1
|
Teixido Tura G, Martinez D, Calvo F, Garcia-Orta R, Sanchez R, Larranaga JM, Hernandiz A, Diaz E, Montanes E, Cabrera F, Sabate A, Nistal F, Forteza A, Evangelista A. Aortic and vascular involvement in Loeys-Dietz Syndrome. Results from the REPAG registry (Spanish network of genetic aortic diseases). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
LDS is a rare disease due to genetic variants in the TGFB pathway. Limited information is available regarding the overall aortic and vascular outcome of these patients
Purpose
To evaluate aortic and vascular complications of patients with mutations in the TGFB pathway.
Methods
Retrospective longitudinal study including patients with (likely) pathogenic (LP/P) variants in the TGFbeta pathway from 10 tertiary centers. Clinical and imaging data were reviewed and data on aortic and vascular outcome included.
Results
A total of 163 patients were included (47.9% women, 38.6% index cases), mean age at first evaluation 32.3±20.4 years, 27.0% with age <16 years. 70 TGFBR1, 43 TGFBR2, 29 SMAD3, 9 TGFB2 and 12 TGFB3 (Table1)
During a mean follow-up of 4.7±3.7 years, 54 (33.1%) patients had at least 1 aortic surgery (max 6). Mean age at first aortic surgery was 37.2±16.8 years (Range 1.2–72.9). First surgery was elective in 42 (77.8%), and included aortic root or ascending aorta in 40 (95.2%) and isolated descending aorta in 2 (4.8%). Emergent surgery included aortic root or ascending aorta in 11 (92.7%). Ascending aorta-root diameter previous to elective surgery was 48.9±4.9mm (range 41–65). 7 patients died during follow-up (2 intracranial bleeding, 1 SD, 2 aortic ruptures, 1post aortic surgery, 1 non-CV). Furthermore, 19 acute aortic syndromes (AAS) were reported (17 dissections, 2 haematomas) in 18 patients, 10 type A (52.6%). Mean age at first AAS was 42.3±11.1 years (min 19.7 years to 62.9 years)
Median survival free of intervention, dissection or death was 57.1 years, being worst for men than women (44.7 yrs vs 69.1 years, p<0.001) (Figure 1), these gender-difference only remained significant in the TGFBR1 and SMAD3 groups (p=0.005 and p=0.008) Regarding aortic branch and intracranial aneurysms, a total of 383 imaging studies of aortic branches and 223 cranial imaging studies were performed during the clinical follow-up. 21 cranial aneurysms and 73 aortic branch aneurisms were reported. 14 (11.5%) patients suffered 19 aneurysms-related events (3 dissections, 3 ruptures, 13 interventions).
Conclusions
In patients with Loeys-Dietz Syndrome, there's a high prevalence of aortic surgeries and acute aortic events, with high numbers of peripheral and intracranial aneurysms. A worst prognosis in men than in women is observed in TGFBR1 and SMAD3 variants. Thus, specialized clinical and imaging follow-up is crucial in the management of these patients
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- G Teixido Tura
- University Hospital Vall d'Hebron, Cardiology , Barcelona , Spain
| | - D Martinez
- Puerta de Hierro Majadahonda University Hospital, Cardiac Surgery, Majadahonda , Madrid , Spain
| | - F Calvo
- Hospital Universitario Alvaro Cunqueiro, Cardiology , Vigo , Spain
| | - R Garcia-Orta
- Virgen de las Nieves University Hospital, Cardiology , Granada , Spain
| | - R Sanchez
- General University Hospital of Alicante , Alicante , Spain
| | - J M Larranaga
- Hospital General A Coruna, Cardiology , A Coruna , Spain
| | - A Hernandiz
- Hospital Universitario y Politecnico La Fe , Valencia , Spain
| | - E Diaz
- Hospital Clinico Universitario, Cardiology , Salamanca , Spain
| | - E Montanes
- University Hospital 12 de Octubre , Madrid , Spain
| | - F Cabrera
- University Hospital Virgen de la Victoria, Cardiology , Malaga , Spain
| | - A Sabate
- University Hospital Vall d'Hebron, Pediatric Cardiology , Barcelona , Spain
| | - F Nistal
- University Hospital Marques de Valdecilla, Cardiac Surgery , Santander , Spain
| | - A Forteza
- Puerta de Hierro Majadahonda University Hospital, Cardiac Surgery, Majadahonda , Madrid , Spain
| | - A Evangelista
- University Hospital Vall d'Hebron, Cardiology , Barcelona , Spain
| |
Collapse
|
2
|
Peinado R, Cano O, Rivas-Gandara N, Alvarez-Ortega C, Garcia-Orta R, Diaz-Infante E, Segura-De La Cal T, Lopez-Ledesma B, Cantalapiedra-Romero J, Macias R, Rueda J, Dos-Subira L, Gallego-Garcia De Vinuesa P, Gonzalez-Garcia AE, Oliver-Ruiz JM. Spanish registry of cardiac resynchronization therapy in adults with congenital heart disease (RETRACCA): clinical outcomes at one year follow-up. Europace 2022. [DOI: 10.1093/europace/euac053.548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Spanish Society of Cardiology
Background
There are limited data about the impact of cardiac resynchronization therapy (CRT) in adults with congenital heart disease (CHD) with conflicting results in patients (P) with systemic right ventricle (SRV).
Objectives
We analyzed the one-year outcomes of adults with CHD implanted with CRT and the impact of CRT in P with SRV as compared with systemic left ventricle (SLV).
Methods
Data were analyzed from the Spanish Registry of CRT in adults with CHD (RETRACCA). This is an observational, ambispective (66 % retrospective), multicenter Registry, including 74 adults with CHD implanted with a CRT device from 6 Spanish centers from 2007 to 2021. Ventricular function was assessed by echocardiography and graded on a four-point ordinal scale. Response to CRT was defined as an improvement in NYHA functional class and/or systemic ventricular ejection fraction by at least one category. In addition to changes in functional class and ventricular function, other outcomes analyzed included mortality, heart transplantation and CRT-related complications.
Results
68 P completed one year of follow-up. Table 1 shows the baseline characteristics of the P prior to CRT. The two main indications for CRT were depressed systolic function of the systemic ventricle with more than 40 % ventricular pacing (69 %) and severely depressed systolic function of systemic ventricle, NYHA FC II-IV and QRS > 150 (18 %). Sixty percent of P received a CRT-ICD, whereas 40 % received a CRT-pacemaker. The approach for CRT system implantation was transvenous in 70 % of the patients, mixed in 21 % and fully epicardial in 9 %. Overall, 43 out of 68 patients (75 %) responded to CRT either by improvement of NYHA FC (56 %) and/or systemic ventricular function (41 %). Compared with baseline, CRT was associated with significant improvement in NYHA FC (p<0.001; figure 1), QRS duration (169±31 vs 150±29; p=0.005), and systemic ventricle systolic function (severe or moderate 80 % vs 58 %; p=0.04). Percentage of responders was similar among patients with a SLV (73 %) and with SRV (81 %; p=0.51). Only pre-implant NYHA FC III-IV was predictive of a positive response in the univariate analysis (OR 3.82; 95 % CI 1.03-14.18). Seven complications occurred at implant (10 %). During the follow-up, there were 8 complications in 7 P: 2 P had heart transplantation, 3 P required hospital admission for decompensation of heart failure, 2 P presented pocket infections and 1 lead malfunction. No differences in complication rates were observed between the systemic LV and systemic RV subgroups.
Conclusions
In this series, at one-year follow-up, CRT resulted in improvement in functional class and/or systemic ventricular function in 75 % of P with adult CHD. The percentages of responders and complications were similar among patients with SLV or SRV.
Collapse
Affiliation(s)
- R Peinado
- University Hospital La Paz, Madrid, Spain
| | - O Cano
- Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | | | | | - R Garcia-Orta
- University Hospital Virgen de las Nieves, Granada, Spain
| | - E Diaz-Infante
- Hospital Universitario Virgen de la Macarena, Sevilla, Spain
| | | | | | | | - R Macias
- University Hospital Virgen de las Nieves, Granada, Spain
| | - J Rueda
- Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | - L Dos-Subira
- University Hospital Vall d’Hebron, Barcelona, Spain
| | | | | | | |
Collapse
|
3
|
Ruperti Repilado FJ, Greutmann M, Bouchardy J, Brennan P, Campens L, Gallego P, Garcia-Orta R, Jensen AS, Ladouceur M, Miranda-Barrio B, Morissens M, Rueda Soriano J, Van Den Bosch AE, Tobler D, Schwerzmann M. The coronavirus disease 2019 pandemic among adult congenital heart disease patients: findings of a one-year multicentric, international study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1878] [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
Introduction
One year after the beginning of the Coronavirus Disease 2019 (COVID-19) pandemic, the evidence on outcomes among adults with congenital heart disease (ACHD) is still limited.
Purpose
We aimed to compare patient characteristics and outcomes between the first and the subsequent COVID-19 waves and to identify overall predictors for complicated disease course among ACHD patients.
Methods
We collected reported COVID-19 cases among ACHD patients followed at 26 tertiary care centers in 10 European countries between March 27, 2020 and March 25, 2021. Patient characteristics, heart defect complexity and residual problems, medical history, date of diagnosis and course and outcome of COVID-19 were recorded. Cases were stratified into first vs. subsequent COVID-19 waves (cut-off date July 15, 2020). A complicated disease course was defined as hospitalization for COVID-19 requiring ventilation and/or inotropic support, extracorporeal membrane oxygenation or death. Data were reported as median (interquartile range) and counts (percentage).
Results
Overall, 548 cases were included (first wave: n=161; subsequent waves: n=387). Median age 33 (26–44) years, 52% female. Thirty-three patients (6%) had a complicated disease course. Between waves (first vs. subsequent), there were no statistically significant differences related to gender (women 57% vs. 49%, p=0.09), body mass index (BMI) category (p=0.7), heart defect complexity (p=0.08) and residual heart defect-related problems (p=0.6). Patients in the first wave were older, had more often ≥2 comorbidities and a complicated disease course (37 vs 33 years, p=0,001; 17% vs. 7%, p=0.0003; and 9% vs. 5%, p=0.04, respectively). The proportion of deaths did not significantly differed between waves (4% vs 2%, p=0.2). A detailed comparison of the above-reported characteristics is depicted in table 1. From multivariable models, adjusted odds ratios (OR) (95% confidence interval) for the prediction of complicated COVID-19 course are depicted in table 2. Main independent predictors for a complicated disease course were: cyanotic heart disease, including unrepaired cyanotic defects or severe pulmonary hypertension with Eisenmenger syndrome (OR 8.49 [3.14–22.94], p<0.001), BMI >25 kg/m2 (OR 3.91 [1.62–9.43], p=0.002), having ≥2 comorbidities (OR 2.63 [1.05–6.62], p=0.04) and age per five years (OR 1.21 [1.05–1.42], p=0.01).
Conclusion
Complicated COVID-19 course among ACHD patients is rare. Outcomes in the first wave were worse when compared to subsequent waves, mainly because patients of the first wave were older and had more comorbidities. Age, cyanotic heart disease (including unrepaired cyanotic defects or severe pulmonary hypertension with Eisenmenger syndrome), having ≥2 comorbidities and a BMI >25 kg/m2 were the main predictors for a complicated disease course.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
| | - M Greutmann
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - J Bouchardy
- University Hospital Centre Vaudois (CHUV), Cardiology, Lausanne, Switzerland
| | - P Brennan
- Belfast Health and Social Care Trust, Cardiology, Belfast, United Kingdom
| | - L Campens
- Ghent University Hospital, Cardiology, Ghent, Belgium
| | - P Gallego
- University Hospital Virgen del Rocio, Cardiology, Seville, Spain
| | - R Garcia-Orta
- University Hospital Virgen de las Nieves, Cardiology, Granada, Spain
| | - A S Jensen
- Rigshospitalet - Copenhagen University Hospital, Cardiology, Copenhagen, Denmark
| | - M Ladouceur
- Hopital Europeen Georges Pompidou- University Paris Descartes, Cardiology, Paris, France
| | | | - M Morissens
- Brugmann University Hospital, Cardiology, Brussels, Belgium
| | - J Rueda Soriano
- Hospital Universitario y Politecnico La Fe, Cardiology, Valencia, Spain
| | - A E Van Den Bosch
- Erasmus University Medical Centre, Cardiology, Rotterdam, Netherlands (The)
| | - D Tobler
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - M Schwerzmann
- Bern University Hospital, Inselspital, Bern, Switzerland
| | | |
Collapse
|
4
|
Schwerzmann M, Ruperti-Repilado FJ, Baumgartner H, Bouma B, Bouchardy J, Budts W, Campens L, Chessa M, Del Cerro Marin MJ, Gabriel H, Gallego P, Garcia-Orta R, Gonzalez AE, Jensen AS, Ladouceur M, Miranda-Barrio B, Morissens M, Pasquet A, Rueda J, van den Bosch AE, van der Zwaan HB, Tobler D, Greutmann M. Clinical outcome of COVID-19 in patients with adult congenital heart disease. Heart 2021; 107:1226-1232. [PMID: 33685931 PMCID: PMC7944416 DOI: 10.1136/heartjnl-2020-318467] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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: 10/15/2020] [Revised: 02/08/2021] [Accepted: 02/16/2021] [Indexed: 12/23/2022] Open
Abstract
AIMS Patients with adult congenital heart disease (ACHD) are a potentially vulnerable patient cohort in case of COVID-19. Some cardiac defects may be associated with a poor COVID-19 outcome. Risk estimation in ACHD is currently based on expert opinion. The aim of this study was to collect clinical outcome data and to identify risk factors for a complicated course of COVID-19 in patients with ACHD. METHODS Twenty-five ACHD centres in nine European countries participated in the study. Consecutive patients with ACHD diagnosed with COVID-19 presenting to one of the participating centres between 27 March and 6 June 2020 were included. A complicated disease course was defined as hospitalisation for COVID-19 requiring non-invasive or invasive ventilation and/or inotropic support, or a fatal outcome. RESULTS Of 105 patients with a mean age of 38±13 years (58% women), 13 had a complicated disease course, of whom 5 died. In univariable analysis, age (OR 1.3, 95% CI 1.1 to 1.7, per 5 years), ≥2 comorbidities (OR 7.1, 95% CI 2.1 to 24.5), body mass index of >25 kg/m2 (OR 7.2, 95% CI 1.9 to 28.3) and cyanotic heart disease (OR 13.2, 95% CI 2.5 to 68.4) were associated with a complicated disease course. In a multivariable logistic regression model, cyanotic heart disease was the most important predictor (OR 60.0, 95% CI 7.6 to 474.0). CONCLUSIONS Among patients with ACHD, general risk factors (age, obesity and multiple comorbidities) are associated with an increased risk of complicated COVID-19 course. Congenital cardiac defects at particularly high risk were cyanotic lesions, including unrepaired cyanotic defects or Eisenmenger syndrome.
Collapse
Affiliation(s)
- Markus Schwerzmann
- Center for Congenital Heart Disease, Inselspital University Hospital, Bern, Switzerland
| | | | - Helmut Baumgartner
- Dept. of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Munster, Nordrhein-Westfalen, Germany
| | - Berto Bouma
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Judith Bouchardy
- Department of Cardiology and Cardiac Surgery, Lausanne University Hospital, Lausanne, Switzerland
- Division of Cardiology, University Hospital of Geneva, Geneva, Switzerland
| | - Werner Budts
- Congenital and Structural Cardiology, University Hospital Leuven, Leuven, Flanders, Belgium
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Flanders, Belgium
| | - Laurence Campens
- Department of Cardiology, Ghent University Hospital, Gent, Oost-Vlaanderen, Belgium
| | - Massimo Chessa
- ACHD UNIT - Pediatric and Adult Congenital Heart Centre, IRCCS - Policlinico San Donato, San Donato Milanese - Milan, Lombardia, Italy
| | | | - Harald Gabriel
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Pastora Gallego
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario, Virgen del Rocio, Instituto de BioMedicina de Sevilla (IBIS) and CIBERCV, Sevilla, Spain
| | - Rocio Garcia-Orta
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario Virgen de las Nieves. 2 Instituto de Investigación Biosanitaria ibs, Granada, Andalucía, Spain
| | | | | | - Magalie Ladouceur
- Adult Congenital Heart Disease Unit, Centre de référence des Malformations Cardiaques Congénitales Complexes, M3C, Université de Paris, Hôpital Européen Georges Pompidou, AP-H, Paris, France
| | - Berta Miranda-Barrio
- Integrated Adult Congenital Heart Disease Unit, Vall d'Hebron University Hospital and Santa Creu i Sant Pau University Hospital, Barcelona, Spain
| | | | - Agnes Pasquet
- Department of Cardiology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Joaquín Rueda
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitari i Politècnic La Fe and CIBERCV, Valencia, Comunidad Valenciana, Spain
| | | | | | - Daniel Tobler
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Matthias Greutmann
- Departament of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
5
|
Broberg CS, Kovacs AH, Sadeghi S, Rosenbaum MS, Lewis MJ, Carazo MR, Rodriguez FH, Halpern DG, Feinberg J, Galilea FA, Baraona F, Cedars AM, Ko JM, Porayette P, Maldonado J, Sarubbi B, Fusco F, Frogoudaki AA, Nir A, Chaudhry A, John AS, Karbassi A, Hoskoppal AK, Frischhertz BP, Hendrickson B, Bouma BJ, Rodriguez-Monserrate CP, Broda CR, Tobler D, Gregg D, Martinez-Quintana E, Yeung E, Krieger EV, Ruperti-Repilado FJ, Giannakoulas G, Lui GK, Ephrem G, Singh HS, Almeneisi HM, Bartlett HL, Lindsay I, Grewal J, Nicolarsen J, Araujo JJ, Cramer JW, Bouchardy J, Al Najashi K, Ryan K, Alshawabkeh L, Andrade L, Ladouceur M, Schwerzmann M, Greutmann M, Meras P, Ferrero P, Dehghani P, Tung PP, Garcia-Orta R, Tompkins RO, Gendi SM, Cohen S, Klewer S, Hascoet S, Mohammadzadeh S, Upadhyay S, Fisher SD, Cook S, Cotts TB, Aboulhosn JA. COVID-19 in Adults With Congenital Heart Disease. J Am Coll Cardiol 2021; 77:1644-1655. [PMID: 33795039 PMCID: PMC8006800 DOI: 10.1016/j.jacc.2021.02.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [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: 12/17/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 12/17/2022]
Abstract
Background Adults with congenital heart disease (CHD) have been considered potentially high risk for novel coronavirus disease-19 (COVID-19) mortality or other complications. Objectives This study sought to define the impact of COVID-19 in adults with CHD and to identify risk factors associated with adverse outcomes. Methods Adults (age 18 years or older) with CHD and with confirmed or clinically suspected COVID-19 were included from CHD centers worldwide. Data collection included anatomic diagnosis and subsequent interventions, comorbidities, medications, echocardiographic findings, presenting symptoms, course of illness, and outcomes. Predictors of death or severe infection were determined. Results From 58 adult CHD centers, the study included 1,044 infected patients (age: 35.1 ± 13.0 years; range 18 to 86 years; 51% women), 87% of whom had laboratory-confirmed coronavirus infection. The cohort included 118 (11%) patients with single ventricle and/or Fontan physiology, 87 (8%) patients with cyanosis, and 73 (7%) patients with pulmonary hypertension. There were 24 COVID-related deaths (case/fatality: 2.3%; 95% confidence interval: 1.4% to 3.2%). Factors associated with death included male sex, diabetes, cyanosis, pulmonary hypertension, renal insufficiency, and previous hospital admission for heart failure. Worse physiological stage was associated with mortality (p = 0.001), whereas anatomic complexity or defect group were not. Conclusions COVID-19 mortality in adults with CHD is commensurate with the general population. The most vulnerable patients are those with worse physiological stage, such as cyanosis and pulmonary hypertension, whereas anatomic complexity does not appear to predict infection severity.
Collapse
Affiliation(s)
- Craig S Broberg
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Adrienne H Kovacs
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Soraya Sadeghi
- Ahmanson/UCLA Adult Congenital Heart Center, Los Angeles, California, USA
| | - Marlon S Rosenbaum
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Matthew J Lewis
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Matthew R Carazo
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Fred H Rodriguez
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Dan G Halpern
- Division of Cardiology, York University Langone Health, New York, New York, USA
| | - Jodi Feinberg
- Division of Cardiology, York University Langone Health, New York, New York, USA
| | | | - Fernando Baraona
- Instituto Nacional del Tórax - Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ari M Cedars
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jong M Ko
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Prashob Porayette
- Division of Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Jennifer Maldonado
- Division of Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Berardo Sarubbi
- Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | - Flavia Fusco
- Monaldi Hospital, Adult Congenital Heart Disease Unit, Naples, Italy
| | | | - Amiram Nir
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Anisa Chaudhry
- Penn State Hershey Heart and Vascular Institute, State College, Pennsylvania, USA
| | - Anitha S John
- Division of Cardiology, Children's National Hospital, Washington, DC, USA
| | | | - Arvind K Hoskoppal
- UPMC Adult Congenital Heart Disease Program, Pittsburgh, Pennsylvania, USA
| | - Benjamin P Frischhertz
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Benjamin Hendrickson
- University of Tennessee Health Science Center, Le Bonheur Heart Institute, Memphis, Tennessee, USA
| | - Berto J Bouma
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | | | - Daniel Tobler
- Division of Cardiology, University Hospital of Basel, Basel, Switzerland
| | - David Gregg
- Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Efren Martinez-Quintana
- Cardiology Service, Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Elizabeth Yeung
- Anschutz Medical Campus, Colorado's Adult and Teen Congenital Heart Program, Aurora, Colorado, USA
| | - Eric V Krieger
- Division of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA
| | | | | | - George K Lui
- Division of Cardiovascular Medicine and Pediatric Cardiology, Stanford University School of Medicine, Stanford, California, USA
| | - Georges Ephrem
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, Indiana, USA
| | - Harsimran S Singh
- Weill Cornell Medicine, New York Presbyterian Hospital, Department of Medicine and Pediatrics, New York, New York, USA
| | - Hassan Mk Almeneisi
- Cincinnati Children's Hospital Medical Center, The Heart Institute, Cincinnati, Ohio, USA
| | - Heather L Bartlett
- Department of Pediatrics and Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Ian Lindsay
- Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah, USA
| | - Jasmine Grewal
- University of British Columbia, St. Paul's Hospital, Vancouver, British Colombia, Canada
| | - Jeremy Nicolarsen
- Providence Adult and Teen Congenital Heart Program, Pediatric and Adult Cardiology, Spokane, Washington, USA
| | - John J Araujo
- Department of Pediatric and Adult Congenital Heart Disease, Somer Incare Cardiovascular Center, Rionegro, Colombia
| | - Jonathan W Cramer
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Judith Bouchardy
- Department of Cardiology and Cardiac Surgery, University Hospital Lausanne, Lausanne, Switzerland
| | - Khalid Al Najashi
- Pediatric Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Kristi Ryan
- OSF Healthcare Children's Hospital of Illinois, Adult Congenital Heart Program, Peoria, Illinois, USA
| | - Laith Alshawabkeh
- Department of Cardiovascular Medicine, University of California San Diego, La Jolla, California, USA
| | - Lauren Andrade
- Division of Cardiology, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Magalie Ladouceur
- Hôpital Européen Georges Pompidou, Adult Congenital Heart Disease Unit, Paris, France
| | - Markus Schwerzmann
- University Hospital Inselspital, Center for Congenital Heart Disease, Bern, Switzerland
| | | | | | - Paolo Ferrero
- ASST Papa Giovanni XXIII, Cardiovascular Department, University of Milano, Bergamo, Italy
| | - Payam Dehghani
- Prairie Vascular Research Network, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Poyee P Tung
- University of Texas at Houston, Adult Congenital Heart Disease, Houston, Texas, USA
| | - Rocio Garcia-Orta
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Rose O Tompkins
- Cedars-Sinai Medical Center, The Geurin Family Congenital Heart Program, Los Angeles, California, USA
| | - Salwa M Gendi
- West Virginia University, Adult Congenital Heart Disease Program, Morgantown, West Virginia, USA
| | - Scott Cohen
- Medical College of Wisconsin, Adult Congenital Heart Disease Program, Milwaukee, Wisconsin, USA
| | - Scott Klewer
- Division of Cardiology, University of Arizona, Tucson, Arizona, USA
| | | | | | - Shailendra Upadhyay
- Connecticut Children's Medical Center, Pediatric Cardiology Hartford, Connecticut, USA
| | - Stacy D Fisher
- Department of Medicine and Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Stephen Cook
- Helen DeVos Children's Hospital, Adult Congenital Heart Center, Grand Rapids, Michigan, USA
| | - Timothy B Cotts
- Department of Medicine and Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jamil A Aboulhosn
- Ahmanson/UCLA Adult Congenital Heart Center, Los Angeles, California, USA.
| |
Collapse
|
6
|
Oliver JM, Gallego P, Gonzalez AE, Avila P, Alonso A, Garcia-Hamilton D, Peinado R, Dos-Subirà L, Pijuan-Domenech A, Rueda J, Rodriguez-Puras MJ, Garcia-Orta R, Martínez-Quintana E, Datino T, Fernandez-Aviles F, Bermejo J. Predicting sudden cardiac death in adults with congenital heart disease. Heart 2020; 107:67-75. [PMID: 32546506 DOI: 10.1136/heartjnl-2020-316791] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES To develop, calibrate, test and validate a logistic regression model for accurate risk prediction of sudden cardiac death (SCD) and non-fatal sudden cardiac arrest (SCA) in adults with congenital heart disease (ACHD), based on baseline lesion-specific risk stratification and individual's characteristics, to guide primary prevention strategies. METHODS We combined data from a single-centre cohort of 3311 consecutive ACHD patients (50% male) at 25-year follow-up with 71 events (53 SCD and 18 non-fatal SCA) and a multicentre case-control group with 207 cases (110 SCD and 97 non-fatal SCA) and 2287 consecutive controls (50% males). Cumulative incidences of events up to 20 years for specific lesions were determined in the prospective cohort. Risk model and its 5-year risk predictions were derived by logistic regression modelling, using separate development (18 centres: 144 cases and 1501 controls) and validation (two centres: 63 cases and 786 controls) datasets. RESULTS According to the combined SCD/SCA cumulative 20 years incidence, a lesion-specific stratification into four clusters-very-low (<1%), low (1%-4%), moderate (4%-12%) and high (>12%)-was built. Multivariable predictors were lesion-specific cluster, young age, male sex, unexplained syncope, ischaemic heart disease, non-life threatening ventricular arrhythmias, QRS duration and ventricular systolic dysfunction or hypertrophy. The model very accurately discriminated (C-index 0.91; 95% CI 0.88 to 0.94) and calibrated (p=0.3 for observed vs expected proportions) in the validation dataset. Compared with current guidelines approach, sensitivity increases 29% with less than 1% change in specificity. CONCLUSIONS Predicting the risk of SCD/SCA in ACHD can be significantly improved using a baseline lesion-specific stratification and simple clinical variables.
Collapse
Affiliation(s)
- Jose M Oliver
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital General Universitario Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid and CIBERCV, Madrid, Spain.,Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
| | - Pastora Gallego
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario Virgen del Rocio, Instituto de BioMedicina de Sevilla (IBIS) and CIBERCV, Sevilla, Spain
| | - Ana Elvira Gonzalez
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
| | - Pablo Avila
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital General Universitario Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid and CIBERCV, Madrid, Spain
| | - Andres Alonso
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital General Universitario Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid and CIBERCV, Madrid, Spain
| | - Diego Garcia-Hamilton
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
| | - Rafael Peinado
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario La Paz, Madrid, Spain
| | - Laura Dos-Subirà
- Unitat Integrada de Cardiopaties Congènites de l'Adolescent i de l'Adult Vall d'Hebron-Sant Pau, Department of Cardiology, Vall d'Hebron University Hospital and CIBERCV, Barcelona, Spain
| | - Antonia Pijuan-Domenech
- Unitat Integrada de Cardiopaties Congènites de l'Adolescent i de l'Adult Vall d'Hebron-Sant Pau, Department of Cardiology, Vall d'Hebron University Hospital and CIBERCV, Barcelona, Spain
| | - Joaquín Rueda
- Adult congenital heart disease unit, Department of Cardiology, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Maria-Jose Rodriguez-Puras
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital Universitario Virgen del Rocio, Instituto de BioMedicina de Sevilla (IBIS) and CIBERCV, Sevilla, Spain
| | - Rocio Garcia-Orta
- Adult Congenital Heart Disease Unit, , Hospitales Virgen de las Nieves y Clínico San Cecilio, Granada, Spain
| | - Efrén Martínez-Quintana
- Adult Congenital Heart Disease Unit, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Tomas Datino
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital General Universitario Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid and CIBERCV, Madrid, Spain
| | - Francisco Fernandez-Aviles
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital General Universitario Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid and CIBERCV, Madrid, Spain
| | - Javier Bermejo
- Adult Congenital Heart Disease Unit, Department of Cardiology, Hospital General Universitario Gregorio Marañon, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid and CIBERCV, Madrid, Spain
| | | |
Collapse
|
7
|
Segura Rodriguez D, Torres-Quintero L, Rodriguez-Torres DJ, Moreno-Escobar E, Garcia-Orta R. 46 Classic or new echocardiographic parameters in the evaluation of the right ventricular function after tricuspid valve surgery? Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Tricuspid valve regurgitation(TR) is frequent in patients undergoing to valvular heart disease surgery, particularly joined to mitral valve surgery. Classically, it was considered that left valve disease surgery would regress the TR without requiring any surgery on it, which has not been confirmed during follow-up. There is no consensus about which tricuspid lesions need to be operated neither which is the best surgical technique.
Purpose
In this study, we have evaluated the right ventricle(RV) function by advanced transthoracic echocardiography before to surgery and three months later.
Methods
Prospective cohort including 43 patients with valve surgical indication and some degree of tricuspid insufficiency. An advanced echocardiographic study was performed to determine the RV function measured by the following variables: basal diameter, Tricuspid Annular Plane Systolic Excursion(TAPSE), end-systolic RV area, fractional area change(FAC), systolic tricuspid valve lateral annular velocities by tissue Doppler(s’) and global longitudinal strain(GLS). Variables were tested to normality with Kolmogorov-Smirnoff test. Wilcoxon test was performed in order to compare measures previous and after surgery.
Results
43 patients were analysed. Mean age 64.7 ± 8.3 years, 31(72.1%) were female, 36 patients(83.7%) with functional TR which was associated to a left valvulopathy in 31(72.4%)cases. 17 patients(39.5%) had severe TR, 19 patients(44.2%) had moderate TR and 7 patients(16.3%) had mild TR. Twelve patients(27.9%) had isolated tricuspid surgery. The most frequent TR surgery was simple annuloplasty with 27 patients (62.8%). The classic RV echocardiographic parameters at initial evaluation and three months after surgery showed the following values respectively:Mean RV basal diameter was 48.3 ± 8.0mm vs. 41.7 ± 4.7 mm(p < 0.001), TAPSE was 19.0 ± 4.4mm vs. 15.7 ± 3.4mm (p < 0.001), peak systolic lateral annular velocity (s") was 0.12 ± 0.11cm/s vs. 0.11± 0.14cm/s(p = 0.001), FAC was 39.2 ± 13.2% vs. 38.2 ± 11.8%(p = Not significant), end-systolic RV area was 15.8 ± 10.2cm² vs. 14.4 ± 4.0cm²(p = Not significant). Nonetheless, there had not worsening in RV function based on myocardial deformation, with no significant differences between RV GLS(-20.0 ± 5.4% vs. -19.6 ± 4.9%; p = Not significant).
Conclusions
In our sample, 3 months post-surgery, the classic echocardiographic parameters based on the translational motion of the heart showed worsening of RV function. The parameters based on myocardial deformation do not show changes in RV function post-surgery, being better indicators of RV function in recently operated patients. These differences could be explain because tricuspid surgery is focus on the annulus that affects its motion while it does not affect to the global RV myocardial function evaluated by GLS.
Collapse
|
8
|
Gallego Garcia De Vinuesa P, Gonzalez Garcia AE, Avila P, Alonso A, Garcia Hamilton D, Peinado R, Dos Subira L, Pijuan-Domenech A, Rueda Soriano J, Rodriguez-Puras MJ, Garcia-Orta R, Martinez-Quintana E, Bermejo J, Fernandez-Aviles F, Oliver JM. 2397Lesion-specific risk for sudden cardiac death or life-threatening ventricular arrhythmias in adult congenital heart disease. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0150] [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
Risk models for primary prevention strategies in adult congenital heart disease (ACHD) must incorporate the heterogeneous risk for sudden cardiac death (SCD) and life-threatening ventricular arrhythmias (LTVA) as stratified by underlying lesion.
Objectives
To determine lesion-specific risk for SCD and LTVA in ACHD.
Methods
We analyzed 3311 ACHD patients (50% males) prospectively followed-up for 37510 person/years. SCD cases were confirmed by means of the Spanish National Death Registry. In addition, we identified all cases of resuscitated cardiac arrest or ventricular tachycardia requiring cardioversion. According to the incidence rate of the composite end-point of SCD and LTVA, lesions were stratified into four groups of risk. Cumulative freedom from SCD or LTVA in patients at high, moderate, low and very low risk were compared by using Cox regression model with left truncation. The c-index of this lesion-specific risk stratification was calculated by using the β-coefficients. The discriminative ability of this lesion-specific risk stratification was also tested in an external cohort of 203 SCD-LTVA cases and 2287 controls from 20 different centers.
Results
71 patients experienced an event (53 SCD, 18 LTVA). Patients at highest risk (incidence rate >1%) were those with Rastelli procedure, severe coronary abnormalities, complex Fallot and cyanotic patients, either Eisenmenger or non-Eisenmenger; at moderate risk (incidence rate 0.25–1.0%) non-complex Fallot, Mustard/Senning repair, Fontan procedures and congenitally corrected transposition; at low risk (incidence rate 0.1–0.25%) Ebstein anomaly and left heart lesions; and at very low risk (incidence rate <0.1%) left-to-right shunts and right ventricular outflow lesions. The discriminative ability in a multicenter external cohort was excellent (c-index ranged from 0.748 to 0.819 by center).
Lesion-specific risk and C-index
Conclusions
A lesion-specific risk stratification based on the incidence rate of SCD and LTVA was performed and validated. This approach could result in a more individualized risk assessment.
Acknowledgement/Funding
Instituto de Salud Carlos III, Ministerio de Economía y Competividad, Spain (Exp PI14/02099 and PI17/01327) and co-financed by FEDER
Collapse
Affiliation(s)
| | | | - P Avila
- University Hospital Gregorio Maranon, Cardiology, Madrid, Spain
| | - A Alonso
- University Hospital Gregorio Maranon, Cardiology, Madrid, Spain
| | | | - R Peinado
- University Hospital La Paz, ACHD Unit, Madrid, Spain
| | - L Dos Subira
- University Hospital Vall d'Hebron, Cardiology, Barcelona, Spain
| | | | - J Rueda Soriano
- University Hospital La Fe, Department of Cardiology, Valencia, Spain
| | - M J Rodriguez-Puras
- Heart Area. Hospital General Virgen Del Rocio, Intercentre ACHD Unit, Seville, Spain
| | - R Garcia-Orta
- University Hospital Virgen de las Nieves, Cardiology, Granada, Spain
| | - E Martinez-Quintana
- University Hospital Insular of Gran Canaria, Las Palmas De Gran Canaria, Spain
| | - J Bermejo
- University Hospital Gregorio Maranon, Cardiology, Madrid, Spain
| | | | - J M Oliver
- University Hospital Gregorio Maranon, Cardiology, Madrid, Spain
| |
Collapse
|