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Fukui M, Cavalcante JL, Bapat VN. Deformation in transcatheter heart valves: Clinical implications and considerations. J Cardiol 2024; 83:351-358. [PMID: 38432474 DOI: 10.1016/j.jjcc.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as a preferred treatment modality for aortic stenosis, marking a significant advancement in cardiac interventions. Transcatheter heart valves (THVs) have also received approval for treating failed bioprosthetic valves and rings across aortic, mitral, tricuspid, and pulmonic positions. Unlike surgically implanted valves, which are sewn into the annulus, THVs are anchored through relative oversizing. Although THVs are designed to function optimally in a fully expanded state, they exhibit a certain degree of tolerance to underexpansion. However, significant deformation beyond this tolerance can adversely affect the valve's hemodynamics and durability, ultimately impacting patient outcomes. Such post-implantation deviations from the valve's intended three-dimensional design are influenced by a variety of physiological and anatomical factors unique to each patient and procedure, leading to underexpansion, eccentric expansion, and vertical deformation. These deformation patterns increase leaflet stress and strain, potentially causing fatigue and damage. This review article delves into the extent of THV deformation, its impact on leaflet function, hypoattenuating leaflet thickening, and structural valve degeneration. It provides an in-depth analysis of deformation specifics in different procedural contexts, including TAVR in native aortic stenosis, aortic and mitral valve-in-valve procedures, and redo-TAVR. Additionally, the review discusses strategies to mitigate THV deformation during the procedure, offering insights into potential solutions to these challenges.
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Affiliation(s)
- Miho Fukui
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA.
| | - João L Cavalcante
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Vinayak N Bapat
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
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2
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Koike H, Fukui M, Treibel T, Stanberry LI, Cheng VY, Enriquez-Sarano M, Schmidt S, Schelbert EB, Wang C, Okada A, Phichaphop A, Sorajja P, Bapat VN, Leipsic J, Lesser JR, Cavalcante JL. Comprehensive Myocardial Assessment by Computed Tomography: Impact on Short-Term Outcomes After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Imaging 2024; 17:396-407. [PMID: 37921717 DOI: 10.1016/j.jcmg.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/12/2023] [Accepted: 08/10/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Quantification of myocardial changes in severe aortic stenosis (AS) is prognostically important. The potential for comprehensive myocardial assessment pre-transcatheter aortic valve replacement (TAVR) by computed tomography angiography (CTA) is unknown. OBJECTIVES This study sought to evaluate whether quantification of left ventricular (LV) extracellular volume-a marker of myocardial fibrosis-and global longitudinal strain-a marker of myocardial deformation-at baseline CTA associate with post-TAVR outcomes. METHODS Consecutive patients with symptomatic severe AS between January 2021 and June 2022 who underwent pre-TAVR CTA were included. Computed tomography extracellular volume (CT-ECV) was derived from septum tracing after generating the 3-dimensional CT-ECV map. Computed tomography global longitudinal strain (CT-GLS) used semi-automated feature tracking analysis. The clinical endpoint was the composite outcome of all-cause mortality and heart failure hospitalization. RESULTS Among the 300 patients (80.0 ± 9.4 years of age, 45% female, median Society of Thoracic Surgeons Predicted Risk of Mortality score 2.80%), the left ventricular ejection fraction (LVEF) was 58% ± 12%, the median CT-ECV was 28.5% (IQR: 26.2%-32.1%), and the median CT-GLS was -20.1% (IQR: -23.8% to -16.3%). Over a median follow-up of 16 months (IQR: 12-22 months), 38 deaths and 70 composite outcomes occurred. Multivariable Cox proportional hazards model, accounting for clinical and echocardiographic variables, demonstrated that CT-ECV (HR: 1.09 [95% CI: 1.02-1.16]; P = 0.008) and CT-GLS (HR: 1.07 [95% CI: 1.01-1.13]; P = 0.017) associated with the composite outcome. In combination, elevated CT-ECV and CT-GLS (above median for each) showed a stronger association with the outcome (HR: 7.14 [95% CI: 2.63-19.36]; P < 0.001). CONCLUSIONS Comprehensive myocardial quantification of CT-ECV and CT-GLS associated with post-TAVR outcomes in a contemporary low-risk cohort with mostly preserved LVEF. Whether these imaging biomarkers can be potentially used for the decision making including timing of AS intervention and post-TAVR follow-up will require integration into future clinical trials.
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Affiliation(s)
- Hideki Koike
- Cardiovascular Imaging Research Center and Core Lab at Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Miho Fukui
- Cardiovascular Imaging Research Center and Core Lab at Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Thomas Treibel
- Institute of Cardiovascular Science, University College London, and Barts Heart Centre, St Bartholomew Hospital, London, United Kingdom
| | - Larissa I Stanberry
- Cardiovascular Imaging Research Center and Core Lab at Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Victor Y Cheng
- Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Maurice Enriquez-Sarano
- Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Stephanie Schmidt
- Cardiovascular Imaging Research Center and Core Lab at Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Erik B Schelbert
- Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Cheng Wang
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Atsushi Okada
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Asa Phichaphop
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Paul Sorajja
- Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Vinayak N Bapat
- Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - John R Lesser
- Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - João L Cavalcante
- Cardiovascular Imaging Research Center and Core Lab at Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA; Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
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Tsuji JM, Shaw NA, Nagashima S, Venkiteswaran JJ, Schiff SL, Watanabe T, Fukui M, Hanada S, Tank M, Neufeld JD. Anoxygenic phototroph of the Chloroflexota uses a type I reaction centre. Nature 2024; 627:915-922. [PMID: 38480893 PMCID: PMC10972752 DOI: 10.1038/s41586-024-07180-y] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 02/08/2024] [Indexed: 04/01/2024]
Abstract
Scientific exploration of phototrophic bacteria over nearly 200 years has revealed large phylogenetic gaps between known phototrophic groups that limit understanding of how phototrophy evolved and diversified1,2. Here, through Boreal Shield lake water incubations, we cultivated an anoxygenic phototrophic bacterium from a previously unknown order within the Chloroflexota phylum that represents a highly novel transition form in the evolution of photosynthesis. Unlike all other known phototrophs, this bacterium uses a type I reaction centre (RCI) for light energy conversion yet belongs to the same bacterial phylum as organisms that use a type II reaction centre (RCII) for phototrophy. Using physiological, phylogenomic and environmental metatranscriptomic data, we demonstrate active RCI-utilizing metabolism by the strain alongside usage of chlorosomes3 and bacteriochlorophylls4 related to those of RCII-utilizing Chloroflexota members. Despite using different reaction centres, our phylogenomic data provide strong evidence that RCI-utilizing and RCII-utilizing Chloroflexia members inherited phototrophy from a most recent common phototrophic ancestor. The Chloroflexota phylum preserves an evolutionary record of the use of contrasting phototrophic modes among genetically related bacteria, giving new context for exploring the diversification of phototrophy on Earth.
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Affiliation(s)
- J M Tsuji
- University of Waterloo, Waterloo, Ontario, Canada.
- Institute of Low Temperature Science, Hokkaido University, Sapporo, Japan.
- Japan Agency for Marine-Earth Science and Technology, Yokosuka, Japan.
| | - N A Shaw
- University of Waterloo, Waterloo, Ontario, Canada
| | - S Nagashima
- Tokyo Metropolitan University, Tokyo, Japan
- Kanagawa University, Yokohama, Japan
| | - J J Venkiteswaran
- University of Waterloo, Waterloo, Ontario, Canada
- Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - S L Schiff
- University of Waterloo, Waterloo, Ontario, Canada
| | - T Watanabe
- Institute of Low Temperature Science, Hokkaido University, Sapporo, Japan
| | - M Fukui
- Institute of Low Temperature Science, Hokkaido University, Sapporo, Japan
| | - S Hanada
- Tokyo Metropolitan University, Tokyo, Japan
- Bioproduction Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - M Tank
- Tokyo Metropolitan University, Tokyo, Japan
- Leibniz Institute DSMZ-German Collection of Microorganisms and Cell Cultures GmbH, Braunschweig, Germany
| | - J D Neufeld
- University of Waterloo, Waterloo, Ontario, Canada.
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Satomura Y, Tachibana M, Yasuda K, Yamano Y, Inoue T, Fukui M, Onuma S, Fukuoka T, Kimura T, Ueno T, Tachibana M, Ozono K, Bessho K. Comprehensive analyses of neurodevelopmental outcomes and quality of life of children with biliary atresia. J Pediatr Gastroenterol Nutr 2024; 78:514-523. [PMID: 38504406 DOI: 10.1002/jpn3.12071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/27/2023] [Accepted: 10/03/2023] [Indexed: 03/21/2024]
Abstract
OBJECTIVES To holistically evaluate neurodevelopmental outcomes and quality of life (QOL) of Japanese patients with biliary atresia (BA) and to investigate the factors associated with the outcomes. METHODS This study enrolled patients with BA aged 5-18 years who visited Osaka University Hospital in 2021. Neurodevelopmental assessments were performed to evaluate intellectual ability, cognitive functions and adaptive skill levels. Furthermore, emotional and behavioral issues, characteristics of attention deficit hyperactivity disorder, and QOL were concomitantly assessed in the same cohort. Biochemical and social factors associated with the results were examined. RESULTS Fifty-three patients, with a median age of 11.2 years were included in the analyses. Patients with BA had a significantly lower Full-Scale Intelligence Quotient or developmental quotient (FSIQ/DQ) score and Vineland Adaptive Behavior Scale (VABS) composite score than the general Japanese population. Household education level and short stature were associated with low and borderline FSIQ/DQ and VABS composite scores, respectively. Among patients with low and borderline FSIQ/DQ scores, those with average or high VABS composite scores received significantly less neuroeducational care than those with low and borderline VABS composite scores. Despite the low FSIQ/DQ and VABS composite scores, the total QOL scores were higher than those of the general population. CONCLUSION Patients with BA had intellectual and behavioral impairments. Notably, patients with intellectual impairments are overlooked and not followed up, especially if adaptive skills are maintained.
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Affiliation(s)
- Yoshinori Satomura
- Department of Pediatrics, Graduate School of Medicine, Osaka University, Osaka, Japan
- Department of Pediatrics, Osaka General Medical Center, Osaka, Japan
| | - Makiko Tachibana
- Department of Pediatrics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kie Yasuda
- Department of Pediatrics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuki Yamano
- Department of Pediatrics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Taisuke Inoue
- Department of Pediatrics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Miho Fukui
- Department of Pediatrics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shinsuke Onuma
- Department of Pediatrics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tomoya Fukuoka
- Department of Pediatrics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takeshi Kimura
- Department of Pediatrics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takehisa Ueno
- Department of Pediatrics Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Masaya Tachibana
- Department of Pediatrics, Graduate School of Medicine, Osaka University, Osaka, Japan
- Molecular Research Center for Children's Mental Development, United Graduate School of Child Development, Osaka University, Osaka, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kazuhiko Bessho
- Department of Pediatrics, Graduate School of Medicine, Osaka University, Osaka, Japan
- Graduate School of Medical Safety Management, Jikei University of Health Care Sciences, Osaka, Japan
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Okada A, Beckmann E, Rocher EE, Fukui M, Wang C, Phichaphop A, Koike H, Thao KR, Willett A, Walser-Kuntz E, Stanberry LI, Enriquez-Sarano M, Lesser JR, Sun B, Steffen RJ, Sorajja P, Cavalcante JL, Bapat VN. Preprocedural Computed Tomography Planning for Surgical Aortic Valve Replacement. Ann Thorac Surg 2024:S0003-4975(24)00121-8. [PMID: 38382704 DOI: 10.1016/j.athoracsur.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/29/2023] [Accepted: 02/13/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Selection of transcatheter valve size using preprocedural computed tomography (CT) is standardized and well established. However, valve sizing for surgical aortic valve replacement (SAVR) is currently performed intraoperatively by using sizers, which may result in variation among operators and risk for prosthesis-patient mismatch. This study evaluated the usefulness of CT annulus measurement for SAVR valve sizing. METHODS This study included patients who underwent SAVR using Inspiris or Magna Ease and received preoperative electrocardiogram-gated CT imaging. Starting from June 2022, study investigators applied a CT sizing algorithm using CT-derived annulus size to guide minimum SAVR label size. The final decision of valve selection was left to the operating surgeon during SAVR. The study compared the appropriateness of valve selection (comparing implanted size with CT-predicted size) and prosthesis-patient mismatch rates without aortic root enlargement between 2 cohorts: 102 cases since June 2022 (CT sizing cohort) and 180 cases from 2020 to 2021 (conventional sizing cohort). RESULTS Implanted size smaller than CT predicted size and severe prosthesis-patient mismatch were significantly lower by CT sizing than by conventional sizing (12% vs 31% [P = .001] and 0% vs 6% [P = .039], respectively). Interoperator variability was a factor associated with implanted size smaller than CT predicted with conventional sizing, whereas it became nonsignificant with CT sizing. CONCLUSIONS Applying CT sizing to SAVR led to improved valve size selection, less prosthesis-patient mismatch, and less interoperator variability. CT sizing for SAVR could also be used to predict prosthesis-patient mismatch before SAVR and identify patients who need aortic root enlargement.
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Affiliation(s)
- Atsushi Okada
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Erik Beckmann
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Erick E Rocher
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Miho Fukui
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Cheng Wang
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Asa Phichaphop
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Hideki Koike
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Kiahltone R Thao
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Andrew Willett
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Evan Walser-Kuntz
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Larissa I Stanberry
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | | | - John R Lesser
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Benjamin Sun
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Robert J Steffen
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - João L Cavalcante
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota; Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Vinayak N Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.
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Fukui M, Okada A, Burns MR, Sato H, Thao KR, Wang C, Koike H, Hamid N, Enriquez-Sarano M, Lesser JR, Cavalcante JL, Sorajja P, Bapat VN. Deformation of transcatheter heart valves with mitral valve-in-valve. EUROINTERVENTION 2023; 19:e937-e947. [PMID: 37899719 PMCID: PMC10719737 DOI: 10.4244/eij-d-23-00614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/24/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND The use of oversizing in mitral valve-in-valve (MViV) procedures can lead to non-uniform expansion of transcatheter heart valves (THV). This may have implications for THV durability. AIMS The objective of this study was to assess the extent and predictors of THV deformation in MViV procedures. METHODS We examined 33 patients who underwent MViV with SAPIEN prostheses. The extent of THV deformation (deformation index, eccentricity, neosinus volume, asymmetric leaflet expansion and vertical deformation) and hypoattenuating leaflet thickening (HALT) were assessed using cardiac computed tomography (CT), performed prospectively at 30 days post-procedure. For descriptive purposes, the THV deformation index was calculated, with values >1.00 representing a more hourglass shape. RESULTS Non-uniform underexpansion of THV was common after MViV implantation, with a median expansion area of 74.0% (interquartile range 68.1-84.1) at the narrowest level and a THV deformation index of 1.21 (1.13-1.29), but circularity was maintained with eccentricity ranging from 0.24 to 0.28. The degree of oversizing was a key factor associated with greater underexpansion and a higher deformation index (β=-0.634; p<0.001; β=0.594; p<0.001, respectively). Overall, the incidence of HALT on the 30-day postprocedural CT was 27.3% (9 of 33). Most patients (32 of 33) were on anticoagulation therapy, but the prothrombin time and international normalised ratio (PT-INR) at the time of the CT scan was <2.5 in 23 of 32 patients. Among patients with a PT-INR of <2.5, HALT was predominantly observed with a high THV deformation index of ≥1.18. CONCLUSIONS THV deformation, i.e., underexpansion and an hourglass shape, commonly occurs after MViV implantation and is negatively affected by excessive oversizing. Optimising THV expansion during MViV could potentially prevent HALT.
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Affiliation(s)
- Miho Fukui
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Atsushi Okada
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Marcus R Burns
- Allina Health Minneapolis Heart Institute - Minneapolis, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Hirotomo Sato
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Kiahltone R Thao
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Cheng Wang
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Hideki Koike
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Nadira Hamid
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
- Allina Health Minneapolis Heart Institute - Minneapolis, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - John R Lesser
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
- Allina Health Minneapolis Heart Institute - Minneapolis, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Joao L Cavalcante
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
- Allina Health Minneapolis Heart Institute - Minneapolis, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
- Allina Health Minneapolis Heart Institute - Minneapolis, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Vinayak N Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
- Allina Health Minneapolis Heart Institute - Minneapolis, Abbott Northwestern Hospital, Minneapolis, MN, USA
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Fukui M, Sorajja P, Enriquez-Sarano M, Lesser JR, Bapat VN, Cavalcante JL. Cardiac MRI Uncovers Pathophysiology of Low Cardiac Output Syndrome Post-Transcatheter Mitral Valve Replacement. JACC Cardiovasc Interv 2023; 16:2927-2930. [PMID: 38092498 DOI: 10.1016/j.jcin.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/29/2023] [Accepted: 10/10/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Miho Fukui
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | - John R Lesser
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Vinayak N Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - João L Cavalcante
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
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8
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Zaid S, Bapat VN, Sathananthan J, Landes U, De Backer O, Tarantini G, Grubb KJ, Kaneko T, Khalique OK, Jilaihawi H, Fukui M, Madhavan M, Cangut B, Harrington K, Thourani VH, Makkar RR, Leon MB, Mack MJ, Tang GHL. Challenges and Future Directions in Redo Aortic Valve Reintervention After Transcatheter Aortic Valve Replacement Failure. Circ Cardiovasc Interv 2023; 16:e012966. [PMID: 37988437 DOI: 10.1161/circinterventions.123.012966] [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] [Indexed: 11/23/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is increasingly being performed in younger and lower surgical risk patients. Reintervention for failed transcatheter heart valves will likely increase in the future as younger patients are expected to outlive the initial bioprosthesis. While redo-TAVR has emerged as an attractive and less invasive alternative to surgical explantation (TAVR-explant) to treat transcatheter heart valve failure, it may not be feasible in all patients due to the risk of coronary obstruction and impaired coronary access. Conversely, TAVR-explant can be offered to most patients who are surgical candidates, but the reported outcomes have shown high mortality and morbidity. This review provides the latest evidence, current challenges, and future directions on redo-TAVR and TAVR-explant for transcatheter heart valve failure, to guide aortic valve reintervention and facilitate patients' lifetime management of aortic stenosis.
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Affiliation(s)
- Syed Zaid
- Division of Cardiology, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX (S.Z.)
| | - Vinayak N Bapat
- Cardiothoracic Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (V.N.B., M.F.)
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.S.)
| | - Uri Landes
- Department of Cardiology, Edith Wolfson Medical Center, Tel-Aviv University, Holon, Israel (U.L.)
| | - Ole De Backer
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark (O.D.B.)
| | | | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (K.J.G.)
| | - Tsuyoshi Kaneko
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO (T.K.)
| | - Omar K Khalique
- DeMatteis Cardiovascular Institute; Division of Cardiac Imaging, St. Francis Hospital & Heart Center, Roslyn, NY (O.K.K.)
| | - Hasan Jilaihawi
- Division of Cardiology, Cedars-Sinai Medical Center, The Smidt Heart Institute, Los Angeles, CA (H.J., R.R.M.)
| | - Miho Fukui
- Cardiothoracic Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (V.N.B., M.F.)
| | - Mahesh Madhavan
- Division of Cardiology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY (M.M, M.B.L.)
| | - Busra Cangut
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, NY (B.C., G.H.L.T.)
| | - Katherine Harrington
- Department of Cardiothoracic Surgery, Baylor, Scott and White the Heart Hospital, Plano, TX (K.H., M.J.M.)
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, GA (V.H.T.)
| | - Raj R Makkar
- Division of Cardiology, Cedars-Sinai Medical Center, The Smidt Heart Institute, Los Angeles, CA (H.J., R.R.M.)
| | - Martin B Leon
- Division of Cardiology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY (M.M, M.B.L.)
| | - Michael J Mack
- Department of Cardiothoracic Surgery, Baylor, Scott and White the Heart Hospital, Plano, TX (K.H., M.J.M.)
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, NY (B.C., G.H.L.T.)
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Fukui M, Okada A, Thao KR, Burns MR, Koike H, Wang C, Phichaphop A, Lesser JR, Sorajja P, Cavalcante JL, Bapat VN. Feasibility of Redo-Transcatheter Aortic Valve Replacement in Sapien Valves Based on In Vivo Computed Tomography Assessment. Circ Cardiovasc Interv 2023; 16:e013497. [PMID: 37988440 DOI: 10.1161/circinterventions.123.013497] [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] [Indexed: 11/23/2023]
Abstract
BACKGROUND Our aim was to assess the feasibility of repeat transcatheter aortic valve (TAV) replacement for degenerated Sapien3 (S3) prostheses by simulating subsequent implantation of S3 or Evolut, using in vivo computed tomography-based sizing and the impact on coronary and patient-prosthesis mismatch risks. METHODS Computed tomography scans from 356 patients with prior S3 TAV replacement implantation were analyzed. The in vivo sizing for second TAV based on averaged area of 3 levels of outflow, mid (narrowest) and inflow, was compared with in vitro recommendations, that is, same size as index S3 for second S3 and 1 size larger for Evolut. Risks of coronary obstruction and patient-prosthesis mismatch were determined by valve-to-aorta distance and estimated effective orifice area, respectively. RESULTS Overall, the majority of patients (n=328; 92.1%) had underexpanded index S3 with an expansion area of 94% (91%-97%), leading to significant differences in size selection of the second TAV between in vivo and in vitro sizing strategies. Expansion area <89% served as a threshold, resulting in 1 size smaller than the in vitro recommendations were selected in 45 patients (13%) for S3-in-S3 and 13 (4%) for Evolut-in-S3, while the remaining patients followed in vitro recommendations (P<0.01, in vivo versus in vitro sizing). Overall, 57% of total patients for S3-in-S3 simulation and 60% for Evolut-in-S3 were considered low risk for coronary complications. Deep index S3 implantation (odds ratio, 0.76 [interquartile range, 0.67-0.87]; P<0.001) and selecting Evolut as the second TAV (11% risk reduction in intermediate- or high-risk patients) reduced coronary risk. Estimated moderate or severe patient-prosthesis mismatch risk was 21% for S3-in-S3 and 1% for Evolut-in-S3, assuming optimal expansion of the second TAV. CONCLUSIONS Redo-TAV replacement with S3-in-S3 and Evolut-in-S3 could be feasible with low risk to coronaries in ≈60% of patients, while the remaining 40% will be at intermediate or high risk. The feasibility of redo-TAV replacement is influenced by sizing strategy, type of second TAV, native annular anatomy, and implant depth.
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Affiliation(s)
- Miho Fukui
- Cardiovascular Imaging Research Center and Core Lab (M.F., H.K., J.L.C.), Minneapolis Heart Institute Foundation, MN
| | - Atsushi Okada
- Valve Science Center (A.O., K.R.T., C.W., A.P., J.R.L., P.S., V.N.B.), Minneapolis Heart Institute Foundation, MN
| | - Kiahltone R Thao
- Valve Science Center (A.O., K.R.T., C.W., A.P., J.R.L., P.S., V.N.B.), Minneapolis Heart Institute Foundation, MN
| | - Marcus R Burns
- Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.R.B., J.R.L., P.S., J.L.C., V.N.B.)
| | - Hideki Koike
- Cardiovascular Imaging Research Center and Core Lab (M.F., H.K., J.L.C.), Minneapolis Heart Institute Foundation, MN
| | - Cheng Wang
- Valve Science Center (A.O., K.R.T., C.W., A.P., J.R.L., P.S., V.N.B.), Minneapolis Heart Institute Foundation, MN
| | - Asa Phichaphop
- Valve Science Center (A.O., K.R.T., C.W., A.P., J.R.L., P.S., V.N.B.), Minneapolis Heart Institute Foundation, MN
| | - John R Lesser
- Valve Science Center (A.O., K.R.T., C.W., A.P., J.R.L., P.S., V.N.B.), Minneapolis Heart Institute Foundation, MN
- Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.R.B., J.R.L., P.S., J.L.C., V.N.B.)
| | - Paul Sorajja
- Valve Science Center (A.O., K.R.T., C.W., A.P., J.R.L., P.S., V.N.B.), Minneapolis Heart Institute Foundation, MN
- Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.R.B., J.R.L., P.S., J.L.C., V.N.B.)
| | - João L Cavalcante
- Cardiovascular Imaging Research Center and Core Lab (M.F., H.K., J.L.C.), Minneapolis Heart Institute Foundation, MN
- Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.R.B., J.R.L., P.S., J.L.C., V.N.B.)
| | - Vinayak N Bapat
- Valve Science Center (A.O., K.R.T., C.W., A.P., J.R.L., P.S., V.N.B.), Minneapolis Heart Institute Foundation, MN
- Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.R.B., J.R.L., P.S., J.L.C., V.N.B.)
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Fukui M, Sorajja P, Cavalcante JL, Thao KR, Okada A, Sato H, Wang C, Koike H, Hamid N, Enriquez-Sarano M, Lesser JR, Bapat VN. Deformation of Transcatheter Heart Valve Following Valve-in-Valve Transcatheter Aortic Valve Replacement: Implications for Hemodynamics. JACC Cardiovasc Interv 2023; 16:515-526. [PMID: 36922036 DOI: 10.1016/j.jcin.2023.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 11/07/2022] [Revised: 12/23/2022] [Accepted: 01/10/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) may be associated with adverse hemodynamics, which might affect clinical outcomes. OBJECTIVES This study sought to evaluate the extent and predictors of transcatheter heart valve (THV) deformity in ViV TAVR and the relation to postprocedural hemodynamics. METHODS We examined 53 patients who underwent ViV TAVR in surgical heart valves with self-expanding Evolut prostheses. THV deformation was examined using cardiac computed tomography prospectively performed 30 days after ViV TAVR, and correlated with 30-day echocardiographic hemodynamic data. RESULTS Near complete expansion of the functional portion of the implanted ViV prostheses (ie, >90%) was observed in 16 (30.2%) patients. Factors related to greater expansion of the functional portion and consequently larger neosinus volume were absence of polymer surgical frame, higher implantation and use of balloon aortic valvuloplasty or bioprosthetic valve fracture during the procedure (all P < 0.05). Underexpansion of the functional portion, but not the valve inflow frame, was closely associated with mean gradient and effective orifice area at 30 days on echocardiography, with and without adjustment for the sizes of the THV and surgical heart valve. CONCLUSIONS Underexpansion of the functional portion of THV prostheses is common during ViV TAVR, occurs more frequently with deep implantation and the presence of a polymer surgical stent frame, and is associated with worse postprocedural hemodynamics. Procedural techniques, such as higher implantation and balloon postdilatation, may be used to help overcome problems with THV underexpansion and improve clinical outcomes.
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Affiliation(s)
- Miho Fukui
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - João L Cavalcante
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Kiahltone R Thao
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Atsushi Okada
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Hirotomo Sato
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Cheng Wang
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Hideki Koike
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Nadira Hamid
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | - John R Lesser
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Vinayak N Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
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Koike H, Fukui M, Idris A, Cheng VY, Sato H, Okada A, Enriquez-Sarano M, Bapat VN, Sorajja P, Lesser JR, Cavalcante JL. ASSOCIATION OF EXTRACELLULAR VOLUME AND GLOBAL LONGITUDINAL STRAIN ASSESSMENT BY COMPUTED TOMOGRAPHY WITH POST TRANSCATHETER AORTIC VALVE REPLACEMENT OUTCOMES. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01252-4] [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: 03/06/2023]
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12
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Hashimoto G, Koike H, Sato H, Fukui M, Sorajja P, Bapat VN, Lesser JR, Enriquez-Sarano M, Cavalcante JL. GLOBAL LONGITUDINAL STRAINBY CARDIAC MAGNETIC RESONANCE ASSOCIATES WITH WORSE REMODELING AND OUTCOMES IN PATIENTS WITH SIGNIFICANT AORTIC REGURGITATION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02415-4] [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: 03/06/2023]
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Olausson E, Wertz J, Fridman Y, Bering P, Maanja M, Niklasson L, Wong TC, Fukui M, Cavalcante JL, Cater G, Kellman P, Bukhari S, Miller CA, Saba S, Ugander M, Schelbert EB. Diffuse myocardial fibrosis associates with incident ventricular arrhythmia in implantable cardioverter defibrillator recipients. medRxiv 2023:2023.02.15.23285925. [PMID: 36824921 PMCID: PMC9949189 DOI: 10.1101/2023.02.15.23285925] [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: 02/18/2023]
Abstract
Background Diffuse myocardial fibrosis (DMF) quantified by extracellular volume (ECV) may represent a vulnerable phenotype and associate with life threatening ventricular arrhythmias more than focal myocardial fibrosis. This principle remains important because 1) risk stratification for implantable cardioverter defibrillators (ICD) remains challenging, and 2) DMF may respond to current or emerging medical therapies (reversible substrate). Objectives To evaluate the association between quantified by ECV in myocardium without focal fibrosis by late gadolinium enhancement (LGE) with time from ICD implantation to 1) appropriate shock, or 2) shock or anti-tachycardia pacing. Methods Among patients referred for cardiovascular magnetic resonance (CMR) without congenital disease, hypertrophic cardiomyopathy, or amyloidosis who received ICDs (n=215), we used Cox regression to associate ECV with incident ICD therapy. Results After a median of 2.9 (IQR 1.5-4.2) years, 25 surviving patients experienced ICD shock and 44 experienced shock or anti-tachycardia pacing. ECV ranged from 20.2% to 39.4%. No patient with ECV<25% experienced an ICD shock. ECV associated with both endpoints, e.g., hazard ratio 2.17 (95%CI 1.17-4.00) for every 5% increase in ECV, p=0.014 in a stepwise model for ICD shock adjusting for ICD indication, age, smoking, atrial fibrillation, and myocardial infarction, whereas focal fibrosis by LGE and global longitudinal strain (GLS) did not. Conclusions DMF measured by ECV associates with ventricular arrhythmias requiring ICD therapy in a dose-response fashion, even adjusting for potential confounding variables, focal fibrosis by LGE, and GLS. ECV-based risk stratification and DMF representing a therapeutic target to prevent ventricular arrhythmia warrant further investigation.
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Affiliation(s)
- Eric Olausson
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | | | - Yaron Fridman
- Asheville Cardiology Associates, Mission Hospital, Asheville, NC, USA
| | | | - Maren Maanja
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Louise Niklasson
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Timothy C Wong
- Heart and Vascular Institute, UPMC, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- UPMC Cardiovascular Magnetic Resonance Center, Pittsburgh, PA, USA
| | - Miho Fukui
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - João L. Cavalcante
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - George Cater
- Heart and Vascular Institute, UPMC, Pittsburgh, PA, USA
- UPMC Cardiovascular Magnetic Resonance Center, Pittsburgh, PA, USA
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Syed Bukhari
- Department of Medicine, Temple University, Philadelphia, PA, USA
| | - Christopher A. Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester, M23 9LT, UK
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
- Kolling Institute, Royal North Shore Hospital, and Sydney Medical School, Northern Clinical School, University of Sydney, Sydney, Australia
| | - Samir Saba
- Heart and Vascular Institute, UPMC, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
- Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology & Regenerative Medicine, School of Biology, Faculty of Biology, Medicine & Health, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
- Kolling Institute, Royal North Shore Hospital, and Sydney Medical School, Northern Clinical School, University of Sydney, Sydney, Australia
| | - Erik B. Schelbert
- Heart and Vascular Institute, UPMC, Pittsburgh, PA, USA
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- UPMC Cardiovascular Magnetic Resonance Center, Pittsburgh, PA, USA
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
- Minneapolis Heart Institute East, United Hospital, Saint Paul, Minnesota
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14
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Sorajja P, Sato H, Bapat VN, Cavalcante JL, Bae R, Fukui M, Stanberry L, Enriquez-Sarano M. Contemporary Anatomic Criteria and Clinical Outcomes With Transcatheter Mitral Repair. Circ Cardiovasc Interv 2023; 16:e012486. [PMID: 36802803 DOI: 10.1161/circinterventions.122.012486] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
BACKGROUND Consensus-driven criteria have recently been proposed for prediction of mitral transcatheter edge-to-edge repair outcomes, yet validation for response to therapy is needed. We examined the relation between contemporary criteria and outcomes with mitral transcatheter edge-to-edge repair therapy. METHODS Mitral transcatheter edge-to-edge repair patients were classified according to anatomic and clinical criteria (1) Heart Valve Collaboratory criteria for nonsuitability; (2) commercial indications (suitable); and (3) neither (ie, intermediate). Analyses for Mitral Valve Academic Research Consortium-defined outcomes of reduction in mitral regurgitation and survival were performed. RESULTS Among 386 patients (median age, 82 years; 48% women), the most common classification was intermediate (46%), with 138 patients (36%) and 70 patients (18%) in the suitable and nonsuitable categories, respectively. Nonsuitable classification was related to prior valve surgery, smaller mitral valve area, type IIIa morphology, larger coaptation depth, and shorter posterior leaflet. Nonsuitable classification was associated with less technical success (P<0.001) and survival free of mortality, heart failure hospitalization, and mitral surgery (P<0.001). Among the nonsuitable patients, technical failure or any 30-day major adverse cardiac event occurred in 25.7%. Nevertheless, in these patients, acceptable mitral regurgitation reduction without adverse events still occurred in 69%, and their 1-year survival with mild or no symptoms was 52%. CONCLUSIONS Contemporary classification criteria identify patients less suitable for mitral transcatheter edge-to-edge repair with respect to acute procedural success and survival, though patients most commonly fit an intermediate category. In experienced centers, sufficient mitral regurgitation reduction can be achieved safely in the selected patients even with challenging anatomy.
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Affiliation(s)
- Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (P.S., H.S., V.N.B., J.L.C., R.B., M.F., L.S., M.E.-S.)
| | - Hirotomo Sato
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (P.S., H.S., V.N.B., J.L.C., R.B., M.F., L.S., M.E.-S.)
| | - Vinayak N Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (P.S., H.S., V.N.B., J.L.C., R.B., M.F., L.S., M.E.-S.).,Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (P.S., V.N.B., J.L.C., R.B.)
| | - João L Cavalcante
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (P.S., H.S., V.N.B., J.L.C., R.B., M.F., L.S., M.E.-S.).,Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (P.S., V.N.B., J.L.C., R.B.)
| | - Richard Bae
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (P.S., H.S., V.N.B., J.L.C., R.B., M.F., L.S., M.E.-S.).,Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (P.S., V.N.B., J.L.C., R.B.)
| | - Miho Fukui
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (P.S., H.S., V.N.B., J.L.C., R.B., M.F., L.S., M.E.-S.)
| | - Larissa Stanberry
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (P.S., H.S., V.N.B., J.L.C., R.B., M.F., L.S., M.E.-S.)
| | - Maurice Enriquez-Sarano
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (P.S., H.S., V.N.B., J.L.C., R.B., M.F., L.S., M.E.-S.)
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15
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Sato H, Cavalcante JL, Enriquez-Sarano M, Bae R, Fukui M, Bapat VN, Sorajja P. Significance of Spontaneous Echocardiographic Contrast in Transcatheter Edge-to-Edge Repair for Mitral Regurgitation. J Am Soc Echocardiogr 2023; 36:87-95. [PMID: 36049594 DOI: 10.1016/j.echo.2022.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/12/2022] [Accepted: 08/17/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Spontaneous echocardiographic contrast (SEC) in the left atrium can occur with transcatheter edge-to-edge repair (TEER), but the clinical significance is unknown. METHODS The authors examined the clinical association of the procedural appearance of SEC in 316 patients (median age, 82 years; interquartile range, 76-86 years; 43.4% women) undergoing TEER with the MitraClip for mitral regurgitation. Acute, 30-day, and 2-year clinical outcomes were analyzed. RESULTS SEC was common, occurring following device implantation in 106 patients (34%). Although the occurrence of SEC was not related to clinical characteristics, such as atrial fibrillation, anticoagulant use, or left ventricular function, there was a strong relation to beneficial outcomes with TEER. The frequency of optimal reduction in mitral regurgitation was higher in patients who had SEC (99.1% vs 72.9%, P < .001). Survival was greater, with a 2-year estimate for freedom from all-cause mortality of 88.4% versus 71.5% (log-rank P = .004). Importantly, the higher survival observed in patients with SEC was present without increased rates of procedural complications or stroke and remained significant in multivariate analyses that adjusted for baseline clinical and echocardiographic variables (P = .01). CONCLUSIONS The occurrence of SEC in patients with TEER is associated with beneficial acute and intermediate-term outcomes.
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Affiliation(s)
- Hirotomo Sato
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - João L Cavalcante
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Maurice Enriquez-Sarano
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Richard Bae
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Miho Fukui
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Vinayak N Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota.
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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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Fukui M, Sorajja P, Bapat V, Walser-Kuntz E, Stanberry L, Enriquez-Sarano M, Cavalcante J. TCT-526 Impact of Left Ventricular Scar and Chamber Size on Reverse Remodeling After Transcatheter Mitral Valve Replacement With Tendyne Device. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sato H, Bapat V, Cavalcante J, Bae R, Fukui M, Enriquez-Sarano M, Sorajja P. TCT-415 Contemporary Anatomic Criteria and Clinical Outcomes With Transcatheter Mitral Repair. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.489] [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: 10/14/2022]
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Fukui M, Sorajja P, Enriquez-Sarano M, Sato H, Lesser JL, Cavalcante J, Bapat V. TCT-520 Deformation of Transcatheter Heart Valve Following Valve-in-Valve Transcatheter Aortic Valve Replacement: Implications for Hemodynamics. J Am Coll Cardiol 2022. [DOI: 10.1016/j.jacc.2022.08.613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Uchida S, Hattori A, Fukui M, Matsunaga T, Takamochi K, Suzuki K. EP02.03-025 Long-Term Oncological Outcomes and Risk Factors of Recurrence After Segmentectomy for Primary Lung Cancer. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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21
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Fukui M, Bapat VN, Garcia S, Dworak MW, Hashimoto G, Sato H, Gössl M, Enriquez-Sarano M, Lesser JR, Cavalcante JL, Sorajja P. Deformation of Transcatheter Aortic Valve Prostheses: Implications for Hypoattenuating Leaflet Thickening and Clinical Outcomes. Circulation 2022; 146:480-493. [PMID: 35862182 DOI: 10.1161/circulationaha.121.058339] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although transcatheter aortic valve replacement (TAVR) therapy continues to grow, there have been concerns about the occurrence of hypoattenuating leaflet thickening (HALT), which may affect prosthesis function or durability. This study aimed to examine prosthesis frame factors and correlate their extent to the frequency of HALT and clinical outcomes. METHODS We prospectively examined 565 patients with cardiac computed tomography screening for HALT at 30 days after balloon-expandable SAPIEN3 and self-expanding EVOLUT TAVR. Deformation of the TAVR prostheses, asymmetric prosthesis leaflet expansion, prosthesis sinus volumes, and commissural alignment were analyzed on the postprocedural computed tomography. For descriptive purposes, an index of prosthesis deformation was calculated, with values >1.00 representing relative midsegment underexpansion. A time-to-event model was performed to evaluate the association of HALT with the clinical outcome. RESULTS Overall, HALT was present in 21% of SAPIEN3 patients and in 16% of EVOLUT patients at 30 days after TAVR. The occurrence of HALT was directly associated with greater prosthesis frame deformation (P<0.001), worse asymmetry of the leaflets (P<0.001), and smaller TAVR neosinus volumes (P<0.001). These relations were present in both prosthetic types and in all of their size ranges (all P<0.05). In multivariable analyses that include clinical variables previously associated with HALT (eg, anticoagulant therapy), variables of TAVR prosthesis deformation remained predictive of HALT. Although HALT was not associated with changes in prosthetic hemodynamics, its presence was associated with the risk of mortality at 1 year, with respect to greater incidences of all-cause mortality (hazard ratio, 2.98 [95% CI, 1.57-5.63]; P=0.001), cardiac death (hazard ratio, 4.58 [95% CI, 1.81-11.6]; P=0.001), and a composite outcome of all-cause mortality and heart failure hospitalization (hazard ratio, 1.94 [95% CI, 1.14-3.30]; P=0.02) with adjustment for age, sex, and comorbidities. CONCLUSIONS Nonuniform expansion of TAVR prostheses resulting in frame deformation, asymmetric leaflet, and smaller neosinus volume is related to occurrence of HALT in patients who undergo TAVR. These data may have implications for both prosthesis valve design and deployment techniques to improve clinical outcomes for these patients.
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Affiliation(s)
- Miho Fukui
- Cardiovascular Imaging Research Center and Core Laboratory (M.F., G.H., J.L.C.), Minneapolis Heart Institute Foundation, MN.,Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.)
| | - Vinayak N Bapat
- Valve Science Center (V.N.B., S.G., M.W.D., H.S., M.G., M.E.-S., J.R.L., P.S.), Minneapolis Heart Institute Foundation, MN.,Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.)
| | - Santiago Garcia
- Valve Science Center (V.N.B., S.G., M.W.D., H.S., M.G., M.E.-S., J.R.L., P.S.), Minneapolis Heart Institute Foundation, MN.,Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.)
| | - Marshall W Dworak
- Valve Science Center (V.N.B., S.G., M.W.D., H.S., M.G., M.E.-S., J.R.L., P.S.), Minneapolis Heart Institute Foundation, MN.,Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.)
| | - Go Hashimoto
- Cardiovascular Imaging Research Center and Core Laboratory (M.F., G.H., J.L.C.), Minneapolis Heart Institute Foundation, MN.,Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.)
| | - Hirotomo Sato
- Valve Science Center (V.N.B., S.G., M.W.D., H.S., M.G., M.E.-S., J.R.L., P.S.), Minneapolis Heart Institute Foundation, MN.,Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.)
| | - Mario Gössl
- Valve Science Center (V.N.B., S.G., M.W.D., H.S., M.G., M.E.-S., J.R.L., P.S.), Minneapolis Heart Institute Foundation, MN.,Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.)
| | - Maurice Enriquez-Sarano
- Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.)
| | - John R Lesser
- Valve Science Center (V.N.B., S.G., M.W.D., H.S., M.G., M.E.-S., J.R.L., P.S.), Minneapolis Heart Institute Foundation, MN.,Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.)
| | - João L Cavalcante
- Cardiovascular Imaging Research Center and Core Laboratory (M.F., G.H., J.L.C.), Minneapolis Heart Institute Foundation, MN.,Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.)
| | - Paul Sorajja
- Valve Science Center (V.N.B., S.G., M.W.D., H.S., M.G., M.E.-S., J.R.L., P.S.), Minneapolis Heart Institute Foundation, MN.,Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.)
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22
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Hashimoto G, Enriquez-Sarano M, Stanberry LI, Oh F, Wang M, Acosta K, Sato H, Lopes BBC, Fukui M, Garcia S, Goessl M, Sorajja P, Bapat VN, Lesser J, Cavalcante JL. Association of Left Ventricular Remodeling Assessment by Cardiac Magnetic Resonance With Outcomes in Patients With Chronic Aortic Regurgitation. JAMA Cardiol 2022; 7:924-933. [PMID: 35857306 DOI: 10.1001/jamacardio.2022.2108] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 02/04/2023]
Abstract
Importance Chronic aortic regurgitation (AR) causes left ventricular (LV) volume overload, which results in progressive LV remodeling negatively affecting outcomes. Whether cardiac magnetic resonance (CMR) volumetric quantification can provide incremental risk stratification over standard clinical and echocardiographic evaluation in patients with chronic moderate or severe AR is unknown. Objective To compare LV remodeling measurements by CMR and echocardiography between patients with and without heart failure symptoms and to verify the association of remodeling measurements of patients with chronic moderate or severe AR but no or minimal symptoms with clinical outcomes receiving medical management. Design, Setting, and Participants This multicenter retrospective cohort study included consecutive patients with at least moderate chronic native AR evaluated by 2-dimensional transthoracic echocardiography and CMR examination within 90 days from each other between January 2012 and February 2020 at Allina Health System. Data were analyzed from June 2021 to January 2022. Exposures Clinical evaluation and risk stratification by CMR. Main Outcomes and Measures The end point was a composite of death, heart failure hospitalization, or progression of New York Heart Association functional class while receiving medical management, censoring patients at the time of aortic valve replacement (when performed) or at the end of follow-up. Results Of the 178 included patients, 119 (66.9%) were male, 158 (88.8%) presented with no or minimal symptoms (New York Heart Association class I or II), and the median (IQR) age was 58 (44-69) years. Compared with patients with no or minimal symptoms, symptomatic patients had greater LV end-systolic volume index (LVESVi) by CMR (median [IQR], 66 [46-85] mL/m2 vs 42 [30-58] mL/m2; P < .001), while there were no significant differences by echocardiography (LVESVi: median [IQR], 38 [30-58] mL/m2 vs 27 [20-42] mL/m2; P = .07; LV end-systolic diameter index: median [IQR], 21 [17-25] mm/m2 vs 18 [15-22] mm/m2; P = .17). During the median (IQR) follow-up of 3.3 (1.6-5.8) years, 50 patients with no or minimal symptoms receiving medical management developed the composite end point, which, in multivariate analysis adjusted for age and EuroSCORE II, was independently associated with LVESVi of 45 mL/m2 or greater and aortic regurgitant fraction of 32% or greater, the latter adding incremental prognostic value to CMR volumetric assessment. Conclusions and Relevance In patients with chronic moderate or severe AR, patients presenting with heart failure symptoms have greater LVESVi by CMR than those with no or minimal symptoms. In patients with no or minimal symptoms, CMR quantification of LVESVi and AR severity may identify those at risk of death or incident heart failure and therefore should be considered in the clinical evaluation and decision-making of these patients.
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Affiliation(s)
- Go Hashimoto
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Maurice Enriquez-Sarano
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Larissa I Stanberry
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Felix Oh
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Matthew Wang
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Keith Acosta
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Hirotomo Sato
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Bernardo B C Lopes
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Miho Fukui
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Santiago Garcia
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Mario Goessl
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Vinayak N Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - John Lesser
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - João L Cavalcante
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
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Fukui M, Enriquez-Sarano M, Koike H, Aluru J, Lesser A, Bapat V, Lesser J, Sorajja P, Cavalcante J. 441 Volumetric Right Ventricle Assessment Post Transcatheter Aortic Valve Replacement:findings In Routine Clinical Practice And Implications For Outcome. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.046] [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: 10/17/2022]
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24
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Hashimoto G, Koike H, Sato H, Fukui M, Garcia S, Goessl M, Sorajja P, Bapat V, Lesser J, Sarano ME, Cavalcante J. Right Ventricular Dysfunction in Functional Mitral Regurgitation Assessed by CT. Cardiovascular Revascularization Medicine 2022. [DOI: 10.1016/j.carrev.2022.06.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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25
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Sato H, Cavalcante JL, Bae R, Bapat VN, Garcia S, Gössl M, Hashimoto G, Fukui M, Enriquez-Sarano M, Sorajja P. Coaptation Reserve Predicts Optimal Reduction in Mitral Regurgitation and Long-Term Survival With Transcatheter Edge-to-Edge Repair. Circ Cardiovasc Interv 2022; 15:e011562. [PMID: 35686547 DOI: 10.1161/circinterventions.121.011562] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although transcatheter edge-to-edge repair (TEER) is effective and safe, there is a need for better prediction of optimal outcomes. We aimed to determine predictors of optimal reduction in mitral regurgitation (MR) and survival with TEER. METHODS We examined mitral anatomy and its change with TEER on outcomes in 183 patients (age, 82 [77-87] years; 53% women). Coaptation reserve was measured as the distance of continuous apposition of the A2 and P2 leaflet segments in 2-dimensional apical long-axis imaging at the site of the predominant jet of MR. Augmentation in coaptation was measured as the total amount of leaflet insertion. Addressable coaptation area was calculated using the physical boundaries of the TEER device. RESULTS Coaptation reserve, its augmentation, and addressable coaptation area were strong predictors of MR reduction (all P<0.001), as well as heart failure hospitalization and death. For patients with either mild or no residual MR, median values for coaptation reserve, its augmentation, and addressable coaptation area were 3.7 (2.8-4.5) mm, 7.3 (5.2-9.5) mm, and 59.0 (48.0-71.8) mm2, respectively. Receiver operating characteristic analyses determined the best values for optimal MR reduction as a coaptation reserve of >3.0 mm (P<0.001), addressable coaptation area of ≥52 mm2 (P<0.001), and coaptation augmentation of ≥4.7 mm (P<0.001). These values were associated with greater 2-year survival free of all-cause mortality and persisting even in analyses restricted to those with mild or no residual MR after TEER. CONCLUSIONS Coaptation reserve and its augmentation are simple, independent parameters that predict optimal MR reduction and better survival in patients undergoing TEER. These findings may have implications for patient selection and expanded use of the therapy.
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Affiliation(s)
- Hirotomo Sato
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (H.S., J.L.C., R.B., V.N.B., S.G., M.G., G.H., M.F., M.E.-S., P.S.)
| | - João L Cavalcante
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (H.S., J.L.C., R.B., V.N.B., S.G., M.G., G.H., M.F., M.E.-S., P.S.)
- Center for Valve and Structural Heart Disease, Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (J.L.C., R.B., V.N.B., S.G., M.G., P.S.)
| | - Richard Bae
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (H.S., J.L.C., R.B., V.N.B., S.G., M.G., G.H., M.F., M.E.-S., P.S.)
- Center for Valve and Structural Heart Disease, Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (J.L.C., R.B., V.N.B., S.G., M.G., P.S.)
| | - Vinayak N Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (H.S., J.L.C., R.B., V.N.B., S.G., M.G., G.H., M.F., M.E.-S., P.S.)
- Center for Valve and Structural Heart Disease, Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (J.L.C., R.B., V.N.B., S.G., M.G., P.S.)
| | - Santiago Garcia
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (H.S., J.L.C., R.B., V.N.B., S.G., M.G., G.H., M.F., M.E.-S., P.S.)
- Center for Valve and Structural Heart Disease, Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (J.L.C., R.B., V.N.B., S.G., M.G., P.S.)
| | - Mario Gössl
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (H.S., J.L.C., R.B., V.N.B., S.G., M.G., G.H., M.F., M.E.-S., P.S.)
- Center for Valve and Structural Heart Disease, Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (J.L.C., R.B., V.N.B., S.G., M.G., P.S.)
| | - Go Hashimoto
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (H.S., J.L.C., R.B., V.N.B., S.G., M.G., G.H., M.F., M.E.-S., P.S.)
| | - Miho Fukui
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (H.S., J.L.C., R.B., V.N.B., S.G., M.G., G.H., M.F., M.E.-S., P.S.)
| | - Maurice Enriquez-Sarano
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (H.S., J.L.C., R.B., V.N.B., S.G., M.G., G.H., M.F., M.E.-S., P.S.)
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, MN (H.S., J.L.C., R.B., V.N.B., S.G., M.G., G.H., M.F., M.E.-S., P.S.)
- Center for Valve and Structural Heart Disease, Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (J.L.C., R.B., V.N.B., S.G., M.G., P.S.)
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Ota Y, Shimakawa S, Tsuda-Kitahara H, Fukui M, Kashiwagi M, Ashida A. Focal seizures during adrenocorticotropic hormone therapy in a school-aged boy: a case report. J Med Case Rep 2022; 16:200. [PMID: 35606840 PMCID: PMC9128254 DOI: 10.1186/s13256-022-03429-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022] Open
Abstract
Background Adrenocorticotropic hormone therapy for infantile spasms, including West syndrome, has been previously reported to induce seizures. We present the findings for a school-aged child with epilepsy who developed new focal seizures during adrenocorticotropic hormone therapy. Case presentation The Japanese patient had posttraumatic epilepsy and developed intractable focal seizures at the age of 13 years. Adrenocorticotropic hormone therapy was administered when the patient was 14 years of age. On day 10 of treatment, he developed new focal seizures, which were characterized by left arm contractions followed by movements of touching things with his right hand and writhing and rocking his body left and right and back and forth as automatisms. The focal seizures clustered for 40 minutes and disappeared after suppository administration of 10 mg diazepam. These focal seizures did not reoccur after more than 2 years of follow-up. Conclusion Adrenocorticotropic hormone-induced seizures can occur in children older than previously reported, and can occur in children with intractable seizures other than epileptic spasms.
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Affiliation(s)
- Yoshitaka Ota
- Department of Pediatrics, Hirakata Municipal Hospital, Hirakata, Osaka, Japan
| | - Shuichi Shimakawa
- Department of Pediatrics, Osaka Medical and Pharmaceutical University Hospital, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Hikaru Tsuda-Kitahara
- Department of Pediatrics, Osaka Medical and Pharmaceutical University Hospital, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Miho Fukui
- Department of Pediatrics, Osaka Medical and Pharmaceutical University Hospital, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Mitsuru Kashiwagi
- Department of Pediatrics, Hirakata Municipal Hospital, Hirakata, Osaka, Japan
| | - Akira Ashida
- Department of Pediatrics, Osaka Medical and Pharmaceutical University Hospital, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
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Fukui M, Islam MZ, Lai HM, Kitamura Y, Kokawa M. Effects of roasting on storage degradability and processing suitability of brown rice powder. Lebensm Wiss Technol 2022. [DOI: 10.1016/j.lwt.2022.113277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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28
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Hashimoto G, Lopes BB, Sato H, Fukui M, Garcia S, Gössl M, Enriquez-Sarano M, Sorajja P, Bapat VN, Lesser J, Cavalcante JL. Computed Tomography Planning for Transcatheter Mitral Valve Replacement. Struct Heart 2022; 6:100012. [PMID: 37273483 PMCID: PMC10236884 DOI: 10.1016/j.shj.2022.100012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 09/02/2021] [Accepted: 11/03/2021] [Indexed: 06/06/2023]
Abstract
Transcatheter mitral valve replacement (TMVR) is a rapidly evolving treatment for mitral regurgitation. As with transcatheter aortic valve replacement, multidetector computed tomography analysis plays a central role in defining the candidacy, device selection and safety for TMVR procedures. This contemporary review will describe in detail the multidetector computed tomography data collection, analysis, and planning for TMVR procedures in patients with native mitral regurgitation as well as in those with failed surgical prosthetic mitral valve replacement or surgical mitral valve repair.
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Affiliation(s)
- Go Hashimoto
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Bernardo B.C. Lopes
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Hirotomo Sato
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Miho Fukui
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Santiago Garcia
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Mario Gössl
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Maurice Enriquez-Sarano
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Vinayak N. Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - John Lesser
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - João L. Cavalcante
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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Karacsonyi J, Koike H, Fukui M, Kostantinis S, Simsek B, Brilakis ES. Retrograde Treatment of a Right Coronary Artery Perforation. JACC Cardiovasc Interv 2022; 15:670-672. [PMID: 35219615 DOI: 10.1016/j.jcin.2022.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Judit Karacsonyi
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Hideki Koike
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Miho Fukui
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Spyridon Kostantinis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Bahadir Simsek
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
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Fukui M, Bapat VN, Garcia S, Sato H, Enriquez-Sarano M, Lesser JR, Cavalcante JL, Sorajja P. DEFORMATION OF SELF-EXPANDING TRANSCATHETER AORTIC VALVE PROSTHESIS FOR HYPO-ATTENUATING LEAFLET THICKENING. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01621-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Garcia S, Fukui M, Dworak MW, Okeson BK, Garberich R, Hashimoto G, Sato H, Cavalcante JL, Bapat VN, Lesser J, Cheng V, Newell MC, Goessl M, Elmariah S, Bradley SM, Sorajja P. Clinical Impact of Hypoattenuating Leaflet Thickening After Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2022; 15:e011480. [PMID: 35236097 DOI: 10.1161/circinterventions.121.011480] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hypoattenuated leaflet thickening (HALT), identified on functional cardiac computed tomography (CTA), can affect valve function and clinical outcomes. The objective of this study was to assess the impact of HALT on clinical outcomes in patients treated with transcatheter aortic valve replacement (TAVR). METHODS In July 2015, Minneapolis Heart Institute implemented prospective screening of HALT at 30-day post-TAVR with CTA. Patients with evidence of HALT were recommended to initiate anticoagulation for 3 to 6 months with warfarin. Echocardiographic, ischemic, and bleeding outcomes were compared between HALT+ and HALT- patients. Survival rates were compared between HALT+ and HALT- patients using log-rank test, with Cox regression analysis used to identify variables independently associated with long-term death landmarked at time of CTA. This analysis included patients treated from July 1, 2015 to October 31, 2019. RESULTS Of 856 patients undergoing TAVR during the study period, 638 (75%) underwent CTA post-TAVR (median time 31 [30-37] days). HALT+ was evident in 79 (12.3%). HALT+ patients were more likely prescribed warfarin at 1, 3, and 12 months (all P<0.001) and had similar gradients compared with HALT- patients. After a median follow-up of 2.2 years (1.5-3.2), HALT+ patients had increased mortality (30% versus 20%; P=0.001). In Cox regression analysis, presence of HALT (hazard ratio, 1.83 [95% CI, 1.13-2.97]; P=0.014) remained independently associated with long-term mortality. CONCLUSIONS In a large, real-world cohort of patients receiving TAVR followed by systematic screening with CTA 30-days post-procedure, HALT was found in 12% of patients and independently associated with long-term mortality. Findings of this nonrandomized, observational cohort study require independent validation.
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Affiliation(s)
- Santiago Garcia
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - Miho Fukui
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - Marshall W Dworak
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - Brynn K Okeson
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - Ross Garberich
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - Go Hashimoto
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - Hirotomo Sato
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - João L Cavalcante
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - Vinayak N Bapat
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - John Lesser
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - Victor Cheng
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - Marc C Newell
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - Mario Goessl
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - Sammy Elmariah
- Massachusetts General Hospital and Harvard Medical School, Boston (S.E.)
| | - Steven M Bradley
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
| | - Paul Sorajja
- Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (S.G., M.F., M.W.D., B.K.O., R.G., G.H., H.S., J.L.C., V.N.B., J.L., V.C., M.C.N., M.G., S.M.B., P.S.)
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Sato H, Cavalcante JL, Bae RY, Bapat VN, Santiago G, Goessl M, Hashimoto G, Fukui M, Enriquez-Sarano M, Sorajja P. THE IMPACT OF COAPTATION RESERVE AND ADDRESSABLE COAPTATION AREA FOR OPTIMAL REDUCTION IN MITRAL REGURGITATION AND LONG-TERM SURVIVAL WITH TRANSCATHETER EDGE-TO-EDGE REPAIR. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01573-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Xue H, Artico J, Davies RH, Adam R, Shetye A, Augusto JB, Bhuva A, Fröjdh F, Wong TC, Fukui M, Cavalcante JL, Treibel TA, Manisty C, Fontana M, Ugander M, Moon JC, Schelbert EB, Kellman P. Automated In-Line Artificial Intelligence Measured Global Longitudinal Shortening and Mitral Annular Plane Systolic Excursion: Reproducibility and Prognostic Significance. J Am Heart Assoc 2022; 11:e023849. [PMID: 35132872 PMCID: PMC9245823 DOI: 10.1161/jaha.121.023849] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/04/2022] [Indexed: 12/25/2022]
Abstract
Background Global longitudinal shortening (GL-Shortening) and the mitral annular plane systolic excursion (MAPSE) are known markers in heart failure patients, but measurement may be subjective and less frequently reported because of the lack of automated analysis. Therefore, a validated, automated artificial intelligence (AI) solution can be of strong clinical interest. Methods and Results The model was implemented on cardiac magnetic resonance scanners with automated in-line processing. Reproducibility was evaluated in a scan-rescan data set (n=160 patients). The prognostic association with adverse events (death or hospitalization for heart failure) was evaluated in a large patient cohort (n=1572) and compared with feature tracking global longitudinal strain measured manually by experts. Automated processing took ≈1.1 seconds for a typical case. On the scan-rescan data set, the model exceeded the precision of human expert (coefficient of variation 7.2% versus 11.1% for GL-Shortening, P=0.0024; 6.5% versus 9.1% for MAPSE, P=0.0124). The minimal detectable change at 90% power was 2.53 percentage points for GL-Shortening and 1.84 mm for MAPSE. AI GL-Shortening correlated well with manual global longitudinal strain (R2=0.85). AI MAPSE had the strongest association with outcomes (χ2, 255; hazard ratio [HR], 2.5 [95% CI, 2.2-2.8]), compared with AI GL-Shortening (χ2, 197; HR, 2.1 [95% CI,1.9-2.4]), manual global longitudinal strain (χ2, 192; HR, 2.1 [95% CI, 1.9-2.3]), and left ventricular ejection fraction (χ2, 147; HR, 1.8 [95% CI, 1.6-1.9]), with P<0.001 for all. Conclusions Automated in-line AI-measured MAPSE and GL-Shortening can deliver immediate and highly reproducible results during cardiac magnetic resonance scanning. These results have strong associations with adverse outcomes that exceed those of global longitudinal strain and left ventricular ejection fraction.
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Affiliation(s)
- Hui Xue
- National Heart, Lung, and Blood InstituteNational Institutes of HealthBethesdaMD
| | - Jessica Artico
- Barts Heart CentreBarts Health NHS TrustLondonUnited Kingdom
- University Hospital and University of TriesteTriesteItaly
| | | | - Robert Adam
- Barts Heart CentreBarts Health NHS TrustLondonUnited Kingdom
| | - Abhishek Shetye
- Barts Heart CentreBarts Health NHS TrustLondonUnited Kingdom
| | - João B. Augusto
- Barts Heart CentreBarts Health NHS TrustLondonUnited Kingdom
- University College LondonLondonUnited Kingdom
| | - Anish Bhuva
- Barts Heart CentreBarts Health NHS TrustLondonUnited Kingdom
| | - Fredrika Fröjdh
- Department of Clinical PhysiologyKarolinska University Hospital, and Karolinska InstituteStockholmSweden
| | - Timothy C. Wong
- UPMC Cardiovascular Magnetic Resonance CenterUPMCPittsburghPA
- Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghPA
- Heart and Vascular InstituteUPMCPittsburghPA
- Clinical and Translational Science InstituteUniversity of PittsburghPittsburghPA
| | - Miho Fukui
- Minneapolis Heart InstituteAbbott Northwestern HospitalMinneapolisMN
| | | | | | | | - Marianna Fontana
- University College LondonLondonUnited Kingdom
- Royal Free HospitalNHS TrustLondonUnited Kingdom
| | - Martin Ugander
- Department of Clinical PhysiologyKarolinska University Hospital, and Karolinska InstituteStockholmSweden
- Kolling InstituteRoyal North Shore Hospital, and Charles Perkins CentreFaculty of Medicine and HealthUniversity of SydneySydneyAustralia
| | - James C. Moon
- Barts Heart CentreBarts Health NHS TrustLondonUnited Kingdom
| | - Erik B. Schelbert
- Minneapolis Heart Institute, United HospitalSt. Paul, Minnesota and Abbott Northwestern HospitalMinneapolisMN
| | - Peter Kellman
- National Heart, Lung, and Blood InstituteNational Institutes of HealthBethesdaMD
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Satomura Y, Bessho K, Nawa N, Kondo H, Ito S, Togawa T, Yano M, Yamano Y, Inoue T, Fukui M, Onuma S, Fukuoka T, Yasuda K, Kimura T, Tachibana M, Kitaoka T, Nabatame S, Ozono K. Novel gene mutations in three Japanese patients with ARC syndrome associated mild phenotypes: a case series. J Med Case Rep 2022; 16:60. [PMID: 35151346 PMCID: PMC8841066 DOI: 10.1186/s13256-022-03279-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background Arthrogryposis, renal dysfunction, and cholestasis syndrome (ARCS) is a rare autosomal recessive disorder caused by mutations in VPS33B (ARCS1) and VIPAS39 (ARCS2). As per literature, most patients with ARCS died of persistent infections and bleeding by the age of 1 year. We report the first Japanese cases with ARCS1 and ARCS2 who presented with mild phenotypes and were diagnosed via genetic testing. Case presentation Case 1: A 6-year-old boy born to nonconsanguineous Japanese parents presented with jaundice and normal serum gamma-glutamyl transferase (GGT) levels, proteinuria, bilateral nerve deafness, motor delay, failure to thrive, and persistent pruritus. After cochlear implantation for deafness at the age of 2 years, despite a normal platelet count and prothrombin time-international normalized ratio, the patient presented with persistent bleeding that required hematoma removal. Although he did not show any obvious signs of arthrogryposis, he was suspected to have ARCS based on other symptoms. Compound heterozygous mutations in VPS33B were identified using targeted next-generation sequencing (NGS), which resulted in no protein expression. Case 2: A 7-month-old boy, the younger brother of case 1, presented with bilateral deafness, renal tubular dysfunction, failure to thrive, and mild cholestasis. He had the same mutations that were identified in his brother’s VPS33B. Case 3: A 24-year-old man born to nonconsanguineous Japanese parents was suspected to have progressive familial intrahepatic cholestasis 1 (PFIC1) in his childhood on the basis of low GGT cholestasis, renal tubular dysfunction, sensory deafness, mental retardation, and persistent itching. A liver biopsy performed at the age of 16 years showed findings that were consistent with PFIC1. He developed anemia owing to intraperitoneal hemorrhage from a peripheral intrahepatic artery the day after the biopsy, and transcatheter arterial embolization was required. ARCS2 was diagnosed using targeted NGS, which identified novel compound heterozygous mutations in VIPAS39. Conclusions The first Japanese cases of ARCS1 and ARCS2 diagnosed using genetic tests were reported in this study. These cases are milder than those previously reported. For patients with ARCS, invasive procedures should be performed with meticulous care to prevent bleeding.
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Iai Y, Shimakawa S, Fukui M, Okumura T, Tsuda-Kitahara H, Ashida A. A comparative analysis of children born with low birthweight and attention deficit hyperactivity disorder. Pediatr Int 2022; 64:e15298. [PMID: 36134643 DOI: 10.1111/ped.15298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/22/2022] [Accepted: 07/03/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND We aimed to compare the profile of the Wechsler Intelligence Scale for Children Fourth Edition (WISC-IV) between Japanese schoolchildren born very preterm (VP) and with very low birthweight (VLBW) and those with attention deficit hyperactivity disorder (ADHD), and to identify the specific neurocognitive characteristics of VLBW/VP children. METHODS The VLBW/VP group in the present study included 50 (19 male, 31 female) first- to third-grade elementary school children born between January 2008 and February 2013 at Osaka Medical and Pharmaceutical University Hospital and Saiseikai Suita Hospital with birthweights <1,500 g and <32 gestational weeks. The ADHD group included 18 (13 male, 5 female) first- to third-grade elementary school children who visited Osaka Medical and Pharmaceutical University Hospital between January 2019 and October 2021. Full-scale intelligence quotient scores, four indices, and 12 subtests of the WISC-IV were calculated for all participants and compared between the VLBW/VP and ADHD groups. We assessed whether the patients' clinical history was associated with a low score on the cancellation task in the VLBW/VP group. RESULTS The WISC-IV profiles showed similar between-group patterns, and the VLBW/VP group had lower cancellation task scores than the ADHD group. CONCLUSIONS This is the first study to compare WISC-IV profiles between VLBW/VP children and those with ADHD. Further investigation is needed on the association between academic performance and the score of the cancellation task, and the neural mechanism of low performance for cancellation tasks in VLBW/VP children.
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Affiliation(s)
- Yuki Iai
- Department of Pediatrics, Hirakata City Hospital, Hirakata, Osaka, Japan
| | - Shuichi Shimakawa
- Department of Pediatrics, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Osaka, Japan
| | - Miho Fukui
- Department of Special Education Support, Faculty of Education, Osaka Ohtani University, Tondabayashi, Osaka, Japan.,LD Center, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.,Child Higher Brain Function Research Institute, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Tomohito Okumura
- LD Center, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.,Child Higher Brain Function Research Institute, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Hikaru Tsuda-Kitahara
- Department of Pediatrics, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Osaka, Japan
| | - Akira Ashida
- Department of Pediatrics, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Osaka, Japan.,LD Center, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
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Hayano C, Shimakawa S, Fukui M, Yoshida S, Tsuda-Kitahara H, Ashida A. Impacts of long-term coronavirus disease 2019 school closures on Japanese school children. Pediatr Int 2022; 64:e15131. [PMID: 35895494 DOI: 10.1111/ped.15131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 11/25/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study investigated the impact of coronavirus disease 2019 pandemic school closures on the mental health of school students with chronic diseases. METHODS Questionnaires were distributed to students from 4th-9th grade diagnosed with chronic diseases at Osaka Medical College Hospital and their parents or caregivers. Questionnaires from 286 families were returned by mail after the schools reopened. The students were divided into the "psychosomatic disorder" group (group P, n = 42), the "developmental disorder" group (group D, n = 89), and the "other disease" group (group O, n = 155). Using students' self-reports on the Questionnaire for Triage and Assessment with 30 items, we assessed the proportion of students with a high risk of psychosomatic disorder in three groups. We investigated how the students requiring the support of somatic symptom (SS) felt about school during school closure. Further, using parents' and caregivers' answers, SS scores were calculated before and during school closure and after school reopening. RESULTS The proportion of students with a high risk of developing psychosomatic disorder increased in all groups. For the students in Group P, the response "I did not want to think about school" indicated an increase in SS scores, and for the students in Group O, "I wanted to get back to school soon" indicated a decrease. Furthermore, especially in Group P students, SS scores decreased transiently during school closure and increased after school reopening. CONCLUSIONS The impact of school closure on mental health differed depending on students' diagnoses and feelings about school during school closures.
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Affiliation(s)
- Chiaki Hayano
- Department of Pediatrics, Osaka Medical and Pharmaceutical Hospital, Takatsuki, Osaka, Japan
| | - Shuichi Shimakawa
- Department of Pediatrics, Osaka Medical and Pharmaceutical Hospital, Takatsuki, Osaka, Japan
| | - Miho Fukui
- Department of Pediatrics, Osaka Medical and Pharmaceutical Hospital, Takatsuki, Osaka, Japan.,Department of Education, Faculty of Education, Osaka Ohtani University, Tondabayashi, Osaka, Japan
| | - Seiji Yoshida
- Department of Pediatrics, Osaka Medical and Pharmaceutical Hospital, Takatsuki, Osaka, Japan
| | - Hikaru Tsuda-Kitahara
- Department of Pediatrics, Osaka Medical and Pharmaceutical Hospital, Takatsuki, Osaka, Japan
| | - Akira Ashida
- Department of Pediatrics, Osaka Medical and Pharmaceutical Hospital, Takatsuki, Osaka, Japan
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Nishimoto S, Shimakawa S, Fukui M, Ogino M, Tsuda-Kitahara H, Toshikawa H, Nomura S, Kunisada K, Kashiwagi M, Miyamoto R, Tamai H, Ashida A. Treatment outcomes for infantile spasms in Japanese children with Down syndrome. Pediatr Int 2021; 63:1495-1503. [PMID: 33638247 DOI: 10.1111/ped.14668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 01/22/2021] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to assess the treatment response to conventional antiepileptic drugs and low-dose adrenocorticotropic hormone therapy for infantile spasms in children with Down syndrome. METHODS We retrospectively investigated the response and relapse rates, electroencephalography findings, patient characteristics during drug withdrawal, and developmental outcome in 10 children with Down syndrome treated for infantile spasms in our hospital. RESULTS All patients showed cessation of infantile spasms and achieved electroencephalographic normalization. Spasm relapse occurred in one of 10 patients (10%). Antiepileptic drugs have been withdrawn for seven of 10 patients (70%), none of whom have experienced seizure relapse since drug withdrawal. The median developmental quotient (n = 8) was 20.5, which shows that the developmental outcome was unfavorable. Low-dose adrenocorticotropic hormone therapy achieved a low seizure remission rate of 28.6%. CONCLUSIONS Elucidation of the optimal treatment for infantile spasms in children with Down syndrome is needed to reduce the duration of infantile spasms and improve the developmental outcome.
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Affiliation(s)
- Satomi Nishimoto
- Department of Pediatrics, Osaka Medical College Hospital, Takatsuki-City, Osaka, Japan
| | - Shuichi Shimakawa
- Department of Pediatrics, Osaka Medical College Hospital, Takatsuki-City, Osaka, Japan
| | - Miho Fukui
- Department of Pediatrics, Osaka Medical College Hospital, Takatsuki-City, Osaka, Japan
| | - Motoko Ogino
- Department of Pediatrics, Osaka Saiseikai Suita Hospital, Suita, Osaka, Japan
| | - Hikaru Tsuda-Kitahara
- Department of Pediatrics, Osaka Medical College Hospital, Takatsuki-City, Osaka, Japan
| | - Hiromitsu Toshikawa
- Department of Pediatrics, Osaka Saiseikai Suita Hospital, Suita, Osaka, Japan
| | - Shohei Nomura
- Department of Pediatrics, Hirakata City Hospital, Hirakata, Osaka, Japan
| | - Kayo Kunisada
- Department of Pediatrics, Seikeikai Hospital, Sakai, Osaka, Japan
| | - Mitsuru Kashiwagi
- Department of Pediatrics, Hirakata City Hospital, Hirakata, Osaka, Japan
| | - Ryohei Miyamoto
- Department of Pediatrics, Miyamoto Children's Clinic, Fushimi, Kyoto, Japan
| | - Hiroshi Tamai
- Department of Pediatrics, Osaka Medical College Hospital, Takatsuki-City, Osaka, Japan
| | - Akira Ashida
- Department of Pediatrics, Osaka Medical College Hospital, Takatsuki-City, Osaka, Japan
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Tachibana M, Miyoshi Y, Fukui M, Onuma S, Fukuoka T, Satomura Y, Yasuda K, Kimura T, Bessho K, Ozono K. Urinary iodine and thyroglobulin are useful markers in infants suspected of congenital hypothyroidism based on newborn screening. J Pediatr Endocrinol Metab 2021; 34:1411-1418. [PMID: 34388329 DOI: 10.1515/jpem-2021-0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/22/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Iodine deficiency and excess both cause thyroid dysfunction. Few data describe the relationship between iodine status and outcomes of congenital hypothyroidism (CH) in iodine-sufficient areas. We investigated urinary iodine (UI) concentration and its relationship with the clinical course of CH. METHODS We reviewed and retrospectively analyzed patients with positive newborn screening (NBS) for CH from January 2012 to June 2019 in Japan, obtaining UI and UI-urine creatinine ratio (UI/Cr), serum TSH, free T4, free T3 and thyroglobulin (Tg) at the first visit, TSH at NBS, levothyroxine (LT4) dose, and subsequent doses. A UI value of 100-299 μg/L was considered adequate. RESULTS Forty-eight patients were included. Median UI and UI/Cr were 325 μg/L and 3,930 µg/gCr, respectively. UI was high (≥300 μg/L) in 26 (54%) and low (≤99 μg/L) in 11 (23%). LT4 was administered to 34 patients. Iodine status was not related to the need for treatment. We found a U-shaped relationship between Tg and UI/Cr. Patients with high Tg (≥400 ng/mL) and abnormal UI levels required significantly lower LT4 doses (≤20 µg/day) at three years of age. Even if they showed severe hypothyroidism initially, they did not need subsequent dose increments. CONCLUSIONS Abnormal UI levels with Tg elevation were associated with lower LT4 dose requirements. The evaluation of iodine status and Tg concentrations were considered useful in patients suspected of CH.
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Affiliation(s)
- Makiko Tachibana
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoko Miyoshi
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Health and Nutrition, Faculty of Health and Nutrition, Osaka Shoin Women's University, Osaka, Japan
| | - Miho Fukui
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shinsuke Onuma
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomoya Fukuoka
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshinori Satomura
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kie Yasuda
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takeshi Kimura
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuhiko Bessho
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
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Fukui M, Hashimoto G, Lopes BBC, Stanberry LI, Garcia S, Gössl M, Enriquez-Sarano M, Bapat VN, Sorajja P, Lesser JR, Cavalcante JL. Association of baseline and change in global longitudinal strain by computed tomography with post-transcatheter aortic valve replacement outcomes. Eur Heart J Cardiovasc Imaging 2021; 23:476-484. [PMID: 34791101 DOI: 10.1093/ehjci/jeab229] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Transcatheter aortic valve replacement (TAVR) procedural planning requires computed tomography angiography (CTA) which allows for the assessment of left ventricular global longitudinal strain (CTA-LVGLS). There is, however, limited data on the feasibility of CTA-LVGLS, and its prognostic value. This study sought to evaluate the incremental prognostic value of baseline CTA-LVGLS, change in CTA-LVGLS after TAVR, and their association with post-TAVR outcomes. METHODS AND RESULTS A total of 431 patients who underwent multiphasic gated CTA using dual-source system for TAVR planning at baseline and 1-month follow-up were included [median (interquartile range) age, 83 (77-87) years; 44% female, STS-PROM score: 3.3 (2.3-5.1)%, Echo-left ventricular ejection fraction (LVEF): 60 (55-65)%, CTA-LVGLS: -18.0 (-21.6 to -14.2)%, feasible in 97% of patients]. CTA-LVGLS was measured using dedicated feature-tracking software. Over a median follow-up of 19 (13-27) months, 99 endpoints of all-cause death or heart failure hospitalization occurred. The relative hazard of the endpoint increased as baseline CTA-LVGLS worsened with -18.2% as the threshold for higher events (P = 0.005). After adjustment for baseline characteristics, CTA-LVGLS remained associated with the endpoint [hazard ratio (HR) (95% confidence interval, CI), 1.08 (1.03-1.14); P = 0.005] and incrementally improved prognostication (C-index difference, 0.026). Although CTA-LVGLS improved after TAVR [-18.3 (-21.6 to -14.3)% vs. -18.7 (-21.9 to -15.4)%, P < 0.001], patients without CTA-LVGLS improvement had higher risk of the endpoint than those with improvement or preserved baseline global longitudinal strain [HR (95% CI), 1.92 (1.19-3.12); P = 0.008]. CONCLUSIONS In this predominantly low-risk TAVR cohort of patients, mostly with normal LVEF, assessment of CTA-LVGLS is highly feasible improving risk stratification by providing independent and incremental prognostic value over 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, Minneapolis, MN 55407, USA
| | - Go Hashimoto
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, 920 E 28th Street, Suite 100, Minneapolis, MN 55407, USA
| | - Bernardo B C Lopes
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, 920 E 28th Street, Suite 100, Minneapolis, MN 55407, USA
| | - Larissa I Stanberry
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, 920 E 28th Street, Suite 100, Minneapolis, MN 55407, USA
| | - Santiago Garcia
- Valve Science Center, Minneapolis Heart Institute Foundation, 920 E 28th Street, Minneapolis, MN, 55407, USA.,Minneapolis Heart Institute, Abbott Northwestern Hospital, 800 E 28th Street, Minneapolis, MN, 55407, USA
| | - Mario Gössl
- Valve Science Center, Minneapolis Heart Institute Foundation, 920 E 28th Street, Minneapolis, MN, 55407, USA.,Minneapolis Heart Institute, Abbott Northwestern Hospital, 800 E 28th Street, Minneapolis, MN, 55407, USA
| | - Maurice Enriquez-Sarano
- Valve Science Center, Minneapolis Heart Institute Foundation, 920 E 28th Street, Minneapolis, MN, 55407, USA.,Minneapolis Heart Institute, Abbott Northwestern Hospital, 800 E 28th Street, Minneapolis, MN, 55407, USA
| | - Vinayak N Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, 920 E 28th Street, Minneapolis, MN, 55407, USA.,Minneapolis Heart Institute, Abbott Northwestern Hospital, 800 E 28th Street, Minneapolis, MN, 55407, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, 920 E 28th Street, Minneapolis, MN, 55407, USA.,Minneapolis Heart Institute, Abbott Northwestern Hospital, 800 E 28th Street, Minneapolis, MN, 55407, USA
| | - John R Lesser
- Valve Science Center, Minneapolis Heart Institute Foundation, 920 E 28th Street, Minneapolis, MN, 55407, USA.,Minneapolis Heart Institute, Abbott Northwestern Hospital, 800 E 28th Street, Minneapolis, MN, 55407, USA
| | - João L Cavalcante
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, 920 E 28th Street, Suite 100, Minneapolis, MN 55407, USA.,Minneapolis Heart Institute, Abbott Northwestern Hospital, 800 E 28th Street, Minneapolis, MN, 55407, USA
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40
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Fukui M, Cavalcante J, Bae R, Bapat V, Goessl M, Garcia S, Enriquez-Sarano M, Sorajja P. TCT-475 Natural History of Mitral Disease Associated With Mitral Annular Calcification. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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41
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Hashimoto G, Sarano M, Sato H, Lopes B, Fukui M, Stanberry L, Cheng V, Garcia S, Goessl M, Sorajja P, Bapat V, Lesser J, Cavalcante J. The left ventricular remodeling assessment by cardiac magnetic resonance in chronic aortic regurgitation; implications for outcome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0231] [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 aortic regurgitation (AR) causes left ventricular (LV) volume overload resulting in progressive LV remodeling, which negatively affect clinical outcome. Clinical Guidelines recommend assessment of LV remodeling by echocardiography, but little is known about comparative remodeling quantification by cardiac magnetic resonance (CMR) and association with outcomes.
Purpose
To assess LV remodeling in AR by CMR, compared with echocardiographic measures and determine its impact on clinical outcome.
Methods
Patients with native, ≥moderate, chronic AR by echocardiography who underwent CMR exam within 90 days of diagnosis from January 2012 to February 2020 were enrolled. The endpoint was a composite of death, heart failure hospitalization, and heart failure symptom exacerbation during follow-up.
Results
The 178 patients included had median age (IQR) of 58 years (44–69), and most (88%, n=158) presented with no or minimal symptoms (NYHA class I/II). At diagnosis symptomatic vs. no/minimal symptoms patients presented with much more advanced LV remodeling by CMR (EDVI 133 [83–151] vs. 96 [80–123] p=0.024, ESVI 66 [46–85] vs. 42 [30–58], P=0.001) while echocardiography showed limited differences (EDVI 76 [57–93] vs. 65 [54–87] p=0.507, ESVI 38 [30–58] vs. 27 [20–42], p=0.072). During follow-up (3.3 years [1.6–5.8]), aortic valve replacement (AVR) was performed in 49 patients. In patients with no/minimal symptoms, the composite endpoint occurred in 54 (34%) patients including eight deaths and 30 heart failure hospitalizations. Patients with LV end-systolic volume index (LVESVi) >45 ml/m2 by CMR had higher likelihood for composite endpoint (Panel A) confirmed in multivariate models, adjusting for age, sex, AVR (time-dependent), EuroSCORE2, and LV End-systolic-dimension-index (LVESDi) >25 mm/2, with adjusted hazard ratio 1.84 [1.02–3.33], p<0.044 (Panel B). LVESVi by CMR was at least as powerful in determining clinical outcomes as guideline-recommended Doppler-Echocardiographic variables.
Conclusion
Assessment of LV remodeling by CMR in patients with clinically significant AR is feasible in routine clinical practice, detects with high sensitivity LV remodeling associated with development of HF symptoms and is independently predictive of clinical outcome. Hence, CMR provides a powerful tool for evaluation and risk stratification of patients with AR.
Funding Acknowledgement
Type of funding sources: None. Panel APanel B
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Affiliation(s)
- G Hashimoto
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - M Sarano
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - H Sato
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - B Lopes
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - M Fukui
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - L Stanberry
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - V Cheng
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - S Garcia
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - M Goessl
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - P Sorajja
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - V Bapat
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - J Lesser
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - J Cavalcante
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
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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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Kwak S, Everett RJ, Treibel TA, Yang S, Hwang D, Ko T, Williams MC, Bing R, Singh T, Joshi S, Lee H, Lee W, Kim YJ, Chin CWL, Fukui M, Al Musa T, Rigolli M, Singh A, Tastet L, Dobson LE, Wiesemann S, Ferreira VM, Captur G, Lee S, Schulz-Menger J, Schelbert EB, Clavel MA, Park SJ, Rheude T, Hadamitzky M, Gerber BL, Newby DE, Myerson SG, Pibarot P, Cavalcante JL, McCann GP, Greenwood JP, Moon JC, Dweck MR, Lee SP. Markers of Myocardial Damage Predict Mortality in Patients With Aortic Stenosis. J Am Coll Cardiol 2021; 78:545-558. [PMID: 34353531 DOI: 10.1016/j.jacc.2021.05.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) is increasingly used for risk stratification in aortic stenosis (AS). However, the relative prognostic power of CMR markers and their respective thresholds remains undefined. OBJECTIVES Using machine learning, the study aimed to identify prognostically important CMR markers in AS and their thresholds of mortality. METHODS Patients with severe AS undergoing AVR (n = 440, derivation; n = 359, validation cohort) were prospectively enrolled across 13 international sites (median 3.8 years' follow-up). CMR was performed shortly before surgical or transcatheter AVR. A random survival forest model was built using 29 variables (13 CMR) with post-AVR death as the outcome. RESULTS There were 52 deaths in the derivation cohort and 51 deaths in the validation cohort. The 4 most predictive CMR markers were extracellular volume fraction, late gadolinium enhancement, indexed left ventricular end-diastolic volume (LVEDVi), and right ventricular ejection fraction. Across the whole cohort and in asymptomatic patients, risk-adjusted predicted mortality increased strongly once extracellular volume fraction exceeded 27%, while late gadolinium enhancement >2% showed persistent high risk. Increased mortality was also observed with both large (LVEDVi >80 mL/m2) and small (LVEDVi ≤55 mL/m2) ventricles, and with high (>80%) and low (≤50%) right ventricular ejection fraction. The predictability was improved when these 4 markers were added to clinical factors (3-year C-index: 0.778 vs 0.739). The prognostic thresholds and risk stratification by CMR variables were reproduced in the validation cohort. CONCLUSIONS Machine learning identified myocardial fibrosis and biventricular remodeling markers as the top predictors of survival in AS and highlighted their nonlinear association with mortality. These markers may have potential in optimizing the decision of AVR.
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Affiliation(s)
- Soongu Kwak
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Russell J Everett
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Thomas A Treibel
- Barts Health NHS Trust and University College London, London, United Kingdom
| | - Seokhun Yang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Doyeon Hwang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Taehoon Ko
- Office of Hospital Information, Seoul National University Hospital, Seoul, Korea
| | - Michelle C Williams
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Rong Bing
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Trisha Singh
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Shruti Joshi
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Heesun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | | | - Miho Fukui
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Tarique Al Musa
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Marzia Rigolli
- University of Oxford Centre for Clinical Magnetic Resonance Research, BHF Centre of Research Excellence (Oxford), NIHR Biomedical Research Centre (Oxford), Oxford, United Kingdom
| | - Anvesha Singh
- Department of Cardiovascular Sciences, Glenfield Hospital, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - Lionel Tastet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Université Laval, Québec City, Québec, Canada
| | - Laura E Dobson
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Stephanie Wiesemann
- Charité Campus Buch ECRC and Helios Clinics Cardiology Germany, DZHK partner site, Berlin, Germany
| | - Vanessa M Ferreira
- University of Oxford Centre for Clinical Magnetic Resonance Research, BHF Centre of Research Excellence (Oxford), NIHR Biomedical Research Centre (Oxford), Oxford, United Kingdom
| | - Gabriella Captur
- Inherited Heart Muscle Disease Clinic, Department of Cardiology, Royal Free Hospital, NHS Foundation Trust, London, United Kingdom
| | - Sahmin Lee
- Division of Cardiology, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jeanette Schulz-Menger
- Charité Campus Buch ECRC and Helios Clinics Cardiology Germany, DZHK partner site, Berlin, Germany
| | - Erik B Schelbert
- UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Université Laval, Québec City, Québec, Canada
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Tobias Rheude
- Department of Cardiology, German Heart Center Munich, Munich, Germany
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Bernhard L Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc and Institut de Recherche Cardiovasculaire, Université Catholique de Louvain, Brussels, Belgium
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Saul G Myerson
- University of Oxford Centre for Clinical Magnetic Resonance Research, BHF Centre of Research Excellence (Oxford), NIHR Biomedical Research Centre (Oxford), Oxford, United Kingdom
| | - Phillipe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Université Laval, Québec City, Québec, Canada
| | - João L Cavalcante
- UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Gerry P McCann
- Department of Cardiovascular Sciences, Glenfield Hospital, University of Leicester and NIHR Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - James C Moon
- Barts Health NHS Trust and University College London, London, United Kingdom
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea; Center for Precision Medicine, Seoul National University Hospital, Seoul, South Korea.
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Onuma S, Fukuoka T, Miyoshi Y, Fukui M, Satomura Y, Yasuda K, Kimura T, Tachibana M, Bessho K, Yamamoto T, Tanaka H, Katsumata N, Fukami M, Hasegawa T, Ozono K. Two girls with a neonatal screening-negative 21-hydroxylase deficiency requiring treatment with hydrocortisone for virilization in late childhood. Clin Pediatr Endocrinol 2021; 30:143-148. [PMID: 34285457 PMCID: PMC8267553 DOI: 10.1297/cpe.30.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/20/2021] [Indexed: 11/09/2022] Open
Abstract
Herein, we report two girls with a neonatal screening (NS)-negative 21-hydroxylase
deficiency (21-OHD) requiring treatment with hydrocortisone due to virilization that
developed in late childhood. Patient 1 was born prematurely on the 30th gestational week
with normal external genitalia at birth. She passed the NS for 21-OHD. At 6 yr of age, she
was referred to a hospital for evaluation of premature pubarche and clitoromegaly. Her
diagnosis was central precocious puberty, and GnRH agonist was initiated. However, her
symptoms did not improve despite treatment for over 4 years. She was then referred to our
hospital where she was diagnosed with 21-OHD. Although she was started on hydrocortisone
therapy, her adult height reached only 140 cm (−3.4 SD). Patient 2 was delivered at 37
weeks of gestation and passed the NS for 21-OHD. She was referred to a hospital because of
premature pubarche at the age of 6 yr. She was diagnosed with 21-OHD, and hydrocortisone
replacement therapy was initiated. Her present height at 13 yr of age is 148 cm (−1.3 SD).
These cases reminded us that the possibility of 21-OHD should be considered when patients
show premature pubarche or precocious puberty, even if they passed the NS test for
21-OHD.
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Affiliation(s)
- Shinsuke Onuma
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomoya Fukuoka
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoko Miyoshi
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Health and Nutrition, Faculty of Health and Nutrition, Osaka Shoin Women's University, Osaka, Japan
| | - Miho Fukui
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshinori Satomura
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kie Yasuda
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takeshi Kimura
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Makiko Tachibana
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuhiko Bessho
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | - Hiroyuki Tanaka
- Department of Pediatrics, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Noriyuki Katsumata
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Maki Fukami
- Department of Molecular Endocrinology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Tomonobu Hasegawa
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
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45
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Hashimoto G, Cavalcante J, Fukui M, Lopes BB, Sato H, Schmidt C, Burns M, Gossl M, Sorajja P, Sarano ME, Lesser J, Bapat V, Garcia S. ASSESSMENT OF BIOPROSTHETIC VALVE REMODELING WITH FRACTURE PROCEDURE IN VALVE-IN-VALVE TAVR BY COMPUTED TOMOGRAPHY ANGIOGRAPHY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02672-3] [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: 10/21/2022]
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46
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Lopes BBC, Sorajja P, Hashimoto G, Fukui M, Bapat VN, Du Y, Bae R, Schwartz RS, Stanberry LI, Enriquez-Sarano M, Garcia SA, Lesser JR, Cavalcante JL. Tricuspid Anatomic Regurgitant Orifice Area by Functional DSCT: A Novel Parameter of Tricuspid Regurgitation Severity. JACC Cardiovasc Imaging 2021; 14:1669-1672. [PMID: 33744143 DOI: 10.1016/j.jcmg.2021.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 11/25/2022]
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47
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Izumi M, Sawa K, Oyanagi J, Noura I, Fukui M, Ogawa K, Matsumoto Y, Tani Y, Suzumura T, Watanabe T, Kaneda H, Mitsuoka S, Asai K, Ohsawa M, Yamamoto N, Kawaguchi T, Koh Y. P72.03 Tumor Microenvironment Disparity in Multiple Primary Lung Cancers. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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48
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Mori S, Shimbo T, Kimura Y, Hayashi M, Kiyohara E, Fukui M, Watanabe M, Bessho K, Fujimoto M, Tamai K. Recessive dystrophic epidermolysis bullosa with extensive transplantation of cultured epidermal autograft product after cardiopulmonary resuscitation: A case report. J Dermatol 2021; 48:e194-e195. [PMID: 33609402 DOI: 10.1111/1346-8138.15798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/11/2021] [Accepted: 01/23/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Shiho Mori
- Department of Stem Cell Therapy Science, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Dermatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Shimbo
- Department of Stem Cell Therapy Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuka Kimura
- Department of Dermatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Mami Hayashi
- Department of Dermatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eiji Kiyohara
- Department of Dermatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Miho Fukui
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Miho Watanabe
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuhiko Bessho
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Katsuto Tamai
- Department of Stem Cell Therapy Science, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Dermatology, Osaka University Graduate School of Medicine, Osaka, Japan
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Du Y, Gössl M, Garcia S, Enriquez-Sarano M, Cavalcante JL, Bae R, Hashimoto G, Fukui M, Lopes B, Ahmed A, Schmidt C, Stanberry L, Garberich R, Bradley SM, Steffen R, Sorajja P. Natural history observations in moderate aortic stenosis. BMC Cardiovasc Disord 2021; 21:108. [PMID: 33607944 PMCID: PMC7893941 DOI: 10.1186/s12872-021-01901-1] [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] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 12/14/2022] Open
Abstract
Background The natural history of patients with moderate aortic stenosis (AS) is poorly understood. We aimed to determine the long-term outcomes of patients with moderate AS. Methods
We examined patients with moderate AS defined by echocardiography in our healthcare system, and performed survival analyses for occurrence of death, heart failure (HF) hospitalization, and progression of AS, with accounting for symptoms, left ventricular dysfunction, and comorbidities. Results We examined 729 patients with moderate AS (median age, 76 years; 59.9 % men) with a median follow-up of 5.0 years (interquartile range: 2.0 to 8.1 years). The 5-year overall survival was 52.3 % (95 % confidence interval [CI]: 48.6 % to 56.0 %) and survival free of death or HF hospitalization was 43.2 % (95 % CI: 39.5 % to 46.9 %). Worse New York Heart Association (NYHA) functional class was associated with poor long-term survival, with mortality rates ranging from 7.9 % (95 % CI: 6.6–9.2 %) to 25.2 % (95 % CI: 20.2–30.3 %) per year. Among patients with minimal or no symptoms, no futility markers, and preserved left ventricular function, 5-year overall survival was 71.9 % (95 % CI: 66.4–77.4 %) and survival free of death or HF hospitalization was 61.4 % (95 % CI: 55.5–67.3 %). Risk factors associated with adverse events were age, NYHA class, low ejection fraction and high aortic valve velocity (all p < 0.05). Conclusions Patients with moderate AS are at significant risk of death. Our findings highlight the need for more study into appropriate therapeutic interventions to improve the prognosis of these patients.
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Affiliation(s)
- Yu Du
- Roger L. and Lynn C. Headrick Chair, Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, 55407, USA.,Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Mario Gössl
- Roger L. and Lynn C. Headrick Chair, Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, 55407, USA
| | - Santiago Garcia
- Roger L. and Lynn C. Headrick Chair, Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, 55407, USA
| | - Maurice Enriquez-Sarano
- Roger L. and Lynn C. Headrick Chair, Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, 55407, USA
| | - Joao L Cavalcante
- Roger L. and Lynn C. Headrick Chair, Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, 55407, USA
| | - Richard Bae
- Roger L. and Lynn C. Headrick Chair, Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, 55407, USA
| | - Go Hashimoto
- Roger L. and Lynn C. Headrick Chair, Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, 55407, USA
| | - Miho Fukui
- Roger L. and Lynn C. Headrick Chair, Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, 55407, USA
| | - Bernardo Lopes
- Roger L. and Lynn C. Headrick Chair, Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, 55407, USA
| | - Aisha Ahmed
- Roger L. and Lynn C. Headrick Chair, Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, 55407, USA
| | - Christian Schmidt
- Roger L. and Lynn C. Headrick Chair, Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, 55407, USA
| | - Larissa Stanberry
- Roger L. and Lynn C. Headrick Chair, Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, 55407, USA
| | - Ross Garberich
- Roger L. and Lynn C. Headrick Chair, Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, 55407, USA
| | - Steven M Bradley
- Roger L. and Lynn C. Headrick Chair, Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, 55407, USA
| | - Robert Steffen
- Roger L. and Lynn C. Headrick Chair, Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, 55407, USA
| | - Paul Sorajja
- Roger L. and Lynn C. Headrick Chair, Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, 55407, USA.
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50
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Fukui M, Hashimoto G, Lopes B, Du Y, Stanberry L, Garcia S, Goessl M, Enriquez-Sarano M, Bapat V, Sorajja P, Lesser J, Cavalcante J. Computed tomography derived left ventricular global longitudinal strain associate with clinical outcomes in patients undergoing transcatheter aortic valve replacement. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.226] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Computed tomography angiography (CTA) is key imaging modality for procedure planning for transcatheter aortic valve replacement (TAVR). Functional assessment by CTA with LV global longitudinal strain (LVGLS) has recently shown to be feasible. However, there is limited data on its prognostic value in patients with severe aortic stenosis (AS) who treated with TAVR.
Purpose
To evaluate the association of baseline CTA-LVGLS with post-TAVR outcome.
Methods
Patients who underwent contrast multiphasic gated CTA for TAVR planning were studied. LVGLS was measured using dedicated feature-tracking software (Medis®). Cox regression analysis evaluated the association of baseline LVGLS with a composite outcome of all-cause death and heart failure hospitalization after TAVR.
Results
A total of 431 patients were included (median [IQR] age, 83 [77,87]years; 44% female); the society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) score, 3.3 [2.3,5.1]%; CTA-LVGLS, -18.0 [-21.6,-14.2]%; LV ejection fraction was preserved at 60 [55,65]%. After a median follow-up of 19 [13,27] months, 99 composite outcomes occurred after TAVR. On multivariable Cox regression analysis, LVGLS was associated with the risk of composite outcome even after adjustment for baseline characteristics (Figure A). Patients with reduced LVGLS (above the median >-18.0%) had higher risk of the composite outcome than those with preserved GLS (p = 0.003; Figure B).
Conclusion
Baseline CTA-LVGLS was associated with the risk of death or heart failure hospitalization over the clinical and echocardiographic characteristics in severe AS patients undergoing TAVR.
Abstract Figure.
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Affiliation(s)
- M Fukui
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - G Hashimoto
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - B Lopes
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - Y Du
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - L Stanberry
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - S Garcia
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - M Goessl
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - M Enriquez-Sarano
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - V Bapat
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - P Sorajja
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - J Lesser
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - J Cavalcante
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
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