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von Stein P, Besler C, Riebisch M, Al‐Hammadi O, Ruf T, Gerçek M, Grothusen C, Mehr M, Becher MU, Friedrichs K, Öztürk C, Baldus S, Guthoff H, Rassaf T, Thiele H, Nickenig G, Hausleiter J, Möllmann H, Horn P, Kelm M, Rudolph V, von Bardeleben R, Nef HM, Luedike P, Lurz P, Pfister R, Mauri V. One-Year Outcomes According to Mitral Regurgitation Etiology Following Transcatheter Edge-to-Edge Repair With the PASCAL System: Results From a Multicenter Registry. J Am Heart Assoc 2023; 12:e031881. [PMID: 38084735 PMCID: PMC10863793 DOI: 10.1161/jaha.123.031881] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/18/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND We previously reported procedural and 30-day outcomes of a German early multicenter experience with the PASCAL system for severe mitral regurgitation (MR). This study reports 1-year outcomes of mitral valve transcatheter edge-to-edge repair with the PASCAL system according to MR etiology in a large all-comer cohort. METHODS AND RESULTS Clinical and echocardiographic outcomes up to 1-year were investigated according to MR etiology (degenerative [DMR], functional [FMR], or mixed [MMR]) in the first 282 patients with symptomatic MR 3+/4+ treated with the PASCAL implant at 9 centers in 2019. A total of 282 patients were included (33% DMR, 50% FMR, 17% MMR). At discharge, MR reduction to ≤1+/2+ was achieved in 58%/87% of DMR, in 75%/97% of FMR, and in 78%/98% of patients with MMR (P=0.004). MR reduction to ≤1+/2+ was sustained at 30 days (50%/83% DMR, 67%/97% FMR, 74%/100% MMR) and at 1 year (53%/78% DMR, 75%/97% FMR, 67%/91% MMR) with significant differences between etiologies. DMR patients with residual MR 3+/4+ at 1-year had at least complex valve morphology in 91.7%. Valve-related reintervention was performed in 7.4% DMR, 0.7% FMR, and 0.0% MMR (P=0.010). At 1-year, New York Heart Association Functional Class was significantly improved irrespective of MR etiology (P<0.001). CONCLUSIONS In this large all-comer cohort, mitral valve transcatheter edge-to-edge repair with the PASCAL system was associated with an acute and sustained MR reduction at 1-year in all causes. However, in patients with DMR, MR reduction was less pronounced, reflecting the high incidence of complex or very complex anatomies being referred for mitral valve transcatheter edge-to-edge repair.
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Affiliation(s)
- Philipp von Stein
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal MedicineCologneGermany
| | - Christian Besler
- Department of CardiologyHeart Center Leipzig at University of LeipzigGermany
| | - Matthias Riebisch
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular CenterUniversity Hospital Essen, Medical FacultyEssenGermany
| | - Osamah Al‐Hammadi
- Medizinische Klinik I, Department of CardiologyUniversity of GiessenGermany
| | - Tobias Ruf
- Heart Valve Center Mainz, Center of Cardiology, Cardiology IUniversity Medical Center MainzMainzGermany
| | - Muhammed Gerçek
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Centre NRW, Bad OeynhausenRuhr University BochumBochumGermany
| | - Christina Grothusen
- Medical Clinic I, Department of Cardiology, St.‐Johannes‐HospitalDortmundGermany
| | - Michael Mehr
- Medizinische Klinik und Poliklinik I der Ludwig‐Maximilians‐Universität MünchenMunichGermany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine IIUniversity Hospital BonnBonnGermany
| | - Kai Friedrichs
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Centre NRW, Bad OeynhausenRuhr University BochumBochumGermany
| | - Can Öztürk
- Heart Center Bonn, Department of Medicine IIUniversity Hospital BonnBonnGermany
| | - Stephan Baldus
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal MedicineCologneGermany
| | - Henning Guthoff
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal MedicineCologneGermany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular CenterUniversity Hospital Essen, Medical FacultyEssenGermany
| | - Holger Thiele
- Department of CardiologyHeart Center Leipzig at University of LeipzigGermany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine IIUniversity Hospital BonnBonnGermany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I der Ludwig‐Maximilians‐Universität MünchenMunichGermany
| | - Helge Möllmann
- Medical Clinic I, Department of Cardiology, St.‐Johannes‐HospitalDortmundGermany
| | - Patrick Horn
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical FacultyUniversity DüsseldorfDuesseldorfGermany
| | - Malte Kelm
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical FacultyUniversity DüsseldorfDuesseldorfGermany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Centre NRW, Bad OeynhausenRuhr University BochumBochumGermany
| | | | - Holger M. Nef
- Medizinische Klinik I, Department of CardiologyUniversity of GiessenGermany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular CenterUniversity Hospital Essen, Medical FacultyEssenGermany
| | - Philipp Lurz
- Department of CardiologyHeart Center Leipzig at University of LeipzigGermany
| | - Roman Pfister
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal MedicineCologneGermany
| | - Victor Mauri
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal MedicineCologneGermany
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Kavsur R, Schaefer C, Stumpf MJ, Weber M, Sugiura A, Becher MU, Zimmer S, Nickenig G, Schahab N. Carotid Stiffness After Transcatheter Aortic Valve Replacement. Angiology 2023:33197231195647. [PMID: 37571920 DOI: 10.1177/00033197231195647] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
The present study aimed to analyze common carotid artery strain properties in patients (n = 59) with severe aortic valve stenosis who underwent transcatheter aortic valve replacement (TAVR). Arterial compliance of the common carotid artery was assessed by ultrasound speckle-tracking before and after TAVR. For sub-analysis the study cohort was divided according to aortic valve area <.75 cm2 (n = 30) vs ≥.75 cm2 (n = 29). Comparison of pre- and post-procedural strain variables showed an improvement in median radial velocity (P < .0001), radial displacement (P = .007), circumferential strain (P = .004), radial strain rate (P = .023), and circumferential strain rate (P < .0001), while the increase of radial strain showed a trend (P = .082). Analysis of aortic valve area revealed an inverse correlation between aortic valve area and the differences (post-procedural-pre-procedural values) for radial strain rate, and circumferential strain. Moreover, sub-analysis revealed that the increase of carotid strain variables before and after TAVR were more pronounced in the sub-group of aortic valve area .75 vs ≥.75 cm2. TAVR led to a reduction of arterial wall stiffness of the common carotid artery assessed by ultrasound speckle-tracking. The decrease of arterial wall stiffness after TAVR was more pronounced in more severe aortic valve stenosis.
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Affiliation(s)
- Refik Kavsur
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Christian Schaefer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Max Jonathan Stumpf
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Nadjib Schahab
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
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Balata M, Gbreel MI, Elrashedy AA, Westenfeld R, Pfister R, Zimmer S, Nickenig G, Becher MU, Sugiura A. Clinical effects of cognitive behavioral therapy in heart failure patients: a meta-analysis of randomized controlled trials. BMC Complement Med Ther 2023; 23:280. [PMID: 37550665 PMCID: PMC10405476 DOI: 10.1186/s12906-023-04117-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 08/03/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND About 20-40% of people with Heart failure (HF) suffer from some depression, which is 4-5% greater than the overall population. This depression can lead to undesirable outcomes, including elevated mortality rate and frequent hospitalization. PURPOSE The current study aims to evaluate the impact of cognitive behavioural therapy (CBT) on self-care and the symptoms of depression and anxiety in HF patients. METHODS We searched PubMed, Web of Science (WOS), Scopus, and Cochrane Library till 15 October 2022. All relevant randomized controlled trials (RCTs) were included. The data were extracted and pooled using Review Manager software (RevMan 5.4). Continuous data were pooled as mean difference and 95% confidence interval (CI). RESULTS Our search retrieved 1146 records, and 7 studies (611 patients) were finally included. We assessed the Beck Depression Inventory-II (BDI-II) as the primary outcome of the study. Hamilton Rating Scale for Depression (HRSD-17), Change in Beck Anxiety Inventory, Kansas City Cardiomyopathy Questionnaire (KCCQ), and Self-Care of Heart Failure Index (SCHFI) were also assessed as secondary outcomes. With CBT, BDI-II showed a significant reduction after 4 to 6 months follow-up (MD = -4.87, 95% CI: [-8.06; -1.69], P = 0.003) as well as 8 to 9 months follow-up (MD = -5.71, 95% CI: [-8.95; -2.46], P = 0.0006). But no significant difference was shown with 3 months follow-up (M.D=-4.34; 95%CI: [-10.70; 2.03], P = 0.18). CONCLUSIONS CBT has long-term (4-9 months) significant favorable outcomes decreasing anxiety and depression compared to non-CBT groups. No significant short-term (less than 3 months) impact on HF patients' self-care, depression, or anxiety were shown.
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Affiliation(s)
- Mahmoud Balata
- Department of Internal Medicine and Polyclinic II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | | | | | - Ralf Westenfeld
- Department of Internal Medicine and Cardiology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Roman Pfister
- Department of Internal Medicine and Cardiology, University Hospital Cologne, Cologne, Germany
| | - Sebastian Zimmer
- Department of Internal Medicine and Polyclinic II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine and Polyclinic II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Marc Ulrich Becher
- Department of Internal Medicine and Polyclinic II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Atsushi Sugiura
- Department of Internal Medicine and Polyclinic II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Vogelhuber J, Tanaka T, Sugiura A, Galka N, Hupp-Herschel HE, Becher MU, Zimmer S, Nickenig G, Kavsur R, Weber M. Association of TRI-SCORE With Clinical Outcomes After Transcatheter Tricuspid Valve Repair. JACC Cardiovasc Interv 2023:S1936-8798(23)00694-5. [PMID: 37294224 DOI: 10.1016/j.jcin.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/04/2023] [Indexed: 06/10/2023]
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Kozlov A, Becher MU, Schlecker S. [Hypertriglyceridemic pancreatitis and cardiac tamponade in a 26-year-old woman]. Inn Med (Heidelb) 2023; 64:88-92. [PMID: 36418500 DOI: 10.1007/s00108-022-01434-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/25/2022]
Abstract
A 26-year-old woman with type 2 diabetes mellitus and discontinued intensive conventional insulin therapy was admitted to the authors' hospital with acute upper abdominal pain. Severe hypertriglyceridemia and acute pancreatitis were diagnosed. Treatment included insulin administration and plasmapheresis. On day 3, the patient developed sudden haemodynamic instability and in-hospital cardiopulmonary arrest. Focused echocardiography showed pericardial effusion with right ventricular collapse. Pericardiocentesis was performed, leading to a return of spontaneous circulation.
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Affiliation(s)
- A Kozlov
- Zentrum für Innere Medizin, Medizinische Klinik II für Kardiologie, Rhythmologie, Pneumologie und Internistische Intensivmedizin, Städtisches Klinikum Solingen, Gotenstr. 1, 42653, Solingen, Deutschland.
| | - M U Becher
- Zentrum für Innere Medizin, Medizinische Klinik II für Kardiologie, Rhythmologie, Pneumologie und Internistische Intensivmedizin, Städtisches Klinikum Solingen, Gotenstr. 1, 42653, Solingen, Deutschland
| | - S Schlecker
- Zentrum für Innere Medizin, Medizinische Klinik II für Kardiologie, Rhythmologie, Pneumologie und Internistische Intensivmedizin, Städtisches Klinikum Solingen, Gotenstr. 1, 42653, Solingen, Deutschland
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Mauri V, Sugiura A, Spieker M, Iliadis C, Horn P, Öztürk C, Besler C, Riebisch M, Al-Hammadi O, Ruf T, Gerçek M, Grothusen C, Mehr M, Becher MU, Mues C, Boeder N, Kreidel F, Friedrichs K, Westenfeld R, Braun D, Baldus S, Rassaf T, Thiele H, Nickenig G, Hausleiter J, Möllmann H, Kelm M, Rudolph V, von Bardeleben RS, Nef HM, Luedike P, Lurz P, Pfister R. Early Outcomes of 2 Mitral Valve Transcatheter Leaflet Approximation Devices: A Propensity Score-Matched Multicenter Comparison. JACC Cardiovasc Interv 2022; 15:2541-2551. [PMID: 36543448 DOI: 10.1016/j.jcin.2022.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/12/2022] [Accepted: 10/04/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND In addition to the edge-to-edge MitraClip repair system, the edge-to-spacer PASCAL repair system was approved for percutaneous treatment of severe mitral regurgitation (MR). Comparative data are lacking. OBJECTIVES The aim of this study was to compare procedural and short-term safety and efficacy of 2 leaflet-based transcatheter mitral valve repair systems. METHODS Procedural and 30-day outcomes were investigated in a propensity score-matched cohort of 307 PASCAL and 307 MitraClip patients at 10 sites. Matching criteria included sex, age, left ventricular ejection fraction, New York Heart Association functional class, MR etiology, left ventricular end-diastolic diameter, left atrial volume index, and vena contracta width. The primary efficacy endpoints were technical success and degree of residual MR at discharge. The primary safety endpoint was the rate of major adverse events (MAE). RESULTS Technical success was 97.0% in the PASCAL group and 98.0% in the MitraClip group (P = 0.624). MR ≤2+ at discharge was comparable in both groups (PASCAL: 93.8% vs MitraClip: 92.4%; P = 0.527), with more patients exhibiting MR ≤1+ in the PASCAL group (70.5% vs 56.6%; P < 0.001). The postprocedural mean gradient was significantly higher in the MitraClip group (3.3 ± 1.5 mm Hg vs 3.9 ± 1.7 mm Hg; P < 0.001). At 30 days, all-cause mortality and MAE rates were similar (mortality: 1.7% vs 3.3%; P = 0.299; MAE: 3.9% vs 5.2%; P = 0.562). CONCLUSIONS In this first large propensity score-matched comparison, procedural success rates and MAE did not differ significantly between patients treated with the PASCAL or MitraClip valve repair system. Procedural results with less than moderate MR and no elevated transmitral gradient were more common in the PASCAL group, which might have an impact on long-term outcome.
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Affiliation(s)
- Victor Mauri
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Max Spieker
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Christos Iliadis
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Patrick Horn
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Can Öztürk
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Christian Besler
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Matthias Riebisch
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Essen, Germany
| | - Osamah Al-Hammadi
- Medizinische Klinik I, Department of Cardiology, University of Giessen, Giessen, Germany
| | - Tobias Ruf
- Heart Valve Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Muhammed Gerçek
- General and Interventional Cardiology, Heart and Diabetes Centre NRW Bad Oeynhausen, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Christina Grothusen
- Medical Clinic I, Department of Cardiology, St-Johannes-Hospital, Dortmund, Germany; Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Michael Mehr
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Christoph Mues
- Medical Clinic I, Department of Cardiology, St-Johannes-Hospital, Dortmund, Germany
| | - Niklas Boeder
- Medizinische Klinik I, Department of Cardiology, University of Giessen, Giessen, Germany
| | - Felix Kreidel
- Heart Valve Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Kai Friedrichs
- General and Interventional Cardiology, Heart and Diabetes Centre NRW Bad Oeynhausen, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Essen, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Helge Möllmann
- Medical Clinic I, Department of Cardiology, St-Johannes-Hospital, Dortmund, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Volker Rudolph
- General and Interventional Cardiology, Heart and Diabetes Centre NRW Bad Oeynhausen, Ruhr University Bochum, Bad Oeynhausen, Germany
| | | | - Holger M Nef
- Medizinische Klinik I, Department of Cardiology, University of Giessen, Giessen, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, Essen, Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Roman Pfister
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Cologne, Germany.
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Sugiura A, Kavsur R, Spieker M, Iliadis C, Mauri V, Tanaka T, Goto T, Weber M, Kelm M, Baldus S, Nickenig G, Westenfeld R, Pfister R, Becher MU. Impact of right ventricular-pulmonary arterial coupling on clinical outcomes of tricuspid regurgitation. EUROINTERVENTION 2022; 18:852-861. [PMID: 35550286 PMCID: PMC9724878 DOI: 10.4244/eij-d-22-00045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/25/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND In terms of pathophysiology, tricuspid regurgitation (TR) and right ventricular (RV) function are linked to each other. AIMS This study sought to evaluate RV-pulmonary artery (PA) coupling and its impact on clinical outcomes of TR in patients undergoing mitral transcatheter edge-to-edge repair (TEER). METHODS We calculated RV-PA coupling ratios in patients undergoing mitral TEER from August 2010 to March 2019 by dividing the tricuspid annular plane systolic excursion (TAPSE) by the echocardiographic estimated PA systolic pressure (PASP). TR was graded as none/trace, mild, moderate, or severe. The primary outcome was all-cause mortality or rehospitalisation within 12 months. RESULTS Among 744 patients analysed, severe TR was documented in 22.3% of patients and the mean TAPSE/PASP was 0.43±0.25. Technical success of TEER was achieved in 97.2% of participants. Severe TR vs TR ≤moderate (adjusted HR 1.92, 95% CI: 1.39-2.66) and TAPSE/PASP (adjusted HR 0.45, 95% CI: 0.22-0.93) were associated with the outcome. Patients were divided according to the TAPSE/PASP tertile. Compared to patients with TR ≤moderate, patients with severe TR had a higher event rate (TAPSE/PASP <0.30: 32.9% vs 45.1%; 0.30≤ TAPSE/PASP <0.44: 27.8% vs 41.8%; TAPSE/PASP ≥0.44: 16.0% vs 40.4%), whereas the prognostic significance of TR was attenuated in patients with reduced TAPSE/PASP (i.e., RV-PA uncoupling; interaction term p=0.03). The trends were consistent in the multivariable regression models, spline curves, and sensitivity analysis using post-interventional parameters. CONCLUSIONS RV-PA coupling affects the outcome correlation of TR in patients undergoing mitral TEER. The prognostic impact of TR is attenuated in patients with RV-PA uncoupling.
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Affiliation(s)
- Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Refik Kavsur
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Maximilian Spieker
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christos Iliadis
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Victor Mauri
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Tetsu Tanaka
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Marcel Weber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Malte Kelm
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Stephan Baldus
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Ralf Westenfeld
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Roman Pfister
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
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Tanaka T, Kavsur R, Sugiura A, Galka N, Oeztuerk C, Vogelhuber J, Becher MU, Weber M, Zimmer S, Nickenig G, Zachoval C. Prognostic impact of acute kidney injury following tricuspid transcatheter edge-to-edge repair. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
A considerable risk of acute kidney injury (AKI) following transcatheter interventions without iodinated contrast agents has also been recognized; however, little is known about the incidence and clinical relevance of post-procedural AKI in patients undergoing transcatheter edge-to-edge repair (TEER) for tricuspid regurgitation (TR).
Purpose
This study aimed to investigate the prognostic impact and predictors of post-procedural AKI following TEER for TR.
Methods
We retrospectively analyzed 218 consecutive patients who underwent TEER for TR. Post-procedural AKI was defined as an increase in serum creatinine of ≥0.3 mg/dl within 48 hours or of ≥50% within seven days after the procedure, compared to baseline. Procedural success was defined as at least one grade reduction in TR severity upon discharge. We determined the association between post-procedural AKI and the composite outcome consisting of all-cause mortality and re-hospitalization due to heart failure within one year after the procedure.
Results
Overall, the mean age of the patients was 79±7 years, and 46.3% of the patients were male. Post-procedural AKI occurred in 32 patients (14.7%) (Figure 1). Among baseline characteristics, male sex and an estimated glomerular filtration rate of <60 ml/min/m2 were associated with the occurrence of AKI. In addition, patients without procedural success had a higher incidence of post-procedural AKI (30.4% vs. 1.8%; p=0.024).
Patients with AKI had a higher incidence of in-hospital mortality compared to those without AKI (12.5% vs. 1.1%; p=0.005). Moreover, AKI was associated with the incidence of the composite outcome within one year after TEER for TR (adjusted hazard ratio: 2.06; 95% confidence interval: 1.11–3.84; p=0.023). In addition, our restricted cubic spline curve showed that a post-procedural increase in the creatinine level within seven days after the procedure was associated with a linear trend of the risk of the composite outcome after TEER (Figure 2).
Conclusions
Post-procedural AKI occurred in 14.7% of patients undergoing TEER for TR, despite the absence of iodinated contrast agents, which was associated with worse clinical outcomes. Male sex and CKD at baseline were related to the occurrence of AKI, and the procedural success of TEER was associated with a lower incidence of AKI. Our findings highlight the clinical impact of AKI following TEER for TR and should help with identifying patients at high risk of AKI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Tanaka
- University hospital Bonn , Bonn , Germany
| | - R Kavsur
- University hospital Bonn , Bonn , Germany
| | - A Sugiura
- University hospital Bonn , Bonn , Germany
| | - N Galka
- University hospital Bonn , Bonn , Germany
| | - C Oeztuerk
- University hospital Bonn , Bonn , Germany
| | | | - M U Becher
- University hospital Bonn , Bonn , Germany
| | - M Weber
- University hospital Bonn , Bonn , Germany
| | - S Zimmer
- University hospital Bonn , Bonn , Germany
| | - G Nickenig
- University hospital Bonn , Bonn , Germany
| | - C Zachoval
- University hospital Bonn , Bonn , Germany
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Iliadis C, Kavsur R, Spieker M, Zachoval C, Becher MU, Westenfeld R, Pfister R. Therapie der sekundären Mitralklappeninsuffizienz – Strategien eines interuniversitären Verbundes. Aktuelle Kardiologie 2022. [DOI: 10.1055/a-1912-4962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ZusammenfassungDie sekundäre Mitralinsuffizienz ist bei Patienten mit Herzinsuffizienz häufig und mit einem schlechten Verlauf assoziiert. Aufgrund des hohen OP-Risikos war die Therapie traditionell auf
eine Behandlung der Herzinsuffizienz beschränkt. Die Entwicklung von kathetergestützten Techniken ermöglicht nun die Behandlung mit geringem Risiko. Wenngleich die Studienevidenz immer noch
begrenzt ist, erfolgte in den aktuellen Leitlinien der europäischen Fachgesellschaften eine Aufwertung der kathetergestützten Therapie für ausgewählte Patienten mit hohem OP-Risiko und hoher
Wahrscheinlichkeit für ein Therapieansprechen. Dennoch bleiben viele Fragen offen, was die Rolle der chirurgischen Behandlung und auch die Patientenselektion für kathetergestützte
Therapieverfahren angeht. Hier beschreiben wir den aktuellen Stand der Behandlung der sekundären Mitralinsuffizienz und zeigen Strategien von transuniversitären Verbundprojekten mit dem
Ziel, Evidenz für die Behandlung dieser Patienten zu entwickeln.
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Affiliation(s)
- Christos Iliadis
- Klinik für Kardiologie, Angiologie, Pneumologie und internistische Intensivmedizin, Universitätsklinik Köln, Köln, Deutschland
| | - Refik Kavsur
- Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Universitätsklinik Bonn, Bonn, Deutschland
| | - Maximilian Spieker
- Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Christian Zachoval
- Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Universitätsklinik Bonn, Bonn, Deutschland
| | - Marc Ulrich Becher
- Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Universitätsklinik Bonn, Bonn, Deutschland
| | - Ralf Westenfeld
- Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Roman Pfister
- Klinik für Kardiologie, Angiologie, Pneumologie und internistische Intensivmedizin, Universitätsklinik Köln, Köln, Deutschland
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10
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Haurand JM, Kavsur R, Ochs L, Tanaka T, Iliadis C, Sugiura A, Kelm M, Nickenig G, Baldus S, Westenfeld R, Becher MU, Pfister R, Horn P. Deep sedation vs. general anesthesia for transcatheter tricuspid valve repair. Front Cardiovasc Med 2022; 9:976822. [PMID: 36119730 PMCID: PMC9471949 DOI: 10.3389/fcvm.2022.976822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/10/2022] [Indexed: 12/01/2022] Open
Abstract
Background Transcatheter tricuspid valve repair (TTVr) is routinely performed under general anesthesia (GA). This study aimed to investigate whether TTVr procedures can be performed effectively and safely without GA but using deep sedation (DS). Methods We performed a retrospective analysis of 104 patients from three centers who underwent TTVr between 2020 and 2021. The primary performance endpoints were technical success and severity of TR assessed at the time of discharge. The safety outcome was a composite of in-hospital complications, including occurrence of death, conversion to surgery, major adverse cardiac and cerebrovascular events, major vascular complications, or occurrence of pneumonia. Results Sixty-four procedures were performed in GA and 40 procedures were performed in DS. The groups did not differ in age, EuroScore II, TR severity, ventricular function, or hemodynamic parameters. Technical success was achieved in 92.5% of the patients in the DS group and in 93.6% of the patients in the GA group (p = 0.805). In none of the patients intraprocedural conversion from DS to GA was required. There was no difference in total duration of the procedure, and number of devices implanted. The degree of TR was ≤2+ in 77.5% of the patients in the DS group and in 74.2% of the patients in the GA group (p = 0.705). The composite safety endpoint did not differ between the groups (2.5 vs. 6.3%, p = 0.384). The total duration of hospital stay was shorter in patients who underwent TTVr in DS compared to those who underwent TTVr in GA (6 [5, 9] days vs. 8 [6, 11] days; p = 0.011). Conclusion Performing TTVr in DS was effective with similar procedural results, and was safe with similar low complication rates compared to GA.
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Affiliation(s)
- Jean Marc Haurand
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Refik Kavsur
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Laurin Ochs
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, Heart Center of the University of Cologne, Cologne, Germany
| | - Tetsu Tanaka
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Christos Iliadis
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, Heart Center of the University of Cologne, Cologne, Germany
| | - Atsushi Sugiura
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Georg Nickenig
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Stephan Baldus
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, Heart Center of the University of Cologne, Cologne, Germany
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
| | - Marc Ulrich Becher
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Roman Pfister
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, Heart Center of the University of Cologne, Cologne, Germany
| | - Patrick Horn
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Düsseldorf, Düsseldorf, Germany
- *Correspondence: Patrick Horn,
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11
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Tanaka T, Kavsur R, Sugiura A, Haurand JM, Galka N, Öztürk C, Vogelhuber J, Becher MU, Weber M, Westenfeld R, Zimmer S, Kelm M, Nickenig G, Horn P, Zachoval C. Acute Kidney Injury Following Tricuspid Transcatheter Edge-to-Edge Repair. JACC Cardiovasc Interv 2022; 15:1936-1945. [PMID: 36008268 DOI: 10.1016/j.jcin.2022.07.018] [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: 03/03/2022] [Revised: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Little is known about the incidence and clinical relevance of postprocedural acute kidney injury (AKI) in patients undergoing transcatheter edge-to-edge repair (TEER) for tricuspid regurgitation (TR). OBJECTIVES The aim of this study was to investigate the prognostic impact of postprocedural AKI following TEER for TR. METHODS Two hundred sixty-eight patients who underwent TEER for TR at 2 centers were retrospectively analyzed. Postprocedural AKI was defined as an increase in serum creatinine of ≥0.3 mg/dL within 48 hours or ≥50% within 7 days after the procedure compared with baseline. The association between AKI and the composite outcome, consisting of all-cause mortality and rehospitalization for heart failure within 1 year after the procedure, was determined. RESULTS The mean age of the patients was 79.0 ± 6.8 years, and 43.3% were men. Postprocedural AKI occurred in 42 patients (15.7%). Age, male sex, an estimated glomerular filtration rate of <60 mL/min/1.73 m2, and absence of procedural success were associated with the occurrence of AKI. Patients with AKI had a higher incidence of in-hospital mortality than those without AKI (9.5% vs 0.9%; P = 0.006). Moreover, AKI was associated with the incidence of the composite outcome within 1 year after TEER for TR (adjusted HR: 2.39; 95% CI: 1.45-3.94; P = 0.001). CONCLUSIONS Postprocedural AKI occurred in 15.7% of patients undergoing TEER for TR, despite the absence of iodinated contrast agents, which was associated with worse clinical outcomes. These findings highlight the clinical impact of AKI following TEER for TR and should help in identifying patients at high risk for AKI.
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Affiliation(s)
- Tetsu Tanaka
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Refik Kavsur
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Jean Marc Haurand
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty of the Heinrich Heine University, Düsseldorf, Germany
| | - Natalia Galka
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Can Öztürk
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Johanna Vogelhuber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty of the Heinrich Heine University, Düsseldorf, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty of the Heinrich Heine University, Düsseldorf, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany
| | - Patrick Horn
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty of the Heinrich Heine University, Düsseldorf, Germany
| | - Christian Zachoval
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Bonn, Germany.
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12
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Goody PR, Zimmer S, Öztürk C, Zimmer A, Kreuz J, Becher MU, Isaak A, Luetkens J, Sugiura A, Jansen F, Nickenig G, Hammerstingl C, Tiyerili V. 3D-speckle-tracking echocardiography correlates with cardiovascular magnetic resonance imaging diagnosis of acute myocarditis – An observational study. IJC Heart & Vasculature 2022; 41:101081. [PMID: 35855974 PMCID: PMC9287637 DOI: 10.1016/j.ijcha.2022.101081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 01/09/2023]
Abstract
Regional changes in myocardial texture (as diagnosed by CMR) were significantly associated with regional impairment of circumferential, longitudinal, and radial strain, as well as regional 3D displacement and total 3D strain. 3D and 2D global longitudinal strain (GLS) showed higher diagnostic performance than well-known parameters associated with myocarditis, such as LVEF and LVEDV in our patient collective. 3D-speckle-tracking echocardiography offers a promising diagnostic tool in the diagnosis of myocarditis.
Background The diagnostic importance of three-dimensional (3D) speckle-tracking strain-imaging echocardiography in patients with acute myocarditis remains unclear. The aim of this study was to test the diagnostic performance of 3D-speckle-tracking echocardiography compared to CMR (cardiovascular magnetic resonance imaging) for the diagnosis of acute myocarditis. Methods and results 45 patients with clinically suspected myocarditis were enrolled in our study (29% female, mean age: 43.9 ± 16.3 years, peak troponin I level: 1.38 ± 3.51 ng/ml). 3D full-volume echocardiographic images were obtained and offline 2D as well as 3D speckle-tracking analysis of regional and global LV deformation was performed. All patients received CMR scans and myocarditis was diagnosed in 29 subjects based on original Lake-Louise criteria. The 16 patients, in whom myocarditis was excluded by CMR, served as controls. Regional changes in myocardial texture (diagnosed by CMR) were significantly associated with regional impairment of circumferential, longitudinal, and radial strain, as well as regional 3D displacement and total 3D strain. Interestingly, the 2D and 3D global longitudinal strain (GLS) showed higher diagnostic performance than well-known parameters associated with myocarditis, such as LVEF (as obtained by echocardiography and CMR) and LVEDV (as obtained by CMR). Conclusions In this study, we examined the use of 3D-speckle-tracking echocardiography in patients with acute myocarditis. Global longitudinal strain was significantly impaired in patients with acute myocarditis and correlated with CMR findings. Therefore, 3D echocardiography could become a useful diagnostic tool in the primary diagnosis of myocarditis.
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Affiliation(s)
- Philip Roger Goody
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Can Öztürk
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Angela Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Jens Kreuz
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alexander Isaak
- Department of Radiology, University Hospital Bonn, Venusberg-Campus 1, 53125 Bonn, Germany
| | - Julian Luetkens
- Department of Radiology, University Hospital Bonn, Venusberg-Campus 1, 53125 Bonn, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Felix Jansen
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Christoph Hammerstingl
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Vedat Tiyerili
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- Department of Internal Medicine I, St.-Johannes-Hospital Dortmund, Dortmund, Germany
- Corresponding author at: Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Venusberg-Campus 1, 53125 Bonn, Germany.
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13
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Tanaka T, Kavsur R, Spieker M, Iliadis C, Metze C, Brachtendorf BM, Horn P, Zachoval C, Sugiura A, Kelm M, Baldus S, Nickenig G, Westenfeld R, Pfister R, Becher MU. Guideline-directed medical therapy after transcatheter edge-to-edge mitral valve repair. Heart 2022; 108:1722-1728. [DOI: 10.1136/heartjnl-2022-320826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/27/2022] [Indexed: 11/04/2022]
Abstract
ObjectiveA sizeable proportion of patients with secondary mitral regurgitation (SMR) do not receive guideline-directed medical therapy (GDMT) for heart failure (HF). We investigated the association between the use of GDMT and mortality in patients with SMR who underwent transcatheter edge-to-edge repair (TEER).MethodsWe retrospectively analysed patients with SMR and a left ventricular ejection fraction of <50% who underwent TEER at three centres. According to current HF guidelines, GDMT was defined as triple therapy consisting of beta-blockers, renin–angiotensin system (RAS) inhibitors and mineralocorticoid receptor antagonists (MRAs). Patients were divided into two groups: GDMT and non-GDMT groups. We calculated the propensity scores and carried out inverse probability of treatment weighting (IPTW) analyses to compare 2-year mortality between the two groups.ResultsOf 463 patients, 228 (49.2%) were treated with GDMT upon discharge. IPTW-adjusted Kaplan-Meier curve showed patients with GDMT had a lower incidence of mortality than those without GDMT (19.8% vs 31.1%, p=0.011). In IPTW-adjusted Cox proportional hazards analysis, GDMT was associated with a reduced risk of 2-year mortality (HR: 0.58; 95% CI: 0.35 to 0.95; p=0.030), which was consistent among clinical subgroups. Moreover, patients with GDMT had a higher rate of left ventricular reverse remodelling at 1 year after TEER than those without GDMT.ConclusionGDMT, defined as triple therapy consisting of beta-blockers, RAS inhibitors and MRAs, was associated with a reduced risk of 2-year mortality after TEER for SMR. Optimisation of medical therapy is crucial to improve clinical outcomes in patients undergoing TEER for SMR.
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14
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Tanaka T, Sugiura A, Kavsur R, Vogelhuber J, Öztürk C, Becher MU, Zimmer S, Nickenig G, Weber M. Leaflet-to-annulus index and residual tricuspid regurgitation following tricuspid transcatheter edge-to-edge repair. EUROINTERVENTION 2022; 18:e169-e178. [PMID: 35193837 PMCID: PMC9904375 DOI: 10.4244/eij-d-21-00862] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND A mismatch between tricuspid leaflet size and annular dilation is one of the morphological features tied to the development of tricuspid regurgitation (TR). AIMS We assessed the association of the leaflet-to-annulus index (LAI) with residual TR after transcatheter edge-to-edge repair (TEER). METHODS Consecutive patients who underwent TEER for TR were enrolled. Significant residual TR was defined as a post-procedural TR ≥3+, and patients were divided into two groups according to the amount of residual TR. The LAI was retrospectively calculated using procedural transoesophageal echocardiography and was defined as follows: (anterior leaflet length+septal leaflet length)/septolateral tricuspid annulus diameter. RESULTS Of 140 patients, 43 patients had residual TR ≥3+ after TEER. The patients with residual TR ≥3+ had a lower LAI compared to those with residual TR <3+ (1.04±0.10 vs 1.13±0.09; p=0.001). In multivariable analysis, the LAI was associated with residual TR ≥3+ (odds ratio [OR] [per 0.1 increase]: 0.57; 95% confidence interval [95% CI]: 0.35-0.94; p=0.02), independent of baseline TR severity or coaptation gap size. Patients with residual TR ≥3+ had a higher incidence of the composite outcome, consisting of all-cause mortality and heart failure hospitalisation within one year after TEER (47.1% vs 26.6%, p=0.02). Residual TR ≥3+ was an independent predictor of the composite outcome within one year (hazard ratio: 2.04; 95% CI: 1.01-4.11; p=0.04). CONCLUSIONS The leaflet-to-annulus mismatch (i.e., LAI) is associated with residual TR ≥3+ after TEER for TR. A detailed echocardiographic analysis of the tricuspid valve will be conducive to identifing suitable subjects for TEER.
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Affiliation(s)
- Tetsu Tanaka
- Medzinische Klinik und Poliklinik Ⅱ, Universitätsklinikum Bonn, Bonn, Germany
| | - Atsushi Sugiura
- Herzzentrum Bonn, Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Refik Kavsur
- Medzinische Klinik und Poliklinik Ⅱ, Universitätsklinikum Bonn, Bonn, Germany
| | - Johanna Vogelhuber
- Medzinische Klinik und Poliklinik Ⅱ, Universitätsklinikum Bonn, Bonn, Germany
| | - Can Öztürk
- Medzinische Klinik und Poliklinik Ⅱ, Universitätsklinikum Bonn, Bonn, Germany
| | - Marc Ulrich Becher
- Medzinische Klinik und Poliklinik Ⅱ, Universitätsklinikum Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Medzinische Klinik und Poliklinik Ⅱ, Universitätsklinikum Bonn, Bonn, Germany
| | - Georg Nickenig
- Medzinische Klinik und Poliklinik Ⅱ, Universitätsklinikum Bonn, Bonn, Germany
| | - Marcel Weber
- Medzinische Klinik und Poliklinik Ⅱ, Universitätsklinikum Bonn, Bonn, Germany
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15
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Shamekhi J, Sugiura A, Spieker M, Iliadis C, Weber M, Öztürk C, Becher MU, Tiyerili V, Zimmer S, Horn P, Westenfeld R, Pfister R, Mauri V, Sinning JM, Kelm M, Baldus S, Nickenig G. A staging classification of right heart remodelling for patients undergoing transcatheter edge-to-edge mitral valve repair. EUROINTERVENTION 2022; 18:43-49. [PMID: 34757918 PMCID: PMC9904371 DOI: 10.4244/eij-d-21-00667] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In patients with severe mitral regurgitation (MR) who are scheduled for transcatheter mitral valve repair (TMVR), risk stratification is predominantly based on surgical risk scores. AIMS We sought to characterise and define stages of right heart remodelling in patients undergoing TMVR and evaluate the impact of this staging classification on survival. METHODS According to echocardiographic parameters, 929 patients undergoing MitraClip treatment were classified into three stages: severe MR without right heart damage (stage 0), with moderate-to-severe tricuspid regurgitation (TR) (stage 1), with right ventricular dysfunction defined as a reduced fractional area change <35% and a tricuspid annular plane systolic excursion <17 mm, or with increased right atrial area >25 cm2 and/or indexed right ventricular volume >30 ml/m2 (stage 2). We compared clinical outcomes and performed a multivariate analysis to evaluate the predictive value of the extent of cardiac damage. RESULTS Rates of one-year all-cause mortality increased with more advanced stages of right heart remodelling (stage 0: 8% vs stage 1: 9.7% vs stage 2: 18.1%; p<0.001). In the multivariate analysis, advanced cardiac damage was an independent predictor of one-year all-cause mortality (stage 2: p=0.007). CONCLUSIONS A simple staging classification objectively characterises the extent of right heart remodelling caused by MR and allows risk prediction in patients undergoing a MitraClip procedure.
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Affiliation(s)
- Jasmin Shamekhi
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Atsushi Sugiura
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Maximilian Spieker
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christos Iliadis
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Marcel Weber
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Can Öztürk
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marc Ulrich Becher
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Vedat Tiyerili
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Patrick Horn
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Ralf Westenfeld
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Roman Pfister
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Victor Mauri
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Jan-Malte Sinning
- Department of Cardiology, St. Vinzenz-Hospital Cologne, Cologne, Germany
| | - Malte Kelm
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Stephan Baldus
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Georg Nickenig
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
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16
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Sugiura A, Kavsur R, Spieker M, Iliadis C, Goto T, Öztürk C, Weber M, Tabata N, Zimmer S, Sinning JM, Mauri V, Horn P, Kelm M, Baldus S, Nickenig G, Westenfeld R, Pfister R, Becher MU. Recurrent Mitral Regurgitation After MitraClip: Predictive Factors, Morphology, and Clinical Implication. Circ Cardiovasc Interv 2022; 15:e010895. [PMID: 35193380 DOI: 10.1161/circinterventions.121.010895] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recurrent mitral regurgitation (MR) following MitraClip has not been thoroughly investigated. We aimed to examine the predictive factors, morphology, and long-term outcome of recurrent MR after MitraClip. METHODS We assessed data from the Heart Failure Network Rhineland registry from August 2010 to October 2018. Competing risk analyses were performed using the Fine and Gray model to assess the risk of recurrent MR. RESULTS Among 685 MitraClip patients with a reduction in MR to ≤2+, 61 patients developed recurrent MR within the first 12 months. Flail leaflet (hazard ratio, 3.68; P=0.002) and residual MR (MR grade 2+ versus ≤1+: hazard ratio, 2.56; P=0.03) were the predictors of recurrent MR in primary MR patients, while left atrial volume (per 10 mL increase: hazard ratio, 1.11; P<0.001) and residual MR (hazard ratio, 2.45; P=0.01) were independently associated with recurrent MR in secondary MR patients. In primary MR patients, loss of leaflet insertion or leaflet tear were the predominant morphologies with recurrent MR. In secondary MR patients, more than half of the patients with recurrent MR did not show any disorder of the clip or leaflets. Patients with recurrent MR were more likely to experience unplanned heart failure hospitalization or heart failure symptom with New York Heart Association scale III/IV (54.1% versus 37.8%; P=0.018) and undergo a repeat mitral valve intervention (9.8% versus 2.2%; P=0.005) during the follow-up. In the landmark survival analysis, patients with recurrent MR tended to have lower long-term survival (58.7% versus 83.9%; P=0.08) than patients without recurrent MR. CONCLUSIONS Flail leaflet and residual MR were the predictors of recurrent MR in primary MR patients, while a larger left atrial volume and residual MR were associated with recurrent MR in secondary MR patients, which may be associated with long-term clinical outcomes of patients after MitraClip.
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Affiliation(s)
- Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.S., R.K., C.O., M.W., S.Z., G.N., M.U.B.)
| | - Refik Kavsur
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.S., R.K., C.O., M.W., S.Z., G.N., M.U.B.)
| | - Maximilian Spieker
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Germany (M.S., P.H., M.K., R.W.)
| | - Christos Iliadis
- Heart Center, Department of Cardiology, University Hospital Cologne, Germany (C.I., V.M., S.B., R.P.)
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Japan (T.G.)
| | - Can Öztürk
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.S., R.K., C.O., M.W., S.Z., G.N., M.U.B.)
| | - Marcel Weber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.S., R.K., C.O., M.W., S.Z., G.N., M.U.B.)
| | - Noriaki Tabata
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Japan (N.T.)
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.S., R.K., C.O., M.W., S.Z., G.N., M.U.B.)
| | - Jan-Malte Sinning
- Department of Cardiology, St Vinzenz-Hospital Cologne, Germany (J.-M.S.)
| | - Victor Mauri
- Heart Center, Department of Cardiology, University Hospital Cologne, Germany (C.I., V.M., S.B., R.P.)
| | - Patrick Horn
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Germany (M.S., P.H., M.K., R.W.)
| | - Malte Kelm
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Germany (M.S., P.H., M.K., R.W.)
| | - Stephan Baldus
- Heart Center, Department of Cardiology, University Hospital Cologne, Germany (C.I., V.M., S.B., R.P.)
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.S., R.K., C.O., M.W., S.Z., G.N., M.U.B.)
| | - Ralf Westenfeld
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Germany (M.S., P.H., M.K., R.W.)
| | - Roman Pfister
- Heart Center, Department of Cardiology, University Hospital Cologne, Germany (C.I., V.M., S.B., R.P.)
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.S., R.K., C.O., M.W., S.Z., G.N., M.U.B.)
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Aksoy A, Tiyerili V, Jansen N, Al Zaidi M, Thiessen M, Sedaghat A, Ulrich Becher M, Jansen F, Nickenig G, Zimmer S. Propensity-score-matched comparison of safety, efficacy, and outcome of intravascular lithotripsy versus high-pressure PTCA in coronary calcified lesions. Int J Cardiol Heart Vasc 2021; 37:100900. [PMID: 34950765 PMCID: PMC8671124 DOI: 10.1016/j.ijcha.2021.100900] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/13/2021] [Accepted: 10/17/2021] [Indexed: 11/03/2022]
Abstract
Calcified coronary lesions are frequently in patients with coronary artery disease. Intravascular lithotripsy was shown to be safe and effective for treating calcified lesions in coronary artery disease. Data of intravascular lithotripsy in comparison to standard techniques are lacking. Intravascular lithotripsy showed higher rate of procedural success without differences in rate of MACE after 12 months in comparison to high- pressure NC-Balloon PTCA.
Background Data regarding safety, efficacy, and outcome of intravascular lithotripsy (IVL) in comparison to standard techniques are lacking. This study sought to compare IVL with non-compliant high-pressure balloon percutaneous coronary angioplasty (PTCA). Methods and results We performed a retrospective propensity-score-matched study to compare procedural success in 57 consecutive patients who received IVL-guided PCI in calcified coronary lesions with 171 matched patients who were treated with high-pressure PTCA with a non-compliant (NC)-balloon. The mean minimal lumen diameter (MLD) for the IVL group was 1.08 ± 0.51 mm, and the median percent diameter stenosis on quantitative angiography was 70.2% (interquartile range, 60.2–78.6%). MLD in the high-pressure dilatation group was 0.97 ± 0.43 mm, and the median percent diameter stenosis was 71.5% (interquartile range, 58.5–77.0%). IVL-guided PCI reduced median stenosis to 17.5% (interquartile range, 9.3–19.8%) with an acute gain of 0.93 ± 0.7 mm. High-pressure dilatation resulted in a final median stenosis of 19.3% (interquartile range, 13.33–28.5%). Procedural success was significantly higher (82.5% vs. 61.4%; p: 0.0035) in the IVL group. MACE through 12 months occurred in 10.5% of cases in the IVL group and in 11.1% of the high-pressure group (p = 0.22). Angiographic complications (coronary dissection, slow or no reflow, new coronary thrombus formation, abrupt vessel closure) were very low (0.2% vs. 0.12%). Conclusion IVL resulted in a significantly higher rate of procedural success compared to high- pressure NC-balloon dilatation in patients with calcified coronary lesions. The rate of MACE through 12 months was similar to the standard therapy.
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Key Words
- AMI, Acute myocardial infarction
- CAD, Coronary artery disease
- Calcification
- DES, Drug eluting stent
- High-pressure PTCA
- IVL, Intravascular lithotripsy
- LAD, Left anterior descending artery
- Lithotripsy
- MACE, Major adverse cardiovascular event
- MLD, Minimal lumen diameter
- NC, non-compliant
- PCI, Percutaneous coronary intervention
- PSM, Propensity-score-matched
- PTCA, Percutaneous transluminal coronary angioplasty
- QCA, Quantitative Coronary Analysis
- RA, Rotational atherectomy (RA)
- RCA, Right coronary artery
- Shockwave
- TIMI, Thrombolysis in myocardial infarction
- atm, Atmosphere
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Affiliation(s)
- Adem Aksoy
- Heart Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Germany
| | - Vedat Tiyerili
- Heart Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Germany
| | - Nora Jansen
- Heart Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Germany
| | - Muntadher Al Zaidi
- Heart Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Germany
| | - Maximillian Thiessen
- Department of Computer Science, University of Bonn, Germany.,Fraunhofer Institute for Intelligent Analysis and Information Systems, Sankt Augustin, Germany
| | - Alexander Sedaghat
- Heart Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Germany
| | - Felix Jansen
- Heart Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Germany
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Aksoy A, Al Zaidi M, Repges E, Becher MU, Müller C, Oldenburg J, Zimmer S, Nickenig G, Tiyerili V. Vitamin K Epoxide Reductase Complex Subunit 1-Like 1 (VKORC1L1) Inhibition Induces a Proliferative and Pro-inflammatory Vascular Smooth Muscle Cell Phenotype. Front Cardiovasc Med 2021; 8:708946. [PMID: 34778390 PMCID: PMC8578699 DOI: 10.3389/fcvm.2021.708946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/05/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Vitamin K antagonists (VKA) are known to promote adverse cardiovascular remodeling. Contrarily, vitamin K supplementation has been discussed to decelerate cardiovascular disease. The recently described VKOR-isoenzyme Vitamin K epoxide reductase complex subunit 1-like 1 (VKORC1L1) is involved in vitamin K maintenance and exerts antioxidant properties. In this study, we sought to investigate the role of VKORC1L1 in neointima formation and on vascular smooth muscle cell (VSMC) function. Methods and Results: Treatment of wild-type mice with Warfarin, a well-known VKA, increased maladaptive neointima formation after carotid artery injury. This was accompanied by reduced vascular mRNA expression of VKORC1L1. In vitro, Warfarin was found to reduce VKORC1L1 mRNA expression in VSMC. VKORC1L1-downregulation by siRNA promoted viability, migration and formation of reactive oxygen species. VKORC1L1 knockdown further increased expression of key markers of vascular inflammation (NFκB, IL-6). Additionally, downregulation of the endoplasmic reticulum (ER) membrane resident VKORC1L1 increased expression of the main ER Stress moderator, glucose-regulated protein 78 kDa (GRP78). Moreover, treatment with the ER Stress inducer tunicamycin promoted VKORC1L1, but not VKORC1 expression. Finally, we sought to investigate, if treatment with vitamin K can exert protective properties on VSMC. Thus, we examined effects of menaquinone-7 (MK7) on VSMC phenotype switch. MK7 treatment dose-dependently alleviated PDGF-induced proliferation and migration. In addition, we detected a reduction in expression of inflammatory and ER Stress markers. Conclusion: VKA treatment promotes neointima formation after carotid wire injury. In addition, VKA treatment reduces aortal VKORC1L1 mRNA expression. VKORC1L1 inhibition contributes to an adverse VSMC phenotype, while MK7 restores VSMC function. Thus, MK7 supplementation might be a feasible therapeutic option to modulate vitamin K- and VKORC1L1-mediated vasculoprotection.
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Affiliation(s)
- Adem Aksoy
- Department of Cardiology, Heart Centre, University of Bonn, Bonn, Germany
| | - Muntadher Al Zaidi
- Department of Cardiology, Heart Centre, University of Bonn, Bonn, Germany
| | - Elena Repges
- Department of Cardiology, Heart Centre, University of Bonn, Bonn, Germany
| | - Marc Ulrich Becher
- Department of Cardiology, Heart Centre, University of Bonn, Bonn, Germany
| | - Cornelius Müller
- Department of Cardiology, Heart Centre, University of Bonn, Bonn, Germany
| | - Johannes Oldenburg
- Institute of Experimental Haematology and Transfusion Medicine, University of Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Cardiology, Heart Centre, University of Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Cardiology, Heart Centre, University of Bonn, Bonn, Germany
| | - Vedat Tiyerili
- Department of Cardiology, Heart Centre, University of Bonn, Bonn, Germany
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Sugiura A, Tanaka T, Kavsur R, Öztürk C, Vogelhuber J, Wilde N, Becher MU, Zimmer S, Nickenig G, Weber M. Leaflet Configuration and Residual Tricuspid Regurgitation After Transcatheter Edge-to-Edge Tricuspid Repair. JACC Cardiovasc Interv 2021; 14:2260-2270. [PMID: 34424200 DOI: 10.1016/j.jcin.2021.07.048] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES This study aimed to assess the anatomical leaflet variation and investigate its impact on the procedural outcome in patients undergoing transcatheter edge-to-edge tricuspid repair. BACKGROUND Tricuspid regurgitation (TR) is associated with a poor prognosis. METHODS The study participants were consecutive patients who underwent transcatheter edge-to-edge tricuspid repair with the MitraClip, TriClip, or PASCAL systems from June 2015 to July 2020 at the Bonn Heart Center. The tricuspid leaflet morphologies were imaged using 2-dimensional and 3-dimensional transesophageal echocardiography. The severity of TR was assessed according to the 5-grade scheme. The primary endpoint was residual TR ≥3+ within 30 days. RESULTS Of the 145 study participants, 103 (71.1%) participants were categorized as the 3-leaflet configuration, while 42 (28.9%) were categorized as the 4-leaflet configuration. Successful device implantation was achieved in 136 (93.8%) patients, with no statistical difference between the 3-leaflet and 4-leaflet configuration groups. However, compared with patients with a 3-leaflet configuration, patients with 4-leaflet configuration more frequently had residual TR ≥3+ (18.4% vs 38.1%; P = 0.018). In the multivariable model, the 4-leaflet configuration was associated with an increased risk of residual TR ≥3+ (odds ratio: 2.65; 95% CI 1.15-6.10; P = 0.022), independent of baseline TR grade, coaptation gap width, and TR jet location. After 1-year follow-up, compared with patients with residual TR <3+, patients with residual TR ≥3+ had a significantly higher incidence of the composite of all-cause mortality or heart failure hospitalization (27.7% vs 56.1%; P = 0.016). CONCLUSIONS A 4-leaflet configuration of the tricuspid valve is observed in approximately one-third of patients undergoing transcatheter edge-to-edge tricuspid repair, which is associated with an increased risk of residual TR after the procedure.
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Affiliation(s)
- Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Tetsu Tanaka
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Refik Kavsur
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Can Öztürk
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Johanna Vogelhuber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Nihal Wilde
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany.
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20
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Sugiura A, Shamekhi J, Goto T, Spieker M, Iliadis C, Kavsur R, Mauri V, Kelm M, Baldus S, Tanaka T, Tabata N, Sinning JM, Weber M, Zimmer S, Nickenig G, Westenfeld R, Pfister R, Becher MU. Early response of right-ventricular function to percutaneous mitral valve repair. Clin Res Cardiol 2021; 111:859-868. [PMID: 34669015 PMCID: PMC9334433 DOI: 10.1007/s00392-021-01951-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022]
Abstract
Background The change in right-ventricular function (RVF) after transcatheter mitral valve repair is still poorly understood. We assessed the early response of RVF to the MitraClip procedure and its clinical relevance. Methods We analyzed consecutive patients who underwent a MitraClip procedure to treat MR between August 2010 and March 2019 in the Heart Failure Network Rhineland registry. RVF was assessed before and after the procedure. Impaired RVF was defined as an RV fractional area change (RVFAC) < 35% or tricuspid annular plane systolic excursion (TAPSE) < 16 mm. Results 816 eligible patients (77 ± 9 years, 58.5% male) were included in the analysis. Baseline values of RVF were: RVFAC 38.6 (IQR 29.7–46.7) % and TAPSE 17.0 (IQR 14.0–21.0) mm. At a median time of 3 (IQR 2–5) days after the procedure, the RVF remained normal in 34% (n = 274), normalized in 17% (n = 140), deteriorated in 15% (n = 125), and was persistently impaired in 34% (n = 277) of patients. The RVF response was significantly associated with a composite outcome of all-cause mortality and hospitalization due to heart failure within a 2-year follow-up. Compared to stable/normal RVF, the adjusted hazard ratios for the outcome were 1.78 (95% CI 1.10–2.86) for normalized RVF, 1.89 (95% CI 1.34–3.15) for deteriorated RVF, and 2.25 (95% CI 1.47–3.44) for persistently impaired RVF. Changes in TAPSE and RVFAC as continuous variables were significantly correlated with the outcome. Conclusion An early change in RVF following transcatheter mitral valve repair is predictive of mortality and hospitalization due to heart failure during follow-up. Graphic abstract Early response of RVF after MitraClip and its clinical significance. An acute, early change in RVF can be observed following the MitraClip procedure, which is associated with the risk of mortality and hospitalization for HF. ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-021-01951-7.
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Affiliation(s)
- Atsushi Sugiura
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Jasmin Shamekhi
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Maximilian Spieker
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christos Iliadis
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Refik Kavsur
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Victor Mauri
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Malte Kelm
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Tetsu Tanaka
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Noriaki Tabata
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Jan-Malte Sinning
- Department of Cardiology, St. Vinzenz-Hospital Cologne, Cologne, Germany
| | - Marcel Weber
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Zimmer
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Georg Nickenig
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Roman Pfister
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Marc Ulrich Becher
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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21
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Tanaka T, Sugiura A, Kavsur R, Vogelhuber J, Oeztuerk C, Becher MU, Zimmer S, Nickenig G, Weber M. Impact of leaflet-to-annulus index on residual tricuspid regurgitation following transcatheter edge-to-edge tricuspid valve repair. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2224] [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
Edge-to-edge transcatheter tricuspid valve repair (TTVR) is a promising treatment option for tricuspid regurgitation (TR), and it is required to identify anatomical parameters to predict the procedural success of TTVR.
Purpose
In this study, we assessed leaflet-to-annulus index (LAI), a simple tool to evaluate the remodeling of tricuspid annulus in relation to the leaflets, and investigated the association of the LAI with residual TR after edge-to-edge TTVR.
Methods
Consecutive 140 patients with symptomatic TR who underwent edge-to-edge TTVR from June 2015 to July 2020 were enrolled. The LAI was calculated using preprocedural transesophageal echocardiography and was defined as follows: (anterior leaflet length + septal leaflet length)/anteroseptal tricuspid annulus diameter (Figure 1). Primary outcome was residual TR ≥3+ at discharge, and patients were allocated into two groups as follows: residual TR ≥3+ and <3+. Secondary outcome was the composite outcome, consisting of all-cause mortality and heart failure hospitalization, within one year after TTVR.
Results
Of the 140 patients, 43 patients had residual TR ≥3+ after TTVR. The patients with residual TR ≥3+ had lower LAI compared to those with residual TR <3+ (1.06±0.10 vs. 1.13±0.09; p=0.001). Multivariable analysis revealed that LAI was associated with residual TR ≥3+ (odds ratio [by 0.1 increase]: 0.57; 95% confidence interval [95% CI]: 0.35–0.94; p=0.02), independently of baseline TR severity, location of TR jet, and coaptation gap size (Table 1). Patients with residual TR ≥3+ had a higher incidence of the composite outcome within one year after TTVR (34.9% vs. 18.6%; log-rank p=0.04) and residual TR ≥3+ was an independent predictor of the composite outcome within one year (hazard ratio: 2.04; 95% CI: 1.01–4.11; p=0.04).
Conclusion
Lower LAI is associated with residual TR ≥3+ after edge-to-edge TTVR, which itself was a significant predictor of the one-year composite outcome. Our findings suggest that LAI is a useful tool to identify patients to be successfully treated with edge-to-edge TTVR.
Funding Acknowledgement
Type of funding sources: None. Figure 1Table 1
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Affiliation(s)
- T Tanaka
- University hospital Bonn, Bonn, Germany
| | - A Sugiura
- University hospital Bonn, Bonn, Germany
| | - R Kavsur
- University hospital Bonn, Bonn, Germany
| | | | | | | | - S Zimmer
- University hospital Bonn, Bonn, Germany
| | | | - M Weber
- University hospital Bonn, Bonn, Germany
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22
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Zweck E, Spieker M, Horn P, Iliadis C, Metze C, Kavsur R, Tiyerili V, Nickenig G, Baldus S, Kelm M, Becher MU, Pfister R, Westenfeld R. Machine learning identifies clinical parameters to predict mortality in patients undergoing transcatheter mitral valve repair. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Transcatheter Mitral Valve Repair (TMVR) with MitraClip is an important treatment option for patients with severe mitral regurgitation. The lack of appropriate, validated and specific means to risk stratify TMVR patients complicates the evaluation of prognostic benefits of TMVR in clinical trials and practice.
Purpose
We aimed to develop an optimized risk stratification model for TMVR patients using machine learning (ML).
Methods
We included a total of 1009 TMVR patients from three large university hospitals, of which one (n=317) served as an external validation cohort. The primary endpoint was all-cause 1-year mortality, which was known in 95% of patients. Model performance was assessed using receiver operating characteristics. In the derivation cohort, different ML algorithms, including random forest, logistic regression, support vectors machines, k nearest neighbors, multilayer perceptron, and extreme gradient boosting (XGBoost) were tested using 5-fold cross-validation in the derivation cohort. The final model (Transcatheter MITral Valve Repair MortALIty PredicTion SYstem; MITRALITY) was tested in the validation cohort with respect to existing clinical scores.
Results
XGBoost was selected as the final algorithm for the MITRALITY Score, using only six baseline clinical features for prediction (in order of predictive importance): blood urea nitrogen, hemoglobin, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), mean arterial pressure, body mass index, and creatinine. In the external validation cohort, the MITRALITY Score's area under the curve (AUC) was 0.783, outperforming existing scores which yielded AUCs of 0.721 and 0.657 at best. 1-year mortality in the MITRALITY Score quartiles across the total cohort was 0.8%, 1.3%, 10.5%, and 54.6%, respectively. Odds of mortality in MITRALITY Score quartile 4 as compared to quartile 1 were 143.02 [34.75; 588.57]. Survival analyses showed that the differences in outcomes between the MITRALITY Score quartiles remained even over a timeframe of 3 years post intervention (log rank: p<0.005). With each increase by 1% in the MITRALITY score, the respective proportional hazard ratio for 3-year survival was 1.06 [1.05, 1.07] (Cox regression, p<0.05).
Conclusion
The MITRALITY Score is a novel, internally and externally validated ML-based tool for risk stratification of patients prior to TMVR. These findings may potentially allow for more precise design of future clinical trials, may enable novel treatment strategies tailored to populations of specific risk and thereby serve future daily clinical practice.
Funding Acknowledgement
Type of funding sources: None. Summary Figure
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Affiliation(s)
- E Zweck
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - M Spieker
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - P Horn
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - C Iliadis
- University of Cologne, Medical Faculty, Department of Cardiology, Cologne, Germany
| | - C Metze
- University of Cologne, Medical Faculty, Department of Cardiology, Cologne, Germany
| | - R Kavsur
- University Hospital Bonn, Department of Cardiology, Bonn, Germany
| | - V Tiyerili
- University Hospital Bonn, Department of Cardiology, Bonn, Germany
| | - G Nickenig
- University Hospital Bonn, Department of Cardiology, Bonn, Germany
| | - S Baldus
- University of Cologne, Medical Faculty, Department of Cardiology, Cologne, Germany
| | - M Kelm
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
| | - M U Becher
- University Hospital Bonn, Department of Cardiology, Bonn, Germany
| | - R Pfister
- University of Cologne, Medical Faculty, Department of Cardiology, Cologne, Germany
| | - R Westenfeld
- University Hospital Dusseldorf, Division of Cardiology, Pulmonology and Vascular Medicine, Dusseldorf, Germany
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Al Zaidi M, Aksoy A, Repges E, Becher MU, Mueller C, Oldenburg J, Zimmer S, Nickenig G, Tiyerili V. Vitamin K epoxide reductase complex subunit 1-like 1 (VKORC1L1) inhibition induces a proliferative and pro-inflammatory vascular smooth muscle cell phenotype. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3348] [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
Vitamin K antagonists (VKA) like Warfarin are known to promote adverse cardiovascular remodelling. Contrarily, vitamin K supplementation has been discussed to decelerate cardiovascular disease. The recently described VKOR-isoenzyme Vitamin K epoxide reductase complex subunit 1-like 1 (VKORC1L1) is involved in vitamin K maintenance and exerts antioxidant properties. In this study, we sought to investigate the role of VKORC1L1 in neointima formation and on vascular smooth muscle cell (VSMC) function.
Methods and results
Treatment of wild-type mice with Warfarin increased maladaptive neointima formation after carotid artery injury. This was accompanied by reduced vascular mRNA expression of VKORC1L1.
In vitro, Warfarin was found to reduce VKORC1L1 mRNA expression in VSMC. VKORC1L1 downregulation by siRNA promoted viability, migration and formation of reactive oxygen species. VKORC1L1 knockdown further increased expression of key markers of vascular inflammation (NFκB, IL-6). Additionally, downregulation of the endoplasmic reticulum (ER) membrane resident VKORC1L1 increased expression of the main ER Stress moderator, glucose-regulated protein 78 kDa (GRP78). Moreover, treatment with the ER Stress inducer Tunicamycin promoted VKORC1L1, but not VKORC1 expression.
Finally, we sought to investigate, if treatment with vitamin K can mediate the protective properties of VKORC1L1. Thus, we examined effects of menaquinone-7 (MK7) on VSMC phenotype switch. MK7 treatment dose-dependently alleviated PDGF-induced proliferation and migration. In addition, we detected a reduction in expression of inflammatory and ER Stress markers.
Conclusion
VKA-induced neointima formation is associated with reduced vascular VKORC1L1 expression. VKORC1L1 inhibition contributes to an adverse VSMC phenotype while MK7 restores VSMC function. Thus, MK7 supplementation might be a feasible therapeutic option to modulate vitamin K- and VKORC1L1-mediated vasculoprotection.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Al Zaidi
- University Hospital Bonn, Dept. of Internal Medicine II; Cardiology, Pulmonology, Angiology, Bonn, Germany
| | - A Aksoy
- University Hospital Bonn, Dept. of Internal Medicine II; Cardiology, Pulmonology, Angiology, Bonn, Germany
| | - E Repges
- University Hospital Bonn, Dept. of Internal Medicine II; Cardiology, Pulmonology, Angiology, Bonn, Germany
| | - M U Becher
- University Hospital Bonn, Dept. of Internal Medicine II; Cardiology, Pulmonology, Angiology, Bonn, Germany
| | - C Mueller
- University Hospital Bonn, Dept. of Internal Medicine II; Cardiology, Pulmonology, Angiology, Bonn, Germany
| | - J Oldenburg
- University Hospital Bonn, Institute of Experimental Haematology and Transfusion Medicine (IHT), Bonn, Germany
| | - S Zimmer
- University Hospital Bonn, Dept. of Internal Medicine II; Cardiology, Pulmonology, Angiology, Bonn, Germany
| | - G Nickenig
- University Hospital Bonn, Dept. of Internal Medicine II; Cardiology, Pulmonology, Angiology, Bonn, Germany
| | - V Tiyerili
- University Hospital Bonn, Dept. of Internal Medicine II; Cardiology, Pulmonology, Angiology, Bonn, Germany
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Tanaka T, Kavsur R, Spieker M, Iliadis C, Metze C, Horn P, Sugiura A, Kelm M, Baldus S, Nickenig G, Westenfeld R, Pfister R, Becher MU. Periprocedural changes in natriuretic peptide levels and clinical outcome after transcatheter mitral valve repair. ESC Heart Fail 2021; 8:5237-5247. [PMID: 34519444 PMCID: PMC8712850 DOI: 10.1002/ehf2.13603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 11/06/2022] Open
Abstract
Aims This multicentre study investigated the association of periprocedural changes in the levels of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) with clinical outcomes after transcatheter edge‐to‐edge mitral valve repair (TMVR). Methods and results Patients were retrospectively analysed who underwent TMVR with the MitraClip system (Abbott Vascular, Santa Clara, CA, USA) and had available sequential NT‐proBNP testing at baseline and 2 months after TMVR. Periprocedural changes in NT‐proBNP following TMVR were assessed as the percent change in NT‐proBNP between baseline and the 2 month follow‐up, and the significant reduction in NT‐proBNP was defined as a decrease of >30% in the follow‐up NT‐proBNP compared with the pre‐procedural NT‐proBNP level. Primary outcome was defined as a composite outcome consisting of all‐cause mortality and hospitalization due to heart failure from 2 months to 2 years after TMVR. Additionally, we identified the cut‐off value of pre‐procedural NT‐proBNP to predict the composite outcome using a receiver operating characteristic analysis (cut‐off: 2485 pg/mL). Of 485 patients undergoing TMVR (age: 76.2 ± 9.2 years, female: 42.1%, secondary mitral regurgitation: 67.2%), 150 patients (30.9%) had the significant reduction in NT‐proBNP (>30%) following the procedure. Patients with the NT‐proBNP reduction had a lower incidence of the composite outcome, compared with those without the reduction in NT‐proBNP (31.4% vs. 40.2%; log‐rank P = 0.03). The significant reduction in NT‐proBNP was also associated with a lower risk of the composite outcome [adjusted hazard ratio (HR): 0.67; 95% confidence interval (CI): 0.45–0.97; P = 0.04], independently of pre‐procedural NT‐proBNP levels and other clinical parameters. The percent change in NT‐proBNP was associated with a linear trend of the incidence of the composite outcome (adjusted HR per 10% decrease: 0.96; 95% CI: 0.94–0.98; P < 0.001). A stratified analysis revealed that the prognostic impact of the significant reduction in NT‐proBNP was consistent among clinical subgroups, including aetiology of mitral regurgitation (P for interaction = 0.99). Higher pre‐procedural NT‐proBNP level (>2485 pg/mL) was associated with the increased risk of the composite outcome (adjusted HR: 1.50; 95% CI: 1.03–2.17; P = 0.03); however, patients with a higher pre‐procedural NT‐proBNP who achieved the significant reduction in NT‐proBNP had a similar risk of the composite outcome to those with a lower pre‐procedural NT‐proBNP. Conclusions Changes in sequential NT‐proBNP measurements were associated with clinical outcomes within 2 years after TMVR. The assessment of NT‐proBNP dynamics may be valuable to assess the residual risk for patients undergoing TMVR and could assist with post‐procedural management after TMVR.
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Affiliation(s)
- Tetsu Tanaka
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg Campus 1, Bonn, 53127, Germany
| | - Refik Kavsur
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg Campus 1, Bonn, 53127, Germany
| | - Maximilian Spieker
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christos Iliadis
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Clemens Metze
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Patrick Horn
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg Campus 1, Bonn, 53127, Germany
| | - Malte Kelm
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Stephan Baldus
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg Campus 1, Bonn, 53127, Germany
| | - Ralf Westenfeld
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Roman Pfister
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg Campus 1, Bonn, 53127, Germany
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Mauri V, Besler C, Riebisch M, Al-Hammadi O, Ruf T, Gerçek M, Horn P, Grothusen C, Mehr M, Becher MU, Mues C, Boeder N, Kreidel F, Friedrichs K, Westenfeld R, Braun D, Öztürk C, Baldus S, Rassaf T, Thiele H, Nickenig G, Hausleiter J, Möllmann H, Kelm M, Rudolph V, von Bardeleben RS, Nef HM, Luedike P, Lurz P, Pfister R. German Multicenter Experience With a New Leaflet-Based Transcatheter Mitral Valve Repair System for Mitral Regurgitation. JACC Cardiovasc Interv 2021; 13:2769-2778. [PMID: 33303115 DOI: 10.1016/j.jcin.2020.08.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/22/2020] [Accepted: 08/18/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the procedural and short-term safety and efficacy of a new leaflet-based transcatheter mitral valve repair system. BACKGROUND The PASCAL repair system has been recently approved for percutaneous treatment of mitral regurgitation (MR). Novel characteristics are broad paddles positioned around a central spacer and the ability for independent leaflet capture. METHODS Procedural and 30-day outcomes were investigated in the first 309 patients with symptomatic MR 3+/4+ treated with the PASCAL repair system at 10 sites. Primary efficacy endpoints were technical success and degree of residual MR at discharge. The primary safety endpoint was the rate of major adverse events (MAE). RESULTS Among the 309 patients (mean age 77 ± 10 years, 42% women, mean European System for Cardiac Operative Risk Evaluation II score 5.8 ± 4.5%) included in this study, MR etiology was degenerative in 33%, functional in 52%, and mixed in 16%. Eighty-six percent of patients were in New York Heart Association functional class III or IV. The technical success rate was 96%. Of 308 patients discharged alive, MR was ≤2+ in 93.5%. At 30 days, the MAE rate was 4.1%, with an estimated all-cause mortality rate of 2.0%, and 72% of patients were in New York Heart Association functional class ≤II (p < 0.001). Rates of device success and CLASP (Edwards PASCAL Transcatheter Mitral Valve Repair System Study) trial-defined clinical success were 81.9% and 86.9%, respectively. Single-leaflet device attachment occurred in 7 patients (2.3%). CONCLUSIONS Mitral valve repair with the PASCAL system in the early post-approval phase was effective and safe, with high procedural success rates and low rates of MAE. MR was significantly reduced, accompanied by significant improvement in functional status.
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Affiliation(s)
- Victor Mauri
- Department of Cardiology, Heart Centre, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Christian Besler
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Matthias Riebisch
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Medical Faculty, Essen, Germany
| | - Osamah Al-Hammadi
- Medizinische Klinik I, Department of Cardiology, University of Giessen, Giessen, Germany
| | - Tobias Ruf
- Heart Valve Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Muhammed Gerçek
- General and Interventional Cardiology, Heart and Diabetes Centre NRW, Bad Oeynhausen, Germany; Ruhr University Bochum, Bochum, Germany
| | - Patrick Horn
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Christina Grothusen
- Medical Clinic I, Department of Cardiology, St-Johannes-Hospital, Dortmund, Germany
| | - Michael Mehr
- Medizinische Klinik und Poliklinik I der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Christoph Mues
- Medical Clinic I, Department of Cardiology, St-Johannes-Hospital, Dortmund, Germany
| | - Niklas Boeder
- Medizinische Klinik I, Department of Cardiology, University of Giessen, Giessen, Germany
| | - Felix Kreidel
- Heart Valve Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz, Mainz, Germany
| | - Kai Friedrichs
- General and Interventional Cardiology, Heart and Diabetes Centre NRW, Bad Oeynhausen, Germany; Ruhr University Bochum, Bochum, Germany
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Can Öztürk
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Centre, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Medical Faculty, Essen, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Helge Möllmann
- Medical Clinic I, Department of Cardiology, St-Johannes-Hospital, Dortmund, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - Volker Rudolph
- General and Interventional Cardiology, Heart and Diabetes Centre NRW, Bad Oeynhausen, Germany; Ruhr University Bochum, Bochum, Germany
| | | | - Holger M Nef
- Medizinische Klinik I, Department of Cardiology, University of Giessen, Giessen, Germany
| | - Peter Luedike
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Medical Faculty, Essen, Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Roman Pfister
- Department of Cardiology, Heart Centre, Faculty of Medicine, University of Cologne, Cologne, Germany.
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Tanaka T, Kavsur R, Sugiura A, Vogelhuber J, Öztürk C, Weber M, Tiyerili V, Zimmer S, Nickenig G, Becher MU. Prognostic impact of hepatorenal function in patients undergoing transcatheter tricuspid valve repair. Sci Rep 2021; 11:14420. [PMID: 34257395 PMCID: PMC8277825 DOI: 10.1038/s41598-021-93952-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/29/2021] [Indexed: 12/28/2022] Open
Abstract
Hepatorenal dysfunction is a strong risk factor in patients with heart failure (HF). We investigated the prognostic significance of hepatorenal dysfunction in 172 consecutive patients undergoing transcatheter tricuspid valve repair (TTVR). The model for end-stage liver disease excluding international normalized ratio (MELD-XI) score was calculated as 5.11 × ln(serum total bilirubin [mg/dl]) + 11.76 × ln(serum creatinine [mg/dl]) + 9.44. Patients were stratified into two groups: high (≥ 14) or low (< 14) MELD-XI score, according to the best cut-off value to predict a one-year composite outcome consisting of all-cause mortality and HF hospitalization. Compared to patients with low MELD-XI score (n = 121), patients with high MELD-XI score (n = 51) had a higher incidence of the composite outcome (47.1% vs. 17.4%; p < 0.0001). In the multivariable analysis, the MELD-XI score was an independent predictor of the composite outcome (adjusted hazard ratio: 1.12; 95% confidence interval [CI] 1.05–1.19; p = 0.0003). In addition, post-procedural TR < 3 + after TTVR was independently associated with a reduction in MELD-XI score six months after TTVR (adjusted odds ratio: 3.37; 95% CI 1.09–10.40; p = 0.03). Thus, the MELD-XI score was associated with the risk of one-year composite outcome, consisting of mortality and HF hospitalization, after TTVR and may help the risk stratification in patients undergoing TTVR.
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Affiliation(s)
- Tetsu Tanaka
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Refik Kavsur
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Atsushi Sugiura
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Johanna Vogelhuber
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Can Öztürk
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Marcel Weber
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Vedat Tiyerili
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Zimmer
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Marc Ulrich Becher
- Department of Internal Medicine II, Heart Center Bonn, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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Kavsur R, Spieker M, Iliadis C, Metze C, Transier M, Tiyerili V, Horn P, Baldus S, Kelm M, Nickenig G, Westenfeld R, Pfister R, Becher MU. Mitral Regurgitation International Database (MIDA) Score Predicts Outcome in Patients With Heart Failure Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair. J Am Heart Assoc 2021; 10:e019548. [PMID: 34187184 PMCID: PMC8403297 DOI: 10.1161/jaha.120.019548] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Optimizing risk stratification in patients undergoing transcatheter mitral valve repair is an ongoing challenge. The Mitral Regurgitation International Database (MIDA) score represents a user-friendly mortality risk stratification tool that is validated on a large-scale registry of patients with degenerative mitral regurgitation (MR). We here assessed the potential benefit of the MIDA risk score for patients with functional or degenerative MR undergoing transcatheter mitral valve repair. Methods and Results In total, 680 patients undergoing MitraClip implantation were stratified according to MIDA score tertiles into a low (0-7), intermediate (8-9), and a high (10-12) MIDA score group. MR was assessed in follow-up echocardiograms in 416 patients at 323±169 days after transcatheter mitral valve repair. During 2-year follow-up, 8.2% (15/182) of patients with low, 21.3% (64/300) with intermediate, and 26.3% (52/198) with high MIDA score died (log-rank test P<0.001). Hazard of all-cause mortality increased by 13% (95% CI, 3%-25%) with every additional point of the MIDA score. Subanalysis of 431 patients with functional MR showed similar results. Furthermore, rates of a combined end point of mortality and hospitalization for heart failure were higher with increasing MIDA score (30% [54/182], 38% [113/300] and 48% [94/198], respectively, log-rank test P=0.001). Frequency of residual MR ≥II at follow-up increased with increasing MIDA score group (33%, 44%, and 59%, respectively, P<0.001). Conclusions The MIDA mortality risk score maintains its predictive utility in patients undergoing transcatheter mitral valve repair, regardless of MR cause. Moreover, it was predictive of worse event-free survival regarding a combined end point of mortality and hospitalization for heart failure, and was associated with postprocedural residual MR ≥II and MR recurrence.
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Affiliation(s)
- Refik Kavsur
- Department of Internal Medicine II University Hospital Bonn Bonn Germany
| | - Maximilian Spieker
- Department of Cardiology, Pulmonology and Vascular Medicine Heinrich-Heine University Hospital Duesseldorf Duesseldorf Germany
| | - Christos Iliadis
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care Heart Center of the University of Cologne Cologne Germany
| | - Clemens Metze
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care Heart Center of the University of Cologne Cologne Germany
| | - Moritz Transier
- Department of Internal Medicine II University Hospital Bonn Bonn Germany
| | - Vedat Tiyerili
- Department of Internal Medicine II University Hospital Bonn Bonn Germany
| | - Patrick Horn
- Department of Cardiology, Pulmonology and Vascular Medicine Heinrich-Heine University Hospital Duesseldorf Duesseldorf Germany
| | - Stephan Baldus
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care Heart Center of the University of Cologne Cologne Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine Heinrich-Heine University Hospital Duesseldorf Duesseldorf Germany
| | - Georg Nickenig
- Department of Internal Medicine II University Hospital Bonn Bonn Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine Heinrich-Heine University Hospital Duesseldorf Duesseldorf Germany
| | - Roman Pfister
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care Heart Center of the University of Cologne Cologne Germany
| | - Marc Ulrich Becher
- Department of Internal Medicine II University Hospital Bonn Bonn Germany
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Al-Kassou B, Shamekhi J, Weber M, Germeroth J, Gillrath J, Feldmann K, Sedaghat A, Werner N, Treede H, Becher MU, Tiyerili V, Grube E, Zimmer S, Nickenig G, Sinning JM. Frailty, malnutrition, and the endocrine system impact outcome in patients undergoing aortic valve replacement. Catheter Cardiovasc Interv 2021; 99:145-157. [PMID: 34143555 DOI: 10.1002/ccd.29821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/01/2021] [Accepted: 06/05/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Frailty is a multidimensional syndrome that affects mortality after aortic valve replacement (AVR). Malnutrition is often associated with the development of frailty. However, data regarding the association of frailty with nutritional status and underlying endocrinological dysregulation in patients with severe aortic valve stenosis are limited. OBJECTIVES We aimed to systematically screen for frailty and malnutrition, to evaluate for underlying endocrinological disorders and inflammation, and to assess the ability of these parameters to predict outcomes after AVR. METHODS Our study included 373 patients undergoing transcatheter and surgical AVR. Frailty was assessed using the Fried Frailty Phenotype (FFP), Essential Frailty Toolset, Lawton-Brody, and Katz Index. Malnutrition was measured using the Mini Nutritional Assessment (MNA-LF) and Controlling Nutritional Status. Outcomes of interest were 30-day and one-year mortality. RESULTS The prevalence of frailty ranged from 6.4% to 65.7% and malnutrition from 5.9% to 10.5%, depending on the evaluation tool. Both parameters were associated with higher levels of cortisol and parathormone as well as lower levels of IGF-1, testosterone, DHEAS, and c-reactive protein. Malnutrition was associated with increased 30-day mortality, and both frailty and malnutrition with increased one-year mortality. In a multivariate analysis, malnutrition measured by the MNA-LF (OR: 2.32 [95%CI: 1.19-4.53], p = 0.01) and frailty as assessed by the FFP (OR: 1.42 [95%CI: 1.02-1.96], p = 0.03) were independent predictors of one-year mortality. CONCLUSION The prevalence of frailty and malnutrition varies significantly depending on the assessment tool. Both syndromes share common endocrinological alterations. Frailty and malnutrition are independent risk factors for mortality after AVR.
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Affiliation(s)
- Baravan Al-Kassou
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Jasmin Shamekhi
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Jana Germeroth
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Jana Gillrath
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Katharina Feldmann
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Alexander Sedaghat
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Nikos Werner
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Hendrik Treede
- Heart Center, Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Marc Ulrich Becher
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Vedat Tiyerili
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Eberhard Grube
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Jan-Malte Sinning
- Heart Center, Department of Medicine II, University Hospital Bonn, Bonn, Germany
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Kavsur R, Becher MU, Nassan W, Sedaghat A, Aksoy A, Schrickel JW, Nickenig G, Tiyerili V. CHA 2DS 2-VASC score predicts coronary artery disease progression and mortality after ventricular arrhythmia in patients with implantable cardioverter-defibrillator. Int J Cardiol Heart Vasc 2021; 34:100802. [PMID: 34095451 PMCID: PMC8165543 DOI: 10.1016/j.ijcha.2021.100802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/06/2021] [Accepted: 05/15/2021] [Indexed: 11/14/2022]
Abstract
Aim The CHA2DS2-VASC score has expanded its use beyond the initial purpose of predicting the risk of stroke in patients with atrial fibrillation. We aimed to investigate the value of the CHA2DS2-VASC score as a risk assessment tool to predict relevant coronary artery disease (CAD) leading to percutaneous coronary intervention (PCI), and all-cause mortality after detected ventricular arrhythmia (VA) in patients with an Implantable Cardioverter-Defibrillator (ICD). Methods A total of 183 ICD-patients who underwent coronary angiography after VA were included and classified according to their CHA2DS2-VASC score in a low(1-3), intermediate(4-5) and high(6-8) score group. We evaluated the predictive value of CHA2DS2-VASC score for the presence of relevant CAD leading to percutaneous coronary intervention (PCI), as well as late all-cause mortality. Results A total of 60 patients (32.8%) had significant CAD and underwent successful PCI. After adjustment for relevant parameters such as ischemic cardiomyopathy, angina pectoris, left ventricular ejection fraction, CHA2DS2-VASC score remained the only independent predictor of CAD leading to PCI [HR 1.73 (1.07–2.80)]. The Area under curve was 0.64 (0.56–72, p = 0.002). Kaplan-Meier analysis and log-rank showed an increased three-year mortality of ICD-patients with an intermediate or high score after VA (p = 0.003). Multivariate cox-regression analysis revealed that CHA2DS2-VASC score was also independently associated with all-cause mortality following adjustment for clinically relevant variables (HR 2.20, 1.17–4.14). Conclusions CHA2DS2-VASC score can be a predictor of CAD leading to PCI in ICD-patients after VA. ICD-Patients with a high score have an increased risk for reduced three-year all-cause mortality after VA.
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Key Words
- AF, Atrial fibrillation
- CABG, Coronary artery bypass graft
- CAD, Coronary artery disease
- CK-MB, Creatine Kinase MB Isoenzyme
- Coronary angiography
- Coronary artery disease
- ICD, Implantable Cardioverter-Defibrillator
- Implantable Cardioverter Defibrillator
- LDL, Low-Density Lipoprotein
- LVEF, Left Ventricular Ejection Fraction
- PCI, Percutaneous Coronary Intervention
- VA, Ventricular Arrhythmia
- VF, Ventricular Fibrillation
- VT, Ventricular Tachycardia
- Ventricular fibrillation
- Ventricular tachycardia
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Affiliation(s)
- Refik Kavsur
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Marc Ulrich Becher
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Welat Nassan
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alexander Sedaghat
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Adem Aksoy
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Jan Wilko Schrickel
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Georg Nickenig
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Vedat Tiyerili
- Department of Internal Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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Kavsur R, Hupp-Herschel HE, Sugiura A, Tanaka T, Öztürk C, Weber M, Nickenig G, Tiyerili V, Becher MU. Prognostic significance of the get with the guidelines-heart failure (GWTG-HF) risk score in patients undergoing trans-catheter tricuspid valve repair (TTVR). Heart Vessels 2021; 36:1903-1910. [PMID: 34023969 PMCID: PMC8556194 DOI: 10.1007/s00380-021-01874-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/14/2021] [Indexed: 11/07/2022]
Abstract
The Get-With-The-Guidelines-Heart-Failure (GWTG-HF) score is a risk assessment tool to predict mortality in patients with heart-failure (HF). We aimed to evaluate the GWTG-HF score for risk stratification in HF patients with tricuspid regurgitation undergoing trans-catheter tricuspid valve repair (TTVR). In total, 181 patients who underwent TTVR via edge-to-edge repair (86%) or annuloplasty (14%) were enrolled. Patients were categorized into a low- (≤ 43 points), intermediate- (44–53 points) and high-risk score groups (≥ 54 points). TTVR led to an improvement of TR (p < 0.0001) and NYHA (p < 0.0001). Kaplan–Meier analysis and log-rank test revealed that higher GWTG-HF scores were associated with reduced rates of event-free survival regarding mortality (96% vs 89% vs 73%, respectively, p = 0.001) and hospitalization for heart failure (HHF) (89% vs 86% vs 74%, respectively, p = 0.026). After adjusting for important variables like renal function, left ventricular ejection fraction and mitral regurgitation, the GWTG-HF score remained an independent predictor of the composite endpoint of HHF or mortality (hazard ratio 1.04 per 1-point increase, p = 0.029). Other remaining predictors were renal function and mitral regurgitation. The GWTG-HF score used as a risk stratification tool of mortality and HHF maintains its prognostic value in a HF population with severe TR undergoing TTVR.
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Affiliation(s)
- Refik Kavsur
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Hannah Emmi Hupp-Herschel
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Tetsu Tanaka
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Can Öztürk
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Vedat Tiyerili
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Iliadis C, Spieker M, Kavsur R, Metze C, Hellmich M, Horn P, Westenfeld R, Tiyerili V, Becher MU, Kelm M, Nickenig G, Baldus S, Pfister R. "Get with the Guidelines Heart Failure Risk Score" for mortality prediction in patients undergoing MitraClip. Clin Res Cardiol 2021; 110:1871-1880. [PMID: 33517496 PMCID: PMC8639563 DOI: 10.1007/s00392-021-01804-3] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/09/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Reliable risk scores in patients undergoing transcatheter edge-to-edge mitral valve repair (TMVR) are lacking. Heart failure is common in these patients, and risk scores derived from heart failure populations might help stratify TMVR patients. METHODS Consecutive patients from three Heart Centers undergoing TMVR were enrolled to investigate the association of the "Get with the Guidelines Heart Failure Risk Score" (comprising the variables systolic blood pressure, urea nitrogen, blood sodium, age, heart rate, race, history of chronic obstructive lung disease) with all-cause mortality. RESULTS Among 815 patients with available data 177 patients died during a median follow-up time of 365 days. Estimated 1-year mortality by quartiles of the score (0-37; 38-42, 43-46 and more than 46 points) was 6%, 10%, 23% and 30%, respectively (p < 0.001), with good concordance between observed and predicted mortality rates (goodness of fit test p = 0.46). Every increase of one score point was associated with a 9% increase in the hazard of mortality (95% CI 1.06-1.11%, p < 0.001). The score was associated with long-term mortality independently of left ventricular ejection fraction, NYHA class and NTproBNP, and was equally predictive in primary and secondary mitral regurgitation. CONCLUSION The "Get with the Guidelines Heart Failure Risk Score" showed a strong association with mortality in patients undergoing TMVR with additive information beyond traditional risk factors. Given the routinely available variables included in this score, application is easy and broadly possible.
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Affiliation(s)
- Christos Iliadis
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, Heart Center of the University of Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Maximilian Spieker
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Refik Kavsur
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Clemens Metze
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, Heart Center of the University of Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Patrick Horn
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Vedat Tiyerili
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Marc Ulrich Becher
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Georg Nickenig
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Stephan Baldus
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, Heart Center of the University of Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Roman Pfister
- Department of Cardiology, Angiology, Pneumology and Medical Intensive Care, Heart Center of the University of Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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Kavsur R, Hupp H, Sugiura A, Öztürk C, Weber M, Nickenig G, Tiyerili V, Becher MU. Pulmonary capillary wedge pressure (PCWP) as prognostic indicator in patients undergoing transcatheter valve repair (TTVR) of severe tricuspid regurgitation. Int J Cardiol 2020; 318:32-38. [DOI: 10.1016/j.ijcard.2020.06.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/19/2020] [Accepted: 06/15/2020] [Indexed: 10/24/2022]
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Wilde N, Sugiura A, Sedaghat A, Becher MU, Kelm M, Baldus S, Nickenig G, Veulemans V, Tiyerili V. Risk of mortality following transcatheter aortic valve replacement for low-flow low-gradient aortic stenosis. Clin Res Cardiol 2020; 110:391-398. [PMID: 33052475 DOI: 10.1007/s00392-020-01752-4] [Citation(s) in RCA: 2] [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: 07/23/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Low-flow low-gradient (LF-LG) aortic stenosis (AS) is associated with high mortality, even after transcatheter aortic valve replacement (TAVR). Further knowledge of risk indicators is needed and a clinical risk score would be desirable for optimizing patient selection and therapeutic strategy. METHODS The study cohort comprised of 219 consecutive LF-LG AS patients undergoing TAVR from 2008 to 2018 in two high-volume German centers. Predictive factors for one-year all-cause mortality were defined according to a Cox proportional hazard model. RESULTS At one-year follow-up after TAVR, 28% of patients had died. A multivariate model revealed six independent predictors of one-year mortality: history of myocardial infarction (HR 2.05, 95%CI 1.13-3.72), eGFR < 30 ml/min/1.73m2 (HR 2.75, 95%CI 1.48-5.11), tricuspid regurgitation moderate or more (HR 2.06, 95%CI 1.14-3.72), stroke volume index < 25 mL/m2 (HR 2.03, 95%CI 1.14-3.62), self-expandable device (HR 2.72, 95%CI 1.17-6.27), and non-transfemoral approach (HR 3.42, 95%CI 1.28-9.14). The Rhineland Risk Score (RRS) consisting of these variables (c statistic 0.75, 95%CI 0.68-0.82, p < 0.001) was superior to the EuroSCORE II (c statistic 0.63) and STS-PROM score (c statistic 0.69) at predicting one-year mortality. Patients with a RRS ≥ 8 had a prohibitive risk of one-year mortality of 67.6% (95%CI 52.0-82.4%). CONCLUSION In patients with LF-LG AS, history of myocardial infarction, renal dysfunction, tricuspid regurgitation, a low stroke volume index, self-expandable device, and non-femoral approach were associated with increased 1-year mortality after TAVR. The RRS might serve as a helpful tool for risk prediction and patient selection for TAVR in patients with LF-LG AS.
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Affiliation(s)
- Nihal Wilde
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alexander Sedaghat
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology, and Angiology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Stephan Baldus
- Heart Center Cologne, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Verena Veulemans
- Department of Cardiology, Pulmonology, and Angiology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Vedat Tiyerili
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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Spieker M, Metze C, Kavsur R, Horn P, Iliadis C, Tiyerili V, Pfister R, Becher MU, Westenfeld R. Prognostic Value of the CHA 2DS 2-VASc Score in Patients Undergoing the MitraClip Procedure. JACC Cardiovasc Interv 2020; 12:2562-2564. [PMID: 31857031 DOI: 10.1016/j.jcin.2019.08.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 11/15/2022]
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Öztürk C, Becher MU, Kalkan A, Kavsur R, Weber M, Nickenig G, Tiyerili V. The modified MIDA-Score predicts mid-term outcomes after interventional therapy of functional mitral regurgitation. PLoS One 2020; 15:e0236265. [PMID: 32697799 PMCID: PMC7375538 DOI: 10.1371/journal.pone.0236265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 07/02/2020] [Indexed: 11/19/2022] Open
Abstract
Aims The preprocedural assessment of outcomes and patients’ prognosis after interventional therapy of functional MR (FMR) is uncertain. Therefore, we aim to develop an easy-to-handle scoring system for adequate prediction of individual outcomes in patients with FMR after the interventional treatment. Materials and methods We retrospectively used medical data of patients with symptomatic FMR, who underwent transcatheter mitral valve repair (TMVR) from January 2014 to August 2016 in our heart center. All patients had the mean follow-up of 18 months. All clinical and echocardiographic data originate from the “Bonner Mitral Valve Register Database”. Results We included 105 patients (76,7±8,8 years, 50,6% female) with symptomatic (NYHA functional class>II) moderate-to-severe or severe FMR at surgical high-risk. We modified the MIDA-Score for degenerative MR (DMR) according to the varying underlying pathomechanisms of FMR, called as “The modified MIDA Score”. We found all-cause mortality of 7% within 18 months after the procedure. 34,1% of our cohort was rehospitalized; 90% of those were due to cardiovascular causes. The modified MIDA score was found to be a strong predictor for mortality and rehospitalization in patients with FMR (AUC: 0,89) and superior to the other conventional scoring systems in prediction of mortality (The modified MIDA-Score: AUC: 0,8, EuroSCORE II: AUC: 0,57, STS-Score: AUC: 0,51). The logistic regression analysis showed the modified MIDA score > 9 points to be the strongest predictor for mortality and rehospitalization after TMVR (OR: 3,35, p = 0,011). Conclusion The modified MIDA score was found to be a promising, easy-to-handle, elementary scoring system for adequate prediction of individual postinterventional prognosis in patients with FMR undergoing TMVR. Further evaluation and validation of this novel scoring system in prospective multicentric studies with a large number of patients is warranted.
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Affiliation(s)
- Can Öztürk
- Heart Centre, Department of Cardiology, University Hospital Bonn, Bonn, Germany
- * E-mail:
| | - Marc Ulrich Becher
- Heart Centre, Department of Cardiology, University Hospital Bonn, Bonn, Germany
| | - Alev Kalkan
- Heart Centre, Department of Cardiology, University Hospital Bonn, Bonn, Germany
| | - Refik Kavsur
- Heart Centre, Department of Cardiology, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Heart Centre, Department of Cardiology, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Heart Centre, Department of Cardiology, University Hospital Bonn, Bonn, Germany
| | - Vedat Tiyerili
- Heart Centre, Department of Cardiology, University Hospital Bonn, Bonn, Germany
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Becher MU. Konzept der sequenziellen natriuretischen Peptidmessungen im Behandlungsplan der Herzinsuffizienz. Dtsch Med Wochenschr 2020; 145:458-463. [DOI: 10.1055/a-0976-8813] [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: 10/24/2022]
Abstract
Was ist neu?
NP-Grenzwert zur Diagnostik einer Herzinsuffizienz Von den klinisch verfügbaren Biomarkern sind die natriuretischen Peptide (NP) die robustesten Prädiktoren für die Diagnose und Prognose bei Herzinsuffizienz (HI). Der prognostische Wert ist insbesondere bei serieller Bestimmung der NP hoch, sodass der klinische Einsatz in internationalen HI-Leitlinien mit höchster Evidenz und Empfehlung weiter in den Vordergrund gerückt ist.
Strategie der sequenziellen NP-Messungen Das Konzept der sequenziellen NP-Messungen dient der Erfassung der Natrium- und Wasserüberladung zu klinisch definierten Zeitpunkten. Ziel eines NP-unterstützten Behandlungsplans ist, nicht nur die Dynamik des klinischen Therapieansprechens zu objektivieren, sondern den individuellen Therapieverlauf klinischen Szenarien zuzuordnen, die ihrerseits eine wesentliche Rolle für die Risikostratifizierung, Prognose und Notwendigkeiten von Therapieoptimierung in der stationären, aber auch ambulanten Versorgung spielen.
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Ozturk C, Vogelhuber J, Reckers D, Becher MU, Nickenig G, Weber M. 43 Echocardiographical analysis of right ventricular function after transcatheter edge-to-edge repair of tricuspid regurgitation. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.005] [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
Tricuspid regurgitation (TR) is a frequent valvular heart disease associated with increased mortality and morbidity. RV function is mostly assessed using tricuspid annulus plane systolic excursion (TAPSE), which shows merely systolic RV function and can be influenced by many other pathologies and image quality. Furthermore, the impact of dedicated percutaneous clip treatment of TR on RV global function and clinical outcomes are scarce.
We aim to perform detailed echocardiographical global RV function analysis inclusively speckle tracking of RV before and after transcatheter edge-to-edge repair of TR (TTVR).
We evaluated 50 patients, who underwent between January 2017 to March 2018 TTVR in our center. Apical four chamber images were used to perform strain analysis of RV. The systolic velocity of free RV wall (S´ Vmax) was measured through PW doppler on lateral TV annulus in color tissue Doppler. RV myocardial performance index is a parameter for systolic as well as diastolic ventricle function and can be calculated using ratio between TV closure to opening time and RV ejection time (RVCOT-RVET/RVET), which can be assessed from PW Doppler of lateral TV annulus in color tissue Doppler.
We retrospectively included 40 patients (73 ± 5.6 years, 32% female) with symptomatic (65% ascites, 95% edema, 100% NYHA > II) high grade functional TR at surgical high risk (EuroSCORE II: 7.6%). 95% of all interventions were successfully performed (TR reduction at least I grade).
Our collective shows normal baseline left ventricle (LV) systolic function (Ejection fraction: 60.8 ± 4.6%) with diastolic LV dysfunction and increased LV end systolic pressure (E/E´ ratio: 17.7 ± 6.5). Baseline RV analysis presented impaired RV systolic function (TAPSE: 1.2 ± 3.2 cm, RV-FAC: 25.6 ± 9.8%, S´ Vmax: 5.6 ± 1.2cm/s) with decreased RV global longitudinal strain (RV-GLS: -8.9 ± 4.3). RV myocardial performance index (RV-MPI) was 0.51 ± 0.4 as a parameter for poor global RV function. Baseline echocardiography showed dilation of both atria (Left atrium: 80.5 ± 14.5ml, right atrium: 26.7 ± 7.8cm2) with pronounced right ventricle congestion (dilated vena cava inferior: 25.5 ± 3.4mm without breath modulation, paradoxical intraventricular septum motion, dilated RV: 57.7 ± 14.5cm2). All TR were high grade (PISA: 0.78 ± 0.3cm, VC width: 0.8 ± 0.2cm, EROA: 0.43 ± 0.1cm2, regurgitant volume: 67.1 ± 10.4ml) and functional with mostly anteroseptal (85%) coaptation defect (coaptation defect diameter: .5.7 ± 3.2mm).
The right heart failure symptoms significantly improved three months after the procedure. Patients with severe right heart failure (TAPSE < 1cm) showed more often rehospitalization and limited improvements in symptoms (p = 0.02).
RV function should be more comprehensively evaluated before interventional TR therapy. The patients with already preprocedural severe right heart failure should be more critically discussed. RV-GLS and RV-MPI are strongest independent parameter of clinical outcome after TTVR.
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Affiliation(s)
- C Ozturk
- University Hospital Bonn, Cardiology, Pneumology and Angiology, Bonn, Germany
| | - J Vogelhuber
- University Hospital Bonn, Cardiology, Pneumology and Angiology, Bonn, Germany
| | - D Reckers
- University Hospital Bonn, Cardiology, Pneumology and Angiology, Bonn, Germany
| | - M U Becher
- University Hospital Bonn, Cardiology, Pneumology and Angiology, Bonn, Germany
| | - G Nickenig
- University Hospital Bonn, Cardiology, Pneumology and Angiology, Bonn, Germany
| | - M Weber
- University Hospital Bonn, Cardiology, Pneumology and Angiology, Bonn, Germany
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Aksoy A, Salazar C, Becher MU, Tiyerili V, Weber M, Jansen F, Sedaghat A, Zimmer S, Leick J, Grube E, Gonzalo N, Sinning JM, Escaned J, Nickenig G, Werner N. Intravascular Lithotripsy in Calcified Coronary Lesions. Circ Cardiovasc Interv 2019; 12:e008154. [DOI: 10.1161/circinterventions.119.008154] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background:
Optimal plaque preparation of calcified coronary lesions is key to prevent stent failure. The purpose of this study was to determine the strategy success and safety of intravascular lithotripsy (IVL) in calcified lesions of an all-comers cohort.
Methods:
Patients with calcified coronary lesions were screened in 3 centers. Seventy-one patients were eligible for IVL. Patients were assigned to (group A) primary IVL therapy for patients with calcified de-novo lesions (n=39 lesions), (group B) secondary IVL therapy for patients with calcified lesions in which noncompliant balloon dilatation failed (n=22 lesions), and (group C) tertiary IVL therapy in patients with stent underexpansion after previous stenting (n=17 lesions). Primary end point was strategy success (stent expansion with <20% in-stent residual stenosis) and safety outcomes (procedural complications, in-hospital major adverse cardiovascular event).
Results:
Seventy-eight calcified lesions were treated using the Shockwave C
2
balloon. Mean diameter stenosis of calcified lesions was 71.8±13.1% at baseline, decreased to 45.1±17.4% immediately after IVL, and to 17.5±15.2% after stenting. Mean minimal lumen diameter was 1.01±0.49 mm at baseline and increased to 1.90±0.61 after IVL, and to 2.88±0.56 mm after stenting. The primary end point of strategy success was reached in 84.6% (group A), 77.3% (group B), and 64.7% (group C). Device delivery and IVL treatment were possible in all lesions. Four type b dissections were observed without further sequelae. No patient suffered from in-hospital major adverse cardiovascular event. Seven Shockwave balloons ruptured during treatment without any sequelae.
Conclusions:
IVL provides a valid strategy for lesion preparation in severely calcified coronary lesions with high success rate, low procedural complications, and low major adverse cardiovascular event rates.
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Affiliation(s)
- Adem Aksoy
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.A., M.U.B., V.T., M.W., F.J., A.S., S.Z., E.G., J.-M.S., G.N.)
| | - Carlos Salazar
- Hospital Clinico San Carlos IdiSSC, Universidad Complutense, Madrid, Spain (C.S., N.G., J.E.)
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.A., M.U.B., V.T., M.W., F.J., A.S., S.Z., E.G., J.-M.S., G.N.)
| | - Vedat Tiyerili
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.A., M.U.B., V.T., M.W., F.J., A.S., S.Z., E.G., J.-M.S., G.N.)
| | - Marcel Weber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.A., M.U.B., V.T., M.W., F.J., A.S., S.Z., E.G., J.-M.S., G.N.)
| | - Felix Jansen
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.A., M.U.B., V.T., M.W., F.J., A.S., S.Z., E.G., J.-M.S., G.N.)
| | - Alexander Sedaghat
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.A., M.U.B., V.T., M.W., F.J., A.S., S.Z., E.G., J.-M.S., G.N.)
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.A., M.U.B., V.T., M.W., F.J., A.S., S.Z., E.G., J.-M.S., G.N.)
| | - Jürgen Leick
- Heart Center Trier, Krankenhaus der Barmherzigen Brüder Trier, Germany (J.L., N.W.)
| | - Eberhard Grube
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.A., M.U.B., V.T., M.W., F.J., A.S., S.Z., E.G., J.-M.S., G.N.)
| | - Nieves Gonzalo
- Hospital Clinico San Carlos IdiSSC, Universidad Complutense, Madrid, Spain (C.S., N.G., J.E.)
| | - Jan-Malte Sinning
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.A., M.U.B., V.T., M.W., F.J., A.S., S.Z., E.G., J.-M.S., G.N.)
| | - Javier Escaned
- Hospital Clinico San Carlos IdiSSC, Universidad Complutense, Madrid, Spain (C.S., N.G., J.E.)
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Germany (A.A., M.U.B., V.T., M.W., F.J., A.S., S.Z., E.G., J.-M.S., G.N.)
| | - Nikos Werner
- Heart Center Trier, Krankenhaus der Barmherzigen Brüder Trier, Germany (J.L., N.W.)
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Jansen F, Yang X, Hoyer FF, Paul K, Heiermann N, Becher MU, Hussein NA, Kebschull M, Bedorf J, Franklin BS, Latz E, Nickenig G, Werner N. Endothelial Microparticle Uptake in Target Cells Is Annexin I/Phosphatidylserine Receptor Dependent and Prevents Apoptosis. Arterioscler Thromb Vasc Biol 2012; 32:1925-35. [DOI: 10.1161/atvbaha.112.253229] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective—
Endothelial microparticles (EMP) are released from activated or apoptotic cells, but their effect on target cells and the exact way of incorporation are largely unknown. We sought to determine the uptake mechanism and the biological effect of EMP on endothelial and endothelial-regenerating cells.
Methods and Results—
EMP were generated from starved endothelial cells and isolated by ultracentrifugation. Caspase 3 activity assay and terminal deoxynucleotidyl transferase dUTP nick end labeling assay showed that EMP protect target endothelial cells against apoptosis in a dose-dependent manner. Proteomic analysis was performed to identify molecules contained in EMP, which might be involved in EMP uptake. Expression of annexin I in EMP was found and confirmed by Western blot, whereas the corresponding receptor phosphatidylserine receptor was present on endothelial target cells. Silencing either annexin I on EMP or phosphatidylserine receptor on target cells using small interfering RNA showed that the uptake of EMP by human coronary artery endothelial cells is annexin I/phosphatidylserine receptor dependent. Annexin I–downregulated EMP abrogated the EMP-mediated protection against apoptosis of endothelial target cells. p38 activation was found to mediate camptothecin-induced apoptosis. Finally, human coronary artery endothelial cells pretreated with EMP inhibited camptothecin-induced p38 activation.
Conclusion—
EMP are incorporated by endothelial cells in an annexin I/phosphatidylserine receptor–dependent manner and protect target cells against apoptosis. Inhibition of p38 activity is involved in EMP-mediated protection against apoptosis.
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Sivritas D, Becher MU, Ebrahimian T, Arfa O, Rapp S, Bohner A, Mueller CF, Umemura T, Wassmann S, Nickenig G, Wassmann K. Antiproliferative effect of estrogen in vascular smooth muscle cells is mediated by Kruppel-like factor-4 and manganese superoxide dismutase. Basic Res Cardiol 2011; 106:563-75. [PMID: 21484412 DOI: 10.1007/s00395-011-0174-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [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: 01/15/2010] [Revised: 03/08/2011] [Accepted: 03/22/2011] [Indexed: 12/29/2022]
Abstract
The mitochondrial antioxidant enzyme manganese superoxide dismutase (MnSOD) and the zinc finger transcription factor Kruppel-like factor-4 (KLF4) are involved in the regulation of redox homeostasis, apoptosis and cell proliferation. We have shown that estrogen exerts antioxidative actions via induction of MnSOD in cultured rat aortic vascular smooth muscle cells (VSMC). The purpose of the present study was to investigate whether estrogen inhibits VSMC proliferation via alteration of KLF4 and MnSOD expression. In cultured rat aortic VSMC, estrogen binding to estrogen receptor-alpha led to rapid increase in KLF4 expression and reduction of cell proliferation by 50%. Protein separation revealed that KLF4 was shifted to the nucleus when VSMC were treated with estrogen. Estrogen-mediated induction of KLF4 and the antiproliferative effect involved activation of PI-3 kinase, Akt phosphorylation and induction of NO synthase activity. Experiments in freshly isolated denuded aortic segments revealed an increase in KLF4 abundance after estrogen treatment and demonstrated that eNOS is expressed in the media at low levels. Transfection experiments showed that estrogen-induced overexpression of MnSOD required KLF4 and that both KLF4 and MnSOD were indispensable for the observed antiproliferative effect of estrogen in VSMC. To confirm these data in vivo, we investigated neointima formation after carotid artery injury in wild-type (WT) and MnSOD+/- mice. Estrogen deficiency led to enhanced neointima formation and higher numbers of Ki67-positive proliferating cells in the neointima of ovariectomized WT and MnSOD+/- mice. Moreover, MnSOD+/- mice showed more extensive neointima formation and Ki67 immunostaining. Interestingly, estrogen replacement prevented neointima formation in WT mice but failed to completely inhibit neointima formation in MnSOD+/- mice. Cultured VSMC derived from MnSOD+/- mice showed enhanced proliferation as compared to WT VSMC, and estrogen treatment failed to inhibit proliferation in MnSOD+/- VSMC. In conclusion, these data demonstrate the importance of MnSOD and KLF4 for proliferation control in VSMC. Our results provide novel insights into how proliferation of VSMC is regulated by estrogen and may help to identify novel targets for the treatment of vascular diseases such as restenosis.
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Affiliation(s)
- Derya Sivritas
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Sigmund-Freud-Strasse 25, Bonn, Germany
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