1% vs. 3.9%; p = 0.18). In the multivariable analysis, older age (odds ratio [OR]: 1.05 for each increase of 1 year; 95% confidence interval [CI]: 1.02 to 1.07; p = 0.001), larger THV size (OR: 1.10; 95% CI: 1.01 to 1.20; p = 0.02), and previous right bundle branch block (OR: 2.04; 95% CI: 1.00 to 4.17; p = 0.05) were associated with an increased risk of PPI. There were no differences in 30-day mortality between the PPI (4.7%) and no-PPI (2.7%) groups (p = 0.19), but PPI patients exhibited a trend toward higher mortality risk at follow-up (hazard ratio: 1.39; 95% CI: 1.02 to 1.91; p = 0.04; p = 0.08 after adjusting for age differences between groups). CONCLUSIONS In a contemporary large series of ViV-TAVR patients, the rate of periprocedural PPI was relatively low, and its incidence decreased with the use of new-generation THV systems. PPI following ViV-TAVR was associated with a trend toward increased mortality at follow-up.
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Affiliation(s)
- Alberto Alperi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Hospital Clínic de Barcelona, Barcelona, Spain.
| | - Matheus Simonato
- Cardiovascular Research Foundation, New York, New York, USA; Escola Paulista de Medicina, São Paulo, Brazil; Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | | | | | - Henrique B Ribeiro
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Azeem Latib
- Montefiore Medical Center, New York, New York, USA
| | - Matteo Montorfano
- Istituto di Ricovero e Cura a Carattere Scientifico-San Raffaele Scientific Institute, Milan, Italy
| | | | - Sabine Bleiziffer
- Herz- und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | - Björn Redfors
- Cardiovascular Research Foundation, New York, New York, USA; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA; Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | | | | | | | | | | | - Albert Chan
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | | | | | | | | | | | | | | | | | - Timm Ubben
- Asklepios Klinik St. Georg, Hamburg, Germany
| | | | | | | | | | - Luca Testa
- Istituto di Ricovero e Cura a Carattere Scientifico-Policlinico San Donato, Milan, Italy
| | | | - Roberto Nerla
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | | | | | - Lars Conzelmann
- Helios Klinik für Herzchirurgie Karlsruhe, Karlsruhe, Germany
| | | | - Francesco Saia
- Università degli Studi di Bologna-Policlinico S. Orsola-Malpighi, Bologna, Italy
| | | | - Hafid Amrane
- Medisch Centrum Leeuwarden, Leeuwarden, the Netherlands
| | | | | | | | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Danny Dvir
- University of Washington, Seattle, Washington, USA; Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel.
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Del Val D, Abdel-Wahab M, Mangner N, Durand E, Ihlemann N, Urena M, Pellegrini C, Giannini F, Gasior T, Wojakowski W, Landt M, Auffret V, Sinning JM, Cheema AN, Nombela-Franco L, Chamandi C, Campelo-Parada F, Munoz-Garcia E, Herrmann HC, Testa L, Won-Keun K, Castillo JC, Alperi A, Tchetche D, Bartorelli AL, Kapadia S, Stortecky S, Amat-Santos I, Wijeysundera HC, Lisko J, Gutiérrez-Ibanes E, Serra V, Salido L, Alkhodair A, Livi U, Chakravarty T, Lerakis S, Vilalta V, Regueiro A, Romaguera R, Kappert U, Barbanti M, Masson JB, Maes F, Fiorina C, Miceli A, Kodali S, Ribeiro HB, Mangione JA, Sandoli de Brito F, Actis Dato GM, Rosato F, Ferreira MC, Correia de Lima V, Colafranceschi AS, Abizaid A, Marino MA, Esteves V, Andrea J, Godinho RR, Alfonso F, Eltchaninoff H, Søndergaard L, Himbert D, Husser O, Latib A, Le Breton H, Servoz C, Pascual I, Siddiqui S, Olivares P, Hernandez-Antolin R, Webb JG, Sponga S, Makkar R, Kini AS, Boukhris M, Gervais P, Linke A, Crusius L, Holzhey D, Rodés-Cabau J. Stroke Complicating Infective Endocarditis After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2021; 77:2276-2287. [PMID: 33958124 DOI: 10.1016/j.jacc.2021.03.233] [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: 01/25/2021] [Revised: 03/10/2021] [Accepted: 03/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Stroke is one of the most common and potentially disabling complications of infective endocarditis (IE). However, scarce data exist about stroke complicating IE after transcatheter aortic valve replacement (TAVR). OBJECTIVES The purpose of this study was to determine the incidence, risk factors, clinical characteristics, management, and outcomes of patients with definite IE after TAVR complicated by stroke during index IE hospitalization. METHODS Data from the Infectious Endocarditis after TAVR International Registry (including 569 patients who developed definite IE following TAVR from 59 centers in 11 countries) was analyzed. Patients were divided into two groups according to stroke occurrence during IE admission (stroke [S-IE] vs. no stroke [NS-IE]). RESULTS A total of 57 (10%) patients had a stroke during IE hospitalization, with no differences in causative microorganism between groups. S-IE patients exhibited higher rates of acute renal failure, systemic embolization, and persistent bacteremia (p < 0.05 for all). Previous stroke before IE, residual aortic regurgitation ≥moderate after TAVR, balloon-expandable valves, IE within 30 days after TAVR, and vegetation size >8 mm were associated with a higher risk of stroke during the index IE hospitalization (p < 0.05 for all). Stroke rate in patients with no risk factors was 3.1% and increased up to 60% in the presence of >3 risk factors. S-IE patients had higher rates of in-hospital mortality (54.4% vs. 28.7%; p < 0.001) and overall mortality at 1 year (66.3% vs. 45.6%; p < 0.001). Surgical treatment was not associated with improved outcomes in S-IE patients (in-hospital mortality: 46.2% in surgical vs. 58.1% in no surgical treatment; p = 0.47). CONCLUSIONS Stroke occurred in 1 of 10 patients with IE post-TAVR. A history of stroke, short time between TAVR and IE, vegetation size, valve prosthesis type, and residual aortic regurgitation determined an increased risk. The occurrence of stroke was associated with increased in-hospital and 1-year mortality rates, and surgical treatment failed to improve clinical outcomes.
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Affiliation(s)
- David Del Val
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mohamed Abdel-Wahab
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Norman Mangner
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Eric Durand
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | | | | | | | - Francesco Giannini
- Ospedale San Raffaele, Milan, Italy; Maria Cecilia Hospital, GVM Care and Research, Cotignola RA, Italy
| | - Tomasz Gasior
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | | | - Martin Landt
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Vincent Auffret
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, F 35000 Rennes, France
| | | | - Asim N Cheema
- St Michaels Hospital, Toronto, Ontario, Canada; Southlake Hospital, Newmarket, Ontario, Canada
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | | | | | - Howard C Herrmann
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Kim Won-Keun
- Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany
| | | | - Alberto Alperi
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Milan, Italy
| | | | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland (on behalf of Swiss TAVI)
| | | | | | - John Lisko
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Enrique Gutiérrez-Ibanes
- Instituto de Investigación Universitaria Gregorio Marañón, Hospital Gregorio Marañon, Madrid, Spain
| | | | - Luisa Salido
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Stamatios Lerakis
- Emory University School of Medicine, Atlanta, Georgia, USA; Mount Sinai Hospital, New York, New York, USA
| | | | | | | | - Utz Kappert
- Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Marco Barbanti
- A.O.U. Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | | | - Frédéric Maes
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Antonio Miceli
- Istituto Clinico Sant'Ambrogio, Milan, Italy; University Hospital Galway, Galway, Ireland
| | - Susheel Kodali
- Columbia University Medical Center, New York, New York, USA
| | - Henrique B Ribeiro
- InCor, Heart Institute, University of São Paulo Medical School, Sao Paulo, Brazil; Hospital Samaritano Paulista, Sao Paulo, Brazil
| | | | | | | | | | | | | | | | - Alexandre Abizaid
- InCor, Heart Institute, University of São Paulo Medical School, Sao Paulo, Brazil
| | | | | | | | | | | | - Helene Eltchaninoff
- Normandie Univ, UNIROUEN, U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | | | | | - Oliver Husser
- Deutsches Herzzentrum München, Munich, Germany; St.-Johannes-Hospital, Dortmund, Germany
| | - Azeem Latib
- Ospedale San Raffaele, Milan, Italy; Montefiore Medical Center, New York, New York, USA
| | - Hervé Le Breton
- Univ Rennes, CHU Rennes, Inserm, LTSI - UMR1099, F 35000 Rennes, France
| | | | - Isaac Pascual
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Paolo Olivares
- Centro Cardiologico Monzino, IRCCS and Department of Biomedical and Clinical Sciences "Luigi Sacco," University of Milan, Milan, Italy
| | | | - John G Webb
- St Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Raj Makkar
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | | | - Marouane Boukhris
- Centre Hospitalier de l'Université de Montreal, Montreal, Quebec, Canada
| | - Philippe Gervais
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Axel Linke
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Lisa Crusius
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - David Holzhey
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada; Hospital Clínic de Barcelona, Barcelona, Spain.
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Abizaid A, Campos CM, Guimarães PO, Costa JDR, Falcão BAA, Mangione F, Caixeta A, Lemos PA, de Brito FS, Cavalcante R, Bezerra CG, Cortes L, Ribeiro HB, de Souza FR, Huemer N, do Val RM, Caramelli B, Calderaro D, Lima FG, Hajjar LA, Mehran R, Filho RK. Patients with COVID-19 who experience a myocardial infarction have complex coronary morphology and high in-hospital mortality: Primary results of a nationwide angiographic study. Catheter Cardiovasc Interv 2021; 98:E370-E378. [PMID: 33904638 PMCID: PMC8239511 DOI: 10.1002/ccd.29709] [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] [Received: 01/19/2021] [Revised: 03/25/2021] [Accepted: 04/02/2021] [Indexed: 01/19/2023]
Abstract
Objectives We aimed to explore angiographic patterns and in‐hospital outcomes of patients with concomitant coronavirus disease‐19 (COVID‐19) and myocardial infarction (MI). Background Patients with COVID‐19 may experience MI during the course of the viral infection. However, this association is currently poorly understood. Methods This is a multicenter prospective study of consecutive patients with concomitant COVID‐19 and MI who underwent coronary angiography. Quantitative and qualitative coronary angiography were analyzed by two observers in an independent core lab. Results A total of 152 patients were included, of whom 142 (93.4%) had COVID‐19 diagnosis confirmation. The median time between symptom onset and hospital admission was 5 (1–10) days. A total of 83 (54.6%) patients presented with ST‐elevation MI. The median angiographic Syntax score was 16 (9.0–25.3) and 69.0% had multi‐vessel disease. At least one complex lesion was found in 73.0% of patients, 51.3% had a thrombus containing lesion, and 57.9% had myocardial blush grades 0/1. The overall in‐hospital mortality was 23.7%. ST‐segment elevation MI presentation and baseline myocardial blush grades 0 or 1 were independently associated with a higher risk of death (HR 2.75, 95%CI 1.30–5.80 and HR 3.73, 95%CI 1.61–8.61, respectively). Conclusions Patients who have a MI in the context of ongoing COVID‐19 mostly present complex coronary morphologies, implying a background of prior atherosclerotic disease superimposed on a thrombotic milieu. The in‐hospital prognosis is poor with a markedly high mortality, prompting further investigation to better clarify this newly described condition.
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Affiliation(s)
- Alexandre Abizaid
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Department of Cardiology, Hospital Sírio Libanês, Sao Paulo, Brazil.,Hospital do Coração (HCor), São Paulo, Brazil
| | - Carlos M Campos
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Department of Cardiology, Instituto Prevent Senior, São Paulo, Brazil
| | - Patrícia O Guimarães
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - José de Ribamar Costa
- Hospital do Coração (HCor), São Paulo, Brazil.,Department of Cardiology, Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
| | - Breno A A Falcão
- Department of Cardiology, Hospital de Messejana, Fortaleza, Brazil
| | - Fernanda Mangione
- Department of Cardiology, Hospital Beneficência Portuguesa, Sao Paulo, Brazil
| | - Adriano Caixeta
- Escola Paulista de Medicina, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
| | - Pedro A Lemos
- Department of Cardiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Fabio S de Brito
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Department of Cardiology, Hospital Sírio Libanês, Sao Paulo, Brazil.,Department of Cardiology, Hospital São Camilo, Sao Paulo, Brazil
| | | | | | - Leandro Cortes
- Department of Cardiology, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil
| | - Henrique B Ribeiro
- Department of Cardiology, Hospital Samaritano Paulista, Sao Paulo, Brazil
| | - Francis R de Souza
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Natassja Huemer
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Renata M do Val
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Bruno Caramelli
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Daniela Calderaro
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Felipe G Lima
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ludhmila A Hajjar
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roberto Kalil Filho
- Heart Institute, InCor, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Department of Cardiology, Hospital Sírio Libanês, Sao Paulo, Brazil
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De Maria GL, Garcia-Garcia HM, Scarsini R, Finn A, Sato Y, Virmani R, Bhindi R, Ciofani JL, Nuche J, Ribeiro HB, Mathias W, Yerasi C, Fischell TA, Otterspoor L, Ribichini F, Ibañez B, Pijls NHJ, Schwartz RS, Kapur NK, Stone GW, Banning AP. Novel device-based therapies to improve outcome in ST-segment elevation myocardial infarction. Eur Heart J Acute Cardiovasc Care 2021; 10:687-697. [PMID: 33760016 DOI: 10.1093/ehjacc/zuab012] [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] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/28/2021] [Accepted: 03/03/2021] [Indexed: 12/17/2022]
Abstract
Primary percutaneous coronary intervention (PPCI) has dramatically changed the outcome of patients with ST-elevation myocardial infarction (STEMI). However, despite improvements in interventional technology, registry data show little recent change in the prognosis of patients who survive STEMI, with a significant incidence of cardiogenic shock, heart failure, and cardiac death. Despite a technically successful PPCI procedure, a variable proportion of patients experience suboptimal myocardial reperfusion. Large infarct size and coronary microvascular injury, as the consequence of ischaemia-reperfusion injury and distal embolization of atherothrombotic debris, account for suboptimal long-term prognosis of STEMI patients. In order to address this unmet therapeutic need, a broad-range of device-based treatments has been developed. These device-based therapies can be categorized according to the pathophysiological pathways they target: (i) techniques to prevent distal atherothrombotic embolization, (ii) techniques to prevent or mitigate ischaemia/reperfusion injury, and (iii) techniques to enhance coronary microvascular function/integrity. This review is an overview of these novel technologies with a focus on their pathophysiological background, procedural details, available evidence, and with a critical perspective about their potential future implementation in the clinical care of STEMI patients.
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Affiliation(s)
- Giovanni Luigi De Maria
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, UK
| | - Hector M Garcia-Garcia
- MedStar Washington Hospital Centre-Interventional Cardiology Department, 110 Irving St NW, Washington, DC, USA
| | - Roberto Scarsini
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Aloke Finn
- CVPath Institute, Gaithersburg, 19 Firstfield Rd, Gaithersburg, MD 20878, USA.,School of Medicine, University of Maryland, Baltimore, 655 W Baltimore St, Baltimore, MD 21201, USA
| | - Yu Sato
- CVPath Institute, Gaithersburg, 19 Firstfield Rd, Gaithersburg, MD 20878, USA
| | - Renu Virmani
- CVPath Institute, Gaithersburg, 19 Firstfield Rd, Gaithersburg, MD 20878, USA
| | - Ravinay Bhindi
- Department of Cardiology, Royal North Shore Hospital, Reserve Road, ST. Leonard 2065, Sydney, Australia
| | - Jonathan L Ciofani
- Department of Cardiology, Royal North Shore Hospital, Reserve Road, ST. Leonard 2065, Sydney, Australia
| | - Jorge Nuche
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Calle Melchor Fernández Almagro 3, 28029, Madrid, Spain.,Servicio de Cardiología, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Cordoba avenue, 28041, Madrid, Spain.,CIBERCV, Av. Monforte de Lemos, 3-5. Pabellón, 11. Planta 0 28029, Madrid, Spain
| | - Henrique B Ribeiro
- Heart Institute (InCor), Clinic Hospital, The University of Sao Paulo School of Medicine, Sao Paulo, State of Sao Paulo 05403-000, Brazil
| | - Wilson Mathias
- Heart Institute (InCor), Clinic Hospital, The University of Sao Paulo School of Medicine, Sao Paulo, State of Sao Paulo 05403-000, Brazil
| | - Charan Yerasi
- MedStar Washington Hospital Centre-Interventional Cardiology Department, 110 Irving St NW, Washington, DC, USA
| | - Tim A Fischell
- Michigan State University, 426 Auditorium Road, East Lansing, MI 48824, USA
| | - Luuk Otterspoor
- Department of Cardiology, Catharina Hospital, Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Piazzale Aristide Stefani 1, 37126, Verona, Italy
| | - Borja Ibañez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Calle Melchor Fernández Almagro 3, 28029, Madrid, Spain.,CIBERCV, Av. Monforte de Lemos, 3-5. Pabellón, 11. Planta 0 28029, Madrid, Spain.,IIS-Fundación Jiménez Díaz, Calle Isaac Peral, 28015 Madrid, Spain
| | - Nico H J Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
| | - Robert S Schwartz
- Minneapolis Heart Institute, 920 E 28th St Ste 100, Minneapolis, MN 55407, USA
| | - Navin K Kapur
- The Cardiovascular Centre, Tufts Medical Centre, 800 Washington St, Boston, MA 02111, USA
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, 1190 Fifth Avenue, New York, NY 10029, USA
| | - Adrian P Banning
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, UK
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Del Val D, Abdel-Wahab M, Linke A, Durand E, Ihlemann N, Urena M, Pellegrini C, Giannini F, Landt M, Auffret V, Sinning JM, Cheema A, Nombela-Franco L, Chamandi C, Campelo-Parada F, Munoz-Garcia A, Herrmann HC, Testa L, Won-Keun K, Castillo JC, Alperi A, Tchetche D, Bartorelli A, Kapadia S, Stortecky S, Amat-Santos I, Wijeysundera HC, Lisko J, Gutiérrez-Ibanes E, Serra V, Salido L, Alkhodair A, Livi U, Chakravarty T, Lerakis S, Vilalta V, Regueiro A, Romaguera R, Barbanti M, Masson JB, Maes F, Fiorina C, Miceli A, Kodali S, Ribeiro HB, Mangione JA, de Brito FS, Actis Dato GM, Rosato F, Ferreira MC, Lima VC, Colafranceschi AS, Abizaid A, Marino MA, Esteves V, Andrea J, Godinho RR, Eltchaninoff H, Søndergaard L, Himbert D, Husser O, Latib A, Le Breton H, Servoz C, Pascual I, Siddiqui S, Olivares P, Hernandez-Antolin R, Webb JG, Sponga S, Makkar R, Kini AS, Boukhris M, Mangner N, Crusius L, Holzhey D, Rodés-Cabau J. Temporal Trends, Characteristics, and Outcomes of Infective Endocarditis After Transcatheter Aortic Valve Replacement. Clin Infect Dis 2021; 73:e3750-e3758. [PMID: 33733675 DOI: 10.1093/cid/ciaa1941] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/31/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Procedural improvements combined with the contemporary clinical profile of patients undergoing transcatheter aortic valve replacement (TAVR) may have influenced the incidence and outcomes of infective endocarditis (IE) following TAVR. We aimed to determine the temporal trends, characteristics, and outcomes of IE post-TAVR. METHODS Observational study including 552 patients presenting definite IE post-TAVR. Patients were divided in 2 groups according to the timing of TAVR (historical cohort [HC]: before 2014; contemporary cohort [CC]: after 2014). RESULTS Overall incidence rates of IE were similar in both cohorts (CC vs HC: 5.45 vs 6.52 per 1000 person-years; P = .12), but the rate of early IE was lower in the CC (2.29‰ vs 4.89‰, P < .001). Enterococci were the most frequent microorganism. Most patients presented complicated IE ( CC: 67.7%; HC: 69.6%; P = .66), but the rate of surgical treatment remained low (CC: 20.7%; HC: 17.3%; P = .32). The CC exhibited lower rates of in-hospital acute kidney injury (35.1% vs 44.6%; P = .036) and in-hospital (26.6% vs 36.4%; P = .016) and 1-year (37.8% vs 53.5%; P < .001) mortality. Higher logistic EuroScore, Staphylococcus aureus etiology, and complications (stroke, heart failure, and acute renal failure) were associated with in-hospital mortality in multivariable analyses (P < .05 for all). CONCLUSIONS Although overall IE incidence has remained stable, the incidence of early IE has declined in recent years. The microorganism, high rate of complications, and very low rate of surgical treatment remained similar. In-hospital and 1-year mortality rates were high but progressively decreased over time.
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Affiliation(s)
- David Del Val
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Mohamed Abdel-Wahab
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | - Axel Linke
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Eric Durand
- Hôpital Charles Nicolle, University of Rouen, Rouen, France
| | | | | | | | - Francesco Giannini
- Ospedale San Raffaele, Milan, Italy.,Maria Cecilia Hospital, GVM Care and Research, Cotignola RA, Italy
| | - Martin Landt
- Heart Center, Segeberger Kliniken, Bad Segeberg, Germany
| | | | | | - Asim Cheema
- St Michaels Hospital, Toronto, Canada.,Southlake Regional Health Centre, Newmarket, Canada
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | | | | | - Howard C Herrmann
- Hospital of the University of Pennsilvania, Philadelphia, Pennsylvania, USA
| | | | | | | | - Alberto Alperi
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | | | | | - John Lisko
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Enrique Gutiérrez-Ibanes
- Instituto de Investigación Universitaria Gregorio Marañón, Hospital Gregorio Marañón, Madrid, Spain
| | | | - Luisa Salido
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Stamatios Lerakis
- Emory University School of Medicine, Atlanta, Georgia, USA.,Mount Sinai Hospital, New York, New York, USA
| | | | | | | | - Marco Barbanti
- A.O.U. Policlinico Vittorio Emanuele, University of Catania, Catania, Italy
| | | | - Frédéric Maes
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Antonio Miceli
- Fondazione Toscana G. Monasterio, Massa, Italy.,Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Susheel Kodali
- Columbia University Medical Center, New York, New York, USA
| | - Henrique B Ribeiro
- Instituto do Coração (Incor), Heart Institute, University of São Paulo, Sao Paulo, Brazil
| | | | - Fabio Sandoli de Brito
- Instituto do Coração (Incor), Heart Institute, University of São Paulo, Sao Paulo, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Oliver Husser
- Deutsches Herzzentrum München, Munich, Germany.,St-Johannes-Hospital, Dortmund, Germany
| | - Azeem Latib
- Ospedale San Raffaele, Milan, Italy.,Montefiore Medical Center, New York, New York, USA
| | | | | | - Isaac Pascual
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Paolo Olivares
- Centro Cardiologico Monzino, IRCCS, University of Milan, Italy
| | | | | | | | - Raj Makkar
- Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | | | | | - Norman Mangner
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Lisa Crusius
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany
| | - David Holzhey
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
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Reddin G, Forrestal BJ, Garcia-Garcia HM, Medvedofsky D, Singh M, Asch FM, Ribeiro HB, Campos CM. Left ventricular global longitudinal strain assessment in patients with takotsubo cardiomyopathy: a call for an echocardiography-based classification. Minerva Cardiol Angiol 2021; 70:321-328. [PMID: 33427420 DOI: 10.23736/s2724-5683.20.05386-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Takotsubo cardiomyopathy (TTC) is classified into 4 types depending on the anatomical area affected identified on gross visual assessment. We have sought to understand if it is feasible and advantageous to use left ventricular global longitudinal strain (LVGLS), LV segmental longitudinal strain and right ventricle free wall strain (RVFWS) to classify TTC. METHODS We conducted a retrospective observational study on twenty-five patients who meet the Modified Mayo Clinic Criteria for TTC [1]. Two independent reviewers performed strain analysis, they were both blinded to patient's diagnosed classification and outcomes. RESULTS Based on classification by traditional assessment the 92% (N.=23) were diagnosed with typical TTC, indicating apical involvement. The entire LV was affected, 67% (N.=16) had abnormal strain (STE>-18) in all three LV regions (base, mid-ventricle and apex). Seventy-one percent of patients (N.=17) had abnormal LVGLS (>-18). Abnormal strain across all three LV regions was associated with higher prevalence (70%, N.=8 Vs 30%, N.=4, respectively) of composite cardiovascular events and longer length of hospital stay. There was a statistically significant difference in average length of hospital stay in those patients who had abnormal strain in all three regions compared to those that did not have abnormal strain across all three regions (8 days compared to 3.44 days, P=0.02). CONCLUSIONS A new classification of TCC based on strain analysis should be developed. The traditional model is arbitrary; it fails to recognize that in most patients the entire LV is affect, it does not have prognostic significance and the most prevalent typical variant indicates apical involvement. Our study suggests that the entire LV is affected, and strain analysis has prognostic significance.
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Affiliation(s)
- Gemma Reddin
- MedStar Washington Hospital Center, Washington (DC), WA, USA
| | | | | | | | - Manavotam Singh
- MedStar Washington Hospital Center, Washington (DC), WA, USA
| | - Federico M Asch
- MedStar Washington Hospital Center, Washington (DC), WA, USA
| | - Henrique B Ribeiro
- University of São Paulo Medical School, Heart Institute - InCor, São Paulo, Brazil
| | - Carlos M Campos
- University of São Paulo Medical School, Heart Institute - InCor, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
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35
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Reddin G, Forrestal BJ, Garcia-Garcia HM, Medvedofsky D, Singh M, Asch FM, Ribeiro HB, Campos CM. Left ventricular global longitudinal strain assessment in patients with Takotsubo Cardiomyopathy: a call for an echocardiography-based classification. Minerva Cardioangiol 2021. [PMID: 33427420 DOI: 10.23736/s0026-4725.20.05386-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Takotsubo Cardiomyopathy (TTC) is classified into 4 types dependent on anatomical area affected identified on gross visual assessment. We have sought to understand if it is feasible and advantageous to use left ventricular global longitudinal strain (LVGLS), LV segmental longitudinal strain and right ventricle free wall strain (RVFWS) to classify TTC. METHODS We conducted a retrospective observational study on twenty-five patients who meet the Modified Mayo Clinic Criteria for TTC [1]. Two independent reviewers performed strain analysis, they were both blinded to patient's diagnosed classification and outcomes. RESULTS Based on classification by traditional assessment the 92% (n=23) were diagnosed with typical TTC, indicating apical involvement. The entire LV was affected, 67% (n=16) had abnormal strain (STE>-18) in all three LV regions (base, mid ventricle and apex). 71% of patients (n=17) had abnormal LVGLS (>-18). Abnormal strain across all three LV regions was associated with higher prevalence (70%, n=8 Vs 30%, n=4 respectively) of composite cardiovascular events and longer length of hospital stay. There was a statistically significant difference in average length of hospital stay in those patients who had abnormal strain in all three region compared to those that did not have abnormal strain across all three regions (8 days compared to 3.44 days, p value 0.02). CONCLUSIONS A new classification of TCC based on strain analysis should be developed. The traditional model is arbitrary; it fails to recognize that in most patients the entire LV is affect, it does not have prognostic significance and the most prevalent typical variant indicates apical involvement. Our study suggests that the entire LV is affected, and strain analysis has prognostic significance.
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Affiliation(s)
- Gemma Reddin
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | | | | | | | | | - Henrique B Ribeiro
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Carlos M Campos
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
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36
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Annabi MS, Côté N, Dahou A, Bartko PE, Bergler-Klein J, Burwash IG, Orwat S, Baumgartner H, Mascherbauer J, Mundigler G, Fukui M, Cavalcante J, Ribeiro HB, Rodès-Cabau J, Clavel MA, Pibarot P. Comparison of Early Surgical or Transcatheter Aortic Valve Replacement Versus Conservative Management in Low-Flow, Low-Gradient Aortic Stenosis Using Inverse Probability of Treatment Weighting: Results From the TOPAS Prospective Observational Cohort Study. J Am Heart Assoc 2020; 9:e017870. [PMID: 33289422 PMCID: PMC7955363 DOI: 10.1161/jaha.120.017870] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background No randomized comparison of early (ie, ≤3 months) aortic valve replacement (AVR) versus conservative management or of transcatheter AVR (TAVR) versus surgical AVR has been conducted in patients with low‐flow, low‐gradient (LFLG) aortic stenosis (AS). Methods and Results A total of 481 consecutive patients (75±10 years; 71% men) with LFLG AS (aortic valve area ≤0.6 cm2/m2 and mean gradient <40 mm Hg), 72% with classic LFLG and 28% with paradoxical LFLG, were prospectively recruited in the multicenter TOPAS (True or Pseudo Severe Aortic Stenosis) study. True‐severe AS or pseudo‐severe AS was adjudicated by flow‐independent criteria. During follow‐up (median [IQR] 36 [11–60] months), 220 patients died. Using inverse probability of treatment weighting to address the bias of nonrandom treatment assignment, early AVR (n=272) was associated with a major overall survival benefit (hazard ratio [HR], 0.34 [95% CI, 0.24–0.50]; P<0.001). This benefit was observed in patients with true‐severe AS but also with pseudo‐severe AS (HR, 0.38 [95% CI, 0.18–0.81]; P=0.01), and in classic (HR, 0.33 [95% CI, 0.22–0.49]; P<0.001) and paradoxical LFLG AS (HR, 0.42 [95% CI, 0.20–0.92]; P=0.03). Compared with conservative management in the conventional multivariate model, trans femoral TAVR was associated with the best survival (HR, 0.23 [95% CI, 0.12–0.43]; P<0.001), followed by surgical AVR (HR, 0.36 [95% CI, 0.23–0.56]; P<0.001) and alternative‐access TAVR (HR, 0.51 [95% CI, 0.31–0.82]; P=0.007). In the inverse probability of treatment weighting model, trans femoral TAVR appeared to be superior to surgical AVR (HR [95% CI] 0.28 [0.11–0.72]; P=0.008) with regard to survival. Conclusions In this large prospective observational study of LFLG AS, early AVR appeared to confer a major survival benefit in both classic and paradoxical LFLG AS. This benefit seems to extend to the subgroup with pseudo‐severe AS. Our findings suggest that TAVR using femoral access might be the best strategy in these patients. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01835028.
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Affiliation(s)
- Mohamed-Salah Annabi
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval Québec Canada
| | - Nancy Côté
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval Québec Canada
| | - Abdellaziz Dahou
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval Québec Canada
| | - Philipp E Bartko
- Division of Cardiology Department of Internal Medicine II Medical University of ViennaVienna General Hospital Vienna Austria
| | - Jutta Bergler-Klein
- Division of Cardiology Department of Internal Medicine II Medical University of ViennaVienna General Hospital Vienna Austria
| | - Ian G Burwash
- University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Stefan Orwat
- Department of Cardiology III-Adult Congenital and Valvular Heart Disease University Hospital Muenster Muenster Germany
| | - Helmut Baumgartner
- Department of Cardiology III-Adult Congenital and Valvular Heart Disease University Hospital Muenster Muenster Germany
| | - Julia Mascherbauer
- Division of Cardiology Department of Internal Medicine II Medical University of ViennaVienna General Hospital Vienna Austria
| | - Gerald Mundigler
- Division of Cardiology Department of Internal Medicine II Medical University of ViennaVienna General Hospital Vienna Austria
| | - Miho Fukui
- Cardiology Minneapolis Heart Institute Minneapolis MN
| | - Joao Cavalcante
- Division of Cardiology University of Pittsburgh PA.,Cardiology Minneapolis Heart Institute Minneapolis MN
| | | | - Josep Rodès-Cabau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval Québec Canada
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval Québec Canada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval Québec Canada
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37
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Affiliation(s)
- Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
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38
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Faroux L, Campelo-Parada F, Munoz-Garcia E, Nombela-Franco L, Fischer Q, Donaint P, Serra V, Veiga G, Gutiérrez E, Vilalta V, Alperi A, Regueiro A, Asmarats L, Ribeiro HB, Matta A, Munoz-Garcia A, Armijo G, Urena M, Metz D, Rodenas-Alesina E, de la Torre Hernandez JM, Fernandez-Nofrerias E, Pascual I, Perez-Fuentes P, Arzamendi D, Campanha-Borges DC, Del Val D, Couture T, Rodés-Cabau J. Procedural Characteristics and Late Outcomes of Percutaneous Coronary Intervention in the Workup Pre-TAVR. JACC Cardiovasc Interv 2020; 13:2601-2613. [PMID: 33069647 DOI: 10.1016/j.jcin.2020.07.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 05/04/2020] [Revised: 06/23/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study sought to determine, in patients undergoing percutaneous coronary intervention (PCI) during the work-up pre-transcatheter aortic valve replacement (TAVR): 1) the clinical and peri-procedural PCI characteristics; 2) the long-term outcomes; and 3) the clinical events in those patients with complex coronary features. BACKGROUND A PCI is performed in about 25% of TAVR candidates, but procedural features and late outcomes of pre-TAVR PCI remain largely unknown. METHODS Multicenter study including 1197 consecutive patients who had PCI in the work-up pre-TAVR. A total of 1,705 lesions (1.5 ± 0.7 lesions per patient) were included. Death, stroke, myocardial infarction, and major adverse cardiovascular and cerebrovascular events (MACCE) were recorded, as well as target lesion failure (TLF) and target vessel failure (TVF). RESULTS One-half of patients exhibited a multivessel disease and the mean SYNTAX (SYNergy between PCI with TAXUS and Cardiac Surgery) score was 12.1 ± 9.1. The lesions were of B2/C type, calcified, bifurcation, and ostial in 49.9%, 45.8%, 21.4%, and 19.3% of cases, respectively. After a median follow-up of 2 (interquartile range: 1 to 3) years, a total of 444 (37.1%) patients presented an MACCE. Forty patients exhibited TVF (3.3%), with TLF identified in 32 (2.7%) patients. By multivariable analysis, previous peripheral artery disease (p < 0.001), chronic obstructive pulmonary disease (p = 0.002), atrial fibrillation (p = 0.003), diabetes mellitus (p = 0.012), and incomplete revascularization (p = 0.014) determined an increased risk of MACCE. In patients with unprotected left main or SYNTAX score >32 (n = 128), TLF, TVF, and MACCE rates were 3.9%, 6.3%, and 35.9%, respectively (p = 0.378; p = 0.065, and p = 0.847, respectively, vs. the rest of the population). CONCLUSIONS Patients undergoing PCI in the work-up pre-TAVR frequently exhibited complex coronary lesions and multivessel disease. PCI was successful in most cases, and TLF and TVF rates at 2-year follow-up were low, also among patients with high-risk coronary features. However, overall MACCE occurred in about one-third of patients, with incomplete revascularization determining an increased risk. These results should inform future studies to better determine the optimal revascularization strategy pre-TAVR.
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Affiliation(s)
- Laurent Faroux
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Erika Munoz-Garcia
- Cardiology Department, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Luis Nombela-Franco
- Cardiology Department, Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Quentin Fischer
- Cardiology Department, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Donaint
- Cardiology Department, Reims University Hospital, Reims, France
| | - Vicenç Serra
- Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Gabriela Veiga
- Cardiology Department, Hospital Marques de Valdecilla, Santander, Spain
| | | | - Victoria Vilalta
- Cardiology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Alberto Alperi
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ander Regueiro
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Lluis Asmarats
- Cardiology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Henrique B Ribeiro
- Cardiology Department, Heart Institute, University of São Paulo, São Paulo, Brazil
| | - Anthony Matta
- Cardiology Department, Hôpital Universitaire de Toulouse, Toulouse, France
| | - Antonio Munoz-Garcia
- Cardiology Department, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - German Armijo
- Cardiology Department, Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Marina Urena
- Cardiology Department, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Damien Metz
- Cardiology Department, Reims University Hospital, Reims, France
| | | | | | | | - Isaac Pascual
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Pedro Perez-Fuentes
- Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Dabit Arzamendi
- Cardiology Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | - David Del Val
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Thomas Couture
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
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Iacomini Ida G, Kalansky MA, Baptista LDPS, de Barros E Silva PGM, Jamus M, Teixeira Garcia JC, Furlan V, Ribeiro EE, Ribeiro HB. Atypical chest pain due to multiple coronary arteries fistulas occluded with percutaneous interlock coils: A case report. J Cardiol Cases 2020; 23:16-19. [PMID: 33437334 DOI: 10.1016/j.jccase.2020.08.009] [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: 04/22/2020] [Revised: 07/19/2020] [Accepted: 08/14/2020] [Indexed: 11/25/2022] Open
Abstract
Coronary artery fistulas, although rare, should be included in the differential diagnosis of atypical chest pain, generally unveiled by cardiac catheterization or multidetector computed tomography. Such anatomical findings in conjunction with detectable ischemia and severe symptoms should prompt their closure. Transcatheter closure of fistulas is an attractive alternative to surgery, especially with the novel devices such as the interlock fibered detachable coils, which can be safely and effectively performed in a variety of circumstances, including the coronary arteries with tortuous anatomies. We present a case of atypical chest pain and large burden of ischemia in the stress scintigraphy, due to multiple coronary fistulas to the bronchial arteries successfully occluded with percutaneous interlock coils. <Learning objective: This report describes the feasibility and safety of multiple tortuous coronary-bronchial fistulas treated with the novel interlock fibered detachable coils, in a patient with prior thromboembolism. This is the first case report to use this device in this situation and shows that, in symptomatic patients with documented ischemia, such novel devices may help in treating coronary fistulas, even in tortuous anatomy.>.
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Affiliation(s)
| | | | | | | | | | | | | | - Expedito E Ribeiro
- Samaritano Paulista Hospital, Sao Paulo, Brazil.,Heart Institute of São Paulo-InCor, Sao Paulo, Brazil
| | - Henrique B Ribeiro
- Samaritano Paulista Hospital, Sao Paulo, Brazil.,Heart Institute of São Paulo-InCor, Sao Paulo, Brazil
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40
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Rodriguez-Gabella T, Catalá P, Muñoz-García AJ, Nombela-Franco L, Del Valle R, Gutiérrez E, Regueiro A, Jimenez-Diaz VA, Ribeiro HB, Rivero F, Fernandez-Diaz JA, Pibarot P, Alonso-Briales JH, Tirado-Conte G, Moris C, Diez Del Hoyo F, Jiménez-Britez G, Zaderenko N, Alfonso F, Gómez I, Carrasco-Moraleja M, Rodés-Cabau J, San Román Calvar JA, Amat-Santos IJ. Renin-Angiotensin System Inhibition Following Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2020; 74:631-641. [PMID: 31370954 DOI: 10.1016/j.jacc.2019.05.055] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [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: 04/08/2019] [Revised: 05/08/2019] [Accepted: 05/14/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several studies have demonstrated the benefits of transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis, but the presence of persistent fibrosis and myocardial hypertrophy has been related to worse prognosis. OBJECTIVES The aim of this study was to explore the potential benefits of renin-angiotensin system (RAS) inhibitors on left ventricular remodeling and major clinical outcomes following successful transcatheter aortic valve replacement (TAVR). METHODS Patients from 10 institutions with severe aortic stenosis who underwent TAVR between August 2007 and August 2017 were included. All baseline data were prospectively recorded, and pre-specified follow-up was performed. Doses and types of RAS inhibitors at discharge were recorded, and matched comparison according to their prescription at discharge was performed. RESULTS A total of 2,785 patients were included. Patients treated with RAS inhibitors (n = 1,622) presented similar surgical risk scores but a higher rate of all cardiovascular risk factors, coronary disease, and myocardial infarction. After adjustment for these baseline differences, reduction of left ventricular volumes and hypertrophy was greater and cardiovascular mortality at 3-year follow-up was lower (odds ratio: 0.59; 95% confidence interval: 0.41 to 0.87; p = 0.007) in patients treated with RAS inhibitors. Moreover, RAS inhibitors demonstrated a global cardiovascular protective effect with significantly lower rates of new-onset atrial fibrillation, cerebrovascular events, and readmissions. CONCLUSIONS Post-TAVR RAS inhibitors are associated with lower cardiac mortality at 3-year follow-up and offer a global cardiovascular protective effect that might be partially explained by a positive left ventricular remodeling. An ongoing randomized trial will help confirm these hypothesis-generating findings. (Renin-Angiotensin System Blockade Benefits in Clinical Evolution and Ventricular Remodeling After Transcatheter Aortic Valve Implantation [RASTAVI]; NCT03201185).
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Affiliation(s)
| | - Pablo Catalá
- Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain
| | | | | | - Raquel Del Valle
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Enrique Gutiérrez
- CIBERCV, Cardiology Department, Hospital Gregorio Marañon, Madrid, Spain
| | - Ander Regueiro
- CIBERCV, Cardiology Department, Hospital Clinic, Barcelona, Spain
| | | | | | | | | | | | | | | | - César Moris
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | | | | | - Itziar Gómez
- CIBERCV, Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain
| | | | | | - J Alberto San Román Calvar
- Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain; CIBERCV, Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Ignacio J Amat-Santos
- Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain; CIBERCV, Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain.
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Aguiar MO, Tavares BG, Tsutsui JM, Fava AM, Borges BC, Oliveira MT, Soeiro A, Nicolau JC, Ribeiro HB, Chiang HP, Sbano JC, Goldsweig A, Rochitte CE, Lopes BB, Ramirez JA, Kalil Filho R, Porter TR, Mathias W. Sonothrombolysis Improves Myocardial Dynamics and Microvascular Obstruction Preventing Left Ventricular Remodeling in Patients With ST Elevation Myocardial Infarction. Circ Cardiovasc Imaging 2020; 13:e009536. [DOI: 10.1161/circimaging.119.009536] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 01/29/2023]
Abstract
Background:
It has recently been demonstrated that high-energy diagnostic transthoracic ultrasound and intravenous microbubbles dissolve thrombi (sonothrombolysis) and increase angiographic recanalization rates in patients with ST-segment–elevation myocardial infarction. We aimed to study the effect of sonothrombolysis on the myocardial dynamics and infarct size obtained by real-time myocardial perfusion echocardiography and their value in preventing left ventricular remodeling.
Methods:
One hundred patients with ST-segment–elevation myocardial infarction were randomized to therapy (50 patients treated with sonothrombolysis and percutaneous coronary intervention) or control (50 patients treated with percutaneous coronary intervention only). Left ventricular volumes, ejection fraction, risk area (before treatment), myocardial perfusion defect over time (infarct size), and global longitudinal strain were determined by quantitative real-time myocardial perfusion echocardiography and speckle tracking echocardiography imaging.
Results:
Risk area was similar in the control and therapy groups (19.2±10.1% versus 20.7±8.9%;
P
=0.56) before treatment. The therapy group presented a behavior significantly different than control group over time (
P
<0.001). The perfusion defect was smaller in the therapy at 48 to 72 hours even in the subgroup of patients with no recanalization at first angiography (12.9±6.5% therapy versus 18.8±9.9% control;
P
=0.015). The left ventricular global longitudinal strain was higher in the therapy than control immediately after percutaneous coronary intervention (14.1±4.1% versus 12.0±3.3%;
P
=0.012), and this difference was maintained until 6 months (17.1±3.5% versus 13.6±3.6%;
P
<0.001). The only predictor of left ventricular remodeling was treatment with sonothrombolysis: the control group was more likely to exhibit left ventricular remodeling with an odds ratio of 2.79 ([95% CI, 0.13–6.86];
P
=0.026).
Conclusions:
Sonothrombolysis reduces microvascular obstruction and improves myocardial dynamics in patients with ST-segment–elevation myocardial infarction and is an independent predictor of left ventricular remodeling over time.
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Affiliation(s)
- Miguel O.D. Aguiar
- Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.)
| | - Bruno G. Tavares
- Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.)
| | - Jeane M. Tsutsui
- Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.)
| | - Agostina M. Fava
- University of Nebraska Medical Center, Omaha (A.M.F., A.G., T.R.P.)
| | - Bruno C. Borges
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Mucio T. Oliveira
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Alexandre Soeiro
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Jose C. Nicolau
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Henrique B. Ribeiro
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Hsu P. Chiang
- Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.)
| | - João C.N. Sbano
- Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.)
| | - Andrew Goldsweig
- University of Nebraska Medical Center, Omaha (A.M.F., A.G., T.R.P.)
| | - Carlos E. Rochitte
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Bernardo B.C. Lopes
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - José A.F. Ramirez
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Roberto Kalil Filho
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Thomas R. Porter
- University of Nebraska Medical Center, Omaha (A.M.F., A.G., T.R.P.)
| | - Wilson Mathias
- Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.)
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42
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Chiang H, Aguiar MO, Tavares BG, Mathias W, Borges BC, Azevedo L, Oliveira M, Soeiro A, Nicolau JC, Ribeiro HB, Sbano JC, Goldsweig A, Kalil-Filho R, Ramires J, Porter T, Tsutsui J. THE IMPACT OF SONOTHROMBOLYSIS ON LEFT VENTRICULAR DIASTOLIC FUNCTION AND LEFT ATRIAL MECHANICS IN PATIENTS WITH ST ELEVATION MYOCARDIAL INFARCTION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32277-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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43
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Lemes MVS, Bacelar AC, Rosa VEE, Caixeta AM, Lemos PA, Ribeiro HB, Almeida BO, Mariani J, Campos CAHM, Tarasoutchi F, Franken M, Brito FS. P929Predictors of renal function improvement in patients with chronic kidney disease undergoing TAVR. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0524] [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
Chronic kidney disease (CKD) is common among patients undergoing transcatheter aortic valve replacement (TAVR). The prognosis of CKD on TAVR outcomes has been previously documented. However, there is a paucity of data about predictors of renal function improvement and its clinical relevance.
Purpose
To determine predictors of renal function improvement after TAVR among patients with CKD.
Methods
Prospective study, analyzing 819 patients from 22 centers with symptomatic severe aortic stenosis included in the Brazilian TAVR Registry between 2008 and 2015. CKD was defined as estimated glomerular filtration rate (eGFR) <60mg/dL, and patients without CKD were excluded. Groups were divided according to variation of eGFR between baseline and 7 days after TAVR: improvement (increase >10% in eGFR) in 197 (34.1%) patients, worsening (decrease >10% in eGFR) in 203 (35.2%), and stable (neither criteria) in 177 (30.7%). Logistic regression analysis was used to identify predictors of renal function improvement. One-year outcomes were determined as Kaplan-Meier survival curves.
Results
CKD was present in 577 (70%) patients. The mean age was 81.9±6.8 years, 56.2% were male, 31.7% had diabetes and 74.5% had hypertension. The mean STS score was 10.6±7.9%, the mean EuroSCORE II were 21.8±15.2% and the preferable access site was transfemoral (93.4%). The mean eGFR was 37.3±12.5 ml/min in the improvement group (IG), 39.6±11.7 ml/min in the stable group (SG) and 40.2±12.3 ml/min in the worsening group (WG), with significant statistical difference between IG and WG (p=0.044). There was no difference related to contrast midia volume between the 3 groups. In the multivariate analysis, coronary artery disease (OR: 0.69; 95% CI 0.48–0.98; p=0.039) and baseline eGFR (OR: 0.98; 95% CI 0.97–1.00; p=0.039) were associated with improvement in renal function. There was no significant difference in 1-year all-cause mortality between IG and SG (15.4 vs 9.5%, log rank p=0.141) (Figure 1A). However, the WG had higher mortality compared with the IG (29.3 vs 15.4%, log rank p<0,001) (Figure 1B).
Figure 1
Conclusion
Improvement in renal function after TAVR was frequently found among patients with CKD. The absence of coronary artery disease and lower baseline eGFR were independent predictors of improvement in renal function. Although the IG had lower 1-year all-cause mortality compared to WG, no difference were observed related to SG.
Acknowledgement/Funding
SBHCI
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Affiliation(s)
- M V S Lemes
- Hospital Israelita Albert Einstein and Heart Institute of University of Sao Paulo, Brazil, Sao Paulo, Brazil
| | - A C Bacelar
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - V E E Rosa
- Hospital Israelita Albert Einstein and Heart Institute of University of Sao Paulo, Brazil, Sao Paulo, Brazil
| | - A M Caixeta
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - P A Lemos
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - H B Ribeiro
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - B O Almeida
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - J Mariani
- Hospital Israelita Albert Einstein and Heart Institute of University of Sao Paulo, Brazil, Sao Paulo, Brazil
| | - C A H M Campos
- Hospital Israelita Albert Einstein and Heart Institute of University of Sao Paulo, Brazil, Sao Paulo, Brazil
| | - F Tarasoutchi
- Hospital Israelita Albert Einstein and Heart Institute of University of Sao Paulo, Brazil, Sao Paulo, Brazil
| | - M Franken
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - F S Brito
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
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44
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Emer Egypto Rosa V, Ribeiro HB, Samapio RO, Morais TC, Rosa MEE, De Santis ASAL, Fernandes JRC, Spina GS, Vieira MLC, Pomerantzeff PMA, Rochitte CE, Mathias Jr W, Tarasoutchi F. P6483Predictors of contractile reserve on dobutamine stress echocardiography in patients with classical low-flow, low-gradient aortic stenosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1073] [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
There is a lack of information on factors that influence contractile reserve (CR) on dobutamine stress echocardiography (DSE) in patients with classical low-flow, low-gradient aortic stenosis (LFLG-AS).
Purpose
This study sought to evaluate the predictors of CR in patients with LFLG-AS.
Methods
Prospective study including 43 consecutive LFLG-AS patients (aortic valve area [AVA] ≤1.0 cm2, mean transaortic gradient <40 mmHg, left ventricular ejection fraction [LVEF] <50%) with true severe aortic stenosis. All patients underwent dobutamine stress echocardiography and T1-mapping cardiac magnetic resonance (CMR). CR was defined as an increase ≥20% in the left ventricular stroke volume at peak stress. Patients with pseudo-severe aortic stenosis were excluded.
Results
All of the patients in the study had degenerative aortic stenosis, with a median age of 67 [60–74] years, most of them being male (83.7%). A high prevalence of comorbidities was found, highlighted by diabetes (42%), hypertension (70%), atrial fibrillation (25%) and coronary artery disease (38%). Mean transaortic gradient was 25 [20–33] mmHg, AVA was 0.88 [0.68–0.95] cm2, LVEF was 35 [28–43]% and 32.6% had moderate/severe functional mitral regurgitation. CMR myocardium extracellular volume fraction (ECV) was 28.8 [26.3–33.0] %, indexed ECV was 35.4 [25.0–41.2] ml/m2, 32.6% had positive transmural delayed-enhancement images and 25.6% had positive mesocardial delayed-enhancement images. On DSE, 30 patients (69.7%) had CR and 13 patients (30.3%) had no CR. Global longitudinal strain was 10 [7–12] %, Δ indexed flow rate was 25 [3–38] ml/m2.seg and Δ mean gradient was 10 [3–16] mmHg. By multivariate analysis, moderate/severe functional mitral regurgitation (HR 0.122, 95% CI 0.020–0.759, p=0.024) and AVA (HR 0.606, 95% CI 0.396–0.925, p=0.020 [for each increase of 0.05 cm2]) were the only factors associated with CR. ECV, indexed ECV and positive transmural or mesocardial delayed-enhancement images were not associated with CR in the univariate analysis.
Conclusions
In our study, the absence of moderate/severe functional mitral regurgitation and AVA were predictors of CR on DSE in patients with LFLG-AS. As AVA was smaller in patients with CR, our finding contradicts the hypothesis that more severe aortic stenosis could also contribute to the lack of CR. Other possible factors that are surrogate of myocardium fibrosis, as ECV, indexed ECV and positive delayed-enhancement images, were not associated with the absence of CR.
Acknowledgement/Funding
FAPESP
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Affiliation(s)
- V Emer Egypto Rosa
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - H B Ribeiro
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - R O Samapio
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - T C Morais
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - M E E Rosa
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - A S A L De Santis
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - J R C Fernandes
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - G S Spina
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - M L C Vieira
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - P M A Pomerantzeff
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - C E Rochitte
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - W Mathias Jr
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - F Tarasoutchi
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
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Emer Egypto Rosa V, Echeverri D, Sztejfman M, Jaikel LAG, Dager A, Abud M, Charry P, Chauvet AA, Tarasoutchi F, Cura F, Ribeiro HB. P2273Predictors of short- and mid-term outcomes after TAVR in low-flow, low-gradient aortic stenosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0750] [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
There is a lack of data on outcomes in classical (C-LFLG) and paradoxical low-flow, low-gradient aortic stenosis (P-LFLG) patients undergoing TAVR.
Purpose
We aim to compare baseline characteristic and procedural outcomes between C-LFLG, P-LFLG and high-gradient aortic stenosis (HG-AS) patients undergoing TAVR.
Methods
Patients included in the Transcatheter RegistrY of aorTic valve biOprosthesis in Latin-AMerica (TRYTOM Registry) were divided in 3 groups: 1) HG-AS: mean transaortic gradient (MG) ≥40 mmHg; 2) P-LFLG: MG <40 mmHg and left ventricular ejection fraction (LVEF) ≥50%; 3) C-LFLG: MG <40 mmHg and LVEF <50%. The outcomes were evaluated at 30-days and 1-year and were classified according to definitions of the VARC-2.
Results
1040 patients were included, 677 (65%) classified as HG-AS, 223 (21%) as P-LFLG and 140 (14%) as C-LFLG. Median follow-up was 16 months (range 0–109). There were baseline differences between HG-AS, P-LFLG and C-LFLG regarding age (80±7 vs 80±5 vs 78±8 years, respectively; p=0.017), NYHA FC III and IV (61.0 vs 72.6 vs 83.6%, respectively; p<0.001), coronary artery disease (44.1 vs 47.1 vs 57.9%, respectively; p=0.012), EuroSCORE II (7.2±6.3 vs 7.5±5.0 vs 12.9±10.4%, respectively; p<0.001), LVEF (56±11 vs 61±7 vs 32±9%, respectively; p<0.001), MG (53±13 vs 30±6 vs 27±7 mmHg, respectively; p<0.001), aortic valve area (0.65±0.16 vs 0.74±0.15 vs 0.70±0.16 cm2, respectively; p<0.001) and creatinine (1.2±0.7 vs 1.1±0.5 vs 1.5±1.3 mg/dl, respectively; p<0.001). Despite these significant baseline differences, we found similar outcomes after TAVR between HG-AS, P-LFLG and C-LFLG regarding device success (89.8 vs 95.1 vs 90.7%, respectively; p=0.057), in-hospital mortality (6.1 vs 5.9 vs 11.8%, respectively; p=0.144) and all other VARC-2 major outcomes, including major bleeding, major vascular complication and disabling stroke. In addition, female sex (OR 2.13, 95% CI 1.16–3.92, p=0.014), LVEF (OR 1.02, 95% CI 1.00–1.04, p=0.039) and MG (OR 0.97, 95% CI 0.95–0.99, p=0.004) were the only predictor of device success by multivariate analysis. Furthermore, 1-year mortality was similar among the groups (9.5 vs 8.3 vs 14.3%, respectively; p=0.358; Figure 1), and by multivariate analysis, diabetes (HR 2.44, 95% CI 1.10–5.41, p=0.028), creatinine (HR 1.65, 95% CI 1.17–2.33, p=0.004), conversion to general anesthesia (HR 7.93, 95% CI 2.08–30.20, p=0.002) and post-procedure disabling stroke (HR 12.84, 95% CI 3.09–53.40, p<0.001) predicted increased 1-year mortality, irrespective on the LVEF and MG.
Conclusions
Apart from baseline differences, TAVR in P-LFLG and C-LFLG was feasible and with similar clinical outcomes when compared to HG-AS. Mid-term mortality rates was associated with diabetes, creatinine and procedure complications.
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Affiliation(s)
- V Emer Egypto Rosa
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | | | | | | | - A Dager
- Angiografia de Occidente, Cali, Colombia
| | - M Abud
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - P Charry
- Hospital Universitario Mayor de Mederi, Bogota, Colombia
| | - A A Chauvet
- Regional Hospital 1st of October, Mexico City, Mexico
| | - F Tarasoutchi
- Heart Institute of the University of Sao Paulo (InCor), VALVULAR HEART DISEASE UNIT, Sao Paulo, Brazil
| | - F Cura
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - H B Ribeiro
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
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Annabi MS, Dahou A, Bergler-Klein J, Burwash IG, Orwat S, Baumgartner H, Bartko PE, Mascherbauer J, Mundigler G, Cavalcante J, Ribeiro HB, Rodes-Cabau J, Clavel MA, Pibarot P. 6099Impact of aortic valve replacement on outcomes of patients with low-flow, low-gradient moderate aortic stenosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0133] [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
Aortic valve replacement (AVR) is recommended for patients with low-flow, low-gradient (LFLG) and true-severe aortic stenosis (TSAS). However, there is very few data on the potential benefit of AVR in patients with LFLG pseudo-severe (i.e. moderate) AS (PSAS).
Methods
Consecutive patients with aortic valve area ≤0.6 cm2/m2, mean gradient <40 mmHg were prospectively recruited in a multicenter observational cohort study. The patients were categorized in TSAS vs. PSAS using previously reported thresholds of flow-independent parameters of AS severity (projected valve area at normal flow rate ≤1.0 cm2 and/or aortic valve calcium score by CT >1200 AU in women and >2000 AU in men). To account for between-treatment-group differences, inverse probability-of-treatment weighting was combined to Cox proportional hazards regression.
Results
Among the 430 patients included in this study, 297 (69%) were classified as TSAS and 274 (57%) underwent AVR. Of note, 21% of the patients treated by AVR were classified as PSAS. In patients managed conservatively (ConsRx), 52% had PSAS and 48% TSAS. During a median follow-up of 28 months [8–60], 198 patients died. The adjusted weighted hazard ratio (awHR) of death associated with AVR as compared to ConsRx was 0.42 [0.24–0.73] (p<0.0001, Figure1-Panel-A). This survival benefit associated with AVR was observed not only in patients with TSAS but also in those with PSAS (awHR: 0.29 [0.12–0.70]; p=0.006, Figure1-Panel-B).
Figure 1
Conclusion
The results of this study suggest that AVR is associated with a survival benefit not only in LFLG patients with TSAS but also in those with PSAS. Randomized trials are needed to confirm the benefit of AVR in patients with moderate AS and depressed LV systolic function.
Acknowledgement/Funding
Canadian Institute of Health Research
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Affiliation(s)
- M S Annabi
- Quebec Heart and Lung Institute, Quebec, Canada
| | - A Dahou
- Quebec Heart and Lung Institute, Quebec, Canada
| | - J Bergler-Klein
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - I G Burwash
- University of Ottawa Heart Institute, Ottawa, Canada
| | - S Orwat
- University Hospital of Munster, Muenster, Germany
| | | | - P E Bartko
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - J Mascherbauer
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - G Mundigler
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - J Cavalcante
- University of Pittsburgh, Division of Cardiology, Pittsburgh, United States of America
| | - H B Ribeiro
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | | | - M A Clavel
- Quebec Heart and Lung Institute, Quebec, Canada
| | - P Pibarot
- Quebec Heart and Lung Institute, Quebec, Canada
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Bernardi FLM, Dvir D, Rodes-Cabau J, Ribeiro HB. Valve-in-Valve Challenges: How to Avoid Coronary Obstruction. Front Cardiovasc Med 2019; 6:120. [PMID: 31508426 PMCID: PMC6716332 DOI: 10.3389/fcvm.2019.00120] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/06/2019] [Indexed: 11/13/2022] Open
Abstract
Coronary obstruction is a rare but life-threatening complication in patients undergoing transcatheter aortic valve replacement (TAVR). Aortic valve-in-valve (VIV) procedures to treat failed surgical bioprosthesis is associated with ~6-fold higher risk for coronary obstruction in certain situations. The primary mechanism consists in the occlusion of the coronary ostium by the dislodged leaflet from the bioprosthesis after deployment of the transcatheter heart valve (THV), which most commonly occurs during the index procedure, but in up to 1/3 of cases a delayed presentation ensues. The clinical presentation consists of severe hypotension and ECG changes in most of the patients, with very high mortality rates. Therefore, pre-procedural multi-slice computed tomography is crucial for identifying high-risk features, such as low coronary heights, shallow sinuses of Valsalva, and short virtual THV to coronary ostial distance (VTC). Also, some models of surgical bioprosthesis present an increased risk for this dreadful complication. Preemptive protective strategies with coronary wiring, with or without placement of an undeployed stent, could mitigate the risks associated with this complication in high-risk patients, even though studies are lacking. This review aims to take a clinical perspective on the challenges in avoiding this complication during VIV procedures.
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Affiliation(s)
- Fernando L M Bernardi
- Hospital São Francisco-São Camilo, Concórdia, Brazil.,Heart Institute of São Paulo (InCor), University of São Paulo, São Paulo, Brazil
| | - Danny Dvir
- Division of Cardiology, University of Washington, Seattle, WA, United States
| | - Josep Rodes-Cabau
- Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, QC, Canada
| | - Henrique B Ribeiro
- Heart Institute of São Paulo (InCor), University of São Paulo, São Paulo, Brazil
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Rosa VE, Ribeiro HB, Sampaio RO, Morais TC, Rosa ME, Pires LJ, Vieira ML, Mathias W, Rochitte CE, de Santis AS, Fernandes JRC, Accorsi TA, Pomerantzeff PM, Rodés-Cabau J, Pibarot P, Tarasoutchi F. Myocardial Fibrosis in Classical Low-Flow, Low-Gradient Aortic Stenosis. Circ Cardiovasc Imaging 2019; 12:e008353. [DOI: 10.1161/circimaging.118.008353] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Vitor E.E. Rosa
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Henrique B. Ribeiro
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Roney O. Sampaio
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Thamara C. Morais
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Marcela E.E. Rosa
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Lucas J.T. Pires
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Marcelo L.C. Vieira
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Wilson Mathias
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Carlos E. Rochitte
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Antonio S.A.L. de Santis
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Joao Ricardo C. Fernandes
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Tarso A.D. Accorsi
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Pablo M.A. Pomerantzeff
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (J.R.-C., P.P.)
| | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (J.R.-C., P.P.)
| | - Flavio Tarasoutchi
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
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Wassef AW, Rodes-Cabau J, Liu Y, Webb JG, Barbanti M, Muñoz-García AJ, Tamburino C, Dager AE, Serra V, Amat-Santos IJ, Alonso Briales JH, San Roman A, Urena M, Himbert D, Nombela-Franco L, Abizaid A, de Brito FS, Ribeiro HB, Ruel M, Lima VC, Nietlispach F, Cheema AN. The Learning Curve and Annual Procedure Volume Standards for Optimum Outcomes of Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2018; 11:1669-1679. [DOI: 10.1016/j.jcin.2018.06.044] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 05/28/2018] [Accepted: 06/26/2018] [Indexed: 11/24/2022]
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Biagioni C, Tirado-Conte G, Rodés-Cabau J, Ryan N, Cerrato E, Nazif TM, Eltchaninoff H, Sondergaard L, Ribeiro HB, Barbanti M, Nietlispach F, De Jaegere P, Agostoni P, Trillo R, Jiménez-Quevedo P, D'Ascenzo F, Wendler O, Maluenda G, Chen M, Tamburino C, Macaya C, Leon MB, Nombela-Franco L. State of Transcatheter Aortic Valve Implantation in Spain Versus Europe and Non-European Countries. J Invasive Cardiol 2018; 30:301-309. [PMID: 30068785] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is now the standard treatment for severe aortic stenosis in high-risk symptomatic patients, and its indications are expanding to lower-risk patients. OBJECTIVES The objective of this study was to analyze the state of TAVI in Spain vs other European and non-European countries. METHODS Using an online questionnaire, we analyzed the routine practice of 250 TAVI centers worldwide. The questionnaire included 59 questions on patient selection, technical aspects of the procedure, and postprocedural management. The centers were divided into Spain (n = 41), rest of Europe (n = 105), and rest of the world (n = 104). RESULTS The cumulative number of procedures (74; range, 40-122) and those performed in the last year (16.5; range, 15-29.5) in Spain, were significantly lower than the rest of Europe (P<.01) and the rest of the world (P<.01). The patient risk profile was higher, with an under-use of functional tests compared to the rest of the world. While the use of computed tomography to analyze the aortic annulus was lower in Spain (P<.001), general anesthesia and transesophageal echocardiography were more frequently used in Spain than in the rest of Europe (P<.001 for both). Dual-antiplatelet therapy is the most common post-TAVI antithrombotic therapy in the absence of an indication for anticoagulation, although its duration is longer in Spain (6 months) compared to European centers (3 months). CONCLUSIONS Routine TAVI practice in Spain differed in some key aspects of preprocedural, intraprocedural, and postprocedural management. Future studies will help to unify strategies and assess their impact on clinical results.
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Affiliation(s)
- Corina Biagioni
- Cardiovascular Institute, Hospital Universitario Clínico San Carlos, IdISSC, C/Prof Martin Lagos s/n 28040 Madrid, Spain.
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