scholarly journals TAVI in Patients with Mitral Annular Calcification and/or Mitral Stenosis

2020 ◽  
Author(s):  
Andreas Schaefer ◽  
Harun Sarwari ◽  
Niklas Schofer ◽  
Yvonne Schneeberger ◽  
Dirk Westermann ◽  
...  
Keyword(s):  
Mitral Stenosis ◽  
Cox Regression ◽  
Diastolic Pressure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Operating Characteristics ◽  
Mitral Annular Calcification ◽  
Ventricular Ejection Fraction ◽  
Transcatheter Aortic Valve ◽  
Annular Calcification

Abstract Background We herein aimed for analysis of influence of mitral annular calcification (MAC) and mitral stenosis (MS) on outcomes in transcatheter aortic valve implantation (TAVI). Methods Between 11/2009 and 06/2017, 1,058 patients underwent TAVI in the presence of concomitant MAC or MS at our center. Subgroups were built and multivariate logistic regression, COX regression, Kaplan–Meier survival analyses, and receiver operating characteristics method were performed. Results Thirty-day mortality was 7.5% (79/1,058) with highest mortality in patients severe MS (MAC: 3.4% vs. mild MS: 5.9% vs. moderate MS: 15.0% vs. severe MS: 72.7%; p < 0.001). Moderate-to-severe MS (odds ratio [OR]: 7.75, confidence interval [CI]: 3.94–16.26, p < 0.001), impaired left ventricular ejection fraction (OR: 1.38, CI: 1.10–1.72, p < 0.01), and coronary artery disease (OR: 1.36, CI: 1.11–1.67, p < 0.01) were predictive of 30-day survival. Left ventricular systolic/end-diastolic pressure drop of <59.5 mm Hg / <19.5 mm Hg was associated with increased mortality. Conclusions TAVI in the presence of MAC and mild MS is associated with acceptable acute outcomes but should be considered high-risk procedures in patients with moderate and especially those with severe MS. Our results suggest adverse hemodynamics after TAVI with concomitant MS, which may be caused by underfilling of the left ventricle leading to low-cardiac output.

Sex differences in transaortic flow rate and association with all-cause mortality in patients with severe aortic stenosis

2021 ◽  
Author(s):  
Sahrai Saeed ◽  
Anastasia Vamvakidou ◽  
Spyridon Zidros ◽  
George Papasozomenos ◽  
Vegard Lysne ◽  
...  
Keyword(s):  
Sex Differences ◽  
Aortic Stenosis ◽  
Flow Rate ◽  
Cox Regression ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Aims It is not known whether transaortic flow rate (FR) in aortic stenosis (AS) differs between men and women, and whether the commonly used cut-off of 200 mL/s is prognostic in females. We aimed to explore sex differences in the determinants of FR, and determine the best sex-specific cut-offs for prediction of all-cause mortality. Methods and results Between 2010 and 2017, a total of 1564 symptomatic patients (mean age 76 ± 13 years, 51% men) with severe AS were prospectively included. Mean follow-up was 35 ± 22 months. The prevalence of cardiovascular disease was significantly higher in men than women (63% vs. 42%, P &lt; 0.001). Men had higher left ventricular mass and lower left ventricular ejection fraction compared to women (both P &lt; 0.001). Men were more likely to undergo an aortic valve intervention (AVI) (54% vs. 45%, P = 0.001), while the death rates were similar (42.0% in men and 40.6% in women, P = 0.580). A total of 779 (49.8%) patients underwent an AVI in which 145 (18.6%) died. In a multivariate Cox regression analysis, each 10 mL/s decrease in FR was associated with a 7% increase in hazard ratio (HR) for all-cause mortality (HR 1.07; 95% CI 1.03–1.11, P &lt; 0.001). The best cut-off value of FR for prediction of all-cause mortality was 179 mL/s in women and 209 mL/s in men. Conclusion Transaortic FR was lower in women than men. In the group undergoing AVI, lower FR was associated with increased risk of all-cause mortality, and the optimal cut-off for prediction of all-cause mortality was lower in women than men.

scholarly journals IMPULSE: the impact of gender on the presentation and management of aortic stenosis across Europe

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001443
Author(s):  
Richard Paul Steeds ◽  
David Messika-Zeitoun ◽  
Jeetendra Thambyrajah ◽  
Antonio Serra ◽  
Eberhard Schulz ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Surgical Aortic Valve Replacement ◽  
Ventricular Ejection Fraction ◽  
Patient Profile ◽  
Transcatheter Aortic Valve ◽  
The Impact

AimsThere is an increasing awareness of gender-related differences in patients with severe aortic stenosis and their outcomes after surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI).MethodsData from the IMPULSE registry were analysed. Patients with severe aortic stenosis (AS) were enrolled between March 2015 and April 2017 and stratified by gender. A subgroup analysis was performed to assess the impact of age.ResultsOverall, 2171 patients were enrolled, and 48.0% were female. Women were characterised by a higher rate of renal impairment (31.7 vs 23.3%; p<0.001), were at higher surgical risk (EuroSCORE II: 4.5 vs 3.6%; p=0.001) and more often in a critical preoperative state (7.0vs 4.2%; p=0.003). Men had an increased rate of previous cardiac surgery (9.4 vs 4.7%; p<0.001) and a reduced left ventricular ejection fraction (4.9 vs 1.3%; p<0.001). Concomitant mitral and tricuspid valve disease was substantially more common among women. Symptoms were highly prevalent in both women and men (83.6 vs 77.3%; p<0.001). AVR was planned in 1379 cases. Women were more frequently scheduled to undergo TAVI (49.3 vs 41.0%; p<0.001) and less frequently for SAVR (20.3 vs 27.5%; p<0.001).ConclusionsThe present data show that female patients with severe AS have a distinct patient profile and are managed in a different way to males. Gender-based differences in the management of patients with severe AS need to be taken into account more systematically to improve outcomes, especially for women.

scholarly journals Effects of peak time of myocardial injury biomarkers on mid-term outcomes of patients undergoing OPCABG

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bo Hu ◽  
Fei Gao ◽  
Mengwei Lv ◽  
Ban Liu ◽  
Yu Shi ◽  
...  
Keyword(s):  
Myocardial Injury ◽  
Cox Regression ◽  
Troponin T ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Peak Time ◽  
Clinical Trial Registry ◽  
Ventricular Ejection Fraction ◽  
The Impact

Abstract Background With the development of cardiac surgery techniques, myocardial injury is gradually reduced, but cannot be completely avoided. Myocardial injury biomarkers (MIBs) can quickly and specifically reflect the degree of myocardial injury. Due to various reasons, there is no consensus on the specific values of MIBs in evaluating postoperative prognosis. This retrospective study was aimed to investigate the impact of MIBs on the mid-term prognosis of patients undergoing off-pump coronary artery bypass grafting (OPCABG). Methods Totally 564 patients undergoing OPCABG with normal courses were included. Cardiac troponin T (cTnT) and creatine kinase myocardial band (CK-MB) were assessed within 48 h before operation and at 6, 12, 24, 48, 72, 96 and 120 h after operation. Patients were grouped by peak values and peak time courses of MIBs. The profile of MIBs and clinical variables as well as their correlations with mid-term prognosis were analyzed by univariable and multivariable Cox regression models. Result Continuous assessment showed that MIBs increased first (12 h after surgery) and then decreased. The peak cTnT and peak CK-MB occurred within 24 h after operation in 76.8% and 67.7% of the patients respectively. No significant correlation was found between CK-MB and mid-term mortality. Delayed cTnT peak (peak cTnT elevated after 24 h after operation) was correlated with lower creatinine clearance rate (69.36 ± 21.67 vs. 82.18 ± 25.17 ml/min/1.73 m2), body mass index (24.35 ± 2.58 vs. 25.27 ± 3.26 kg/m2), less arterial grafts (1.24 ± 0.77 vs. 1.45 ± 0.86), higher EuroSCORE II (2.22 ± 1.12 vs.1.72 ± 0.91) and mid-term mortality (26.5 vs.7.9%). Age (HR: 1.067, CI: 1.006–1.133), left ventricular ejection fraction (HR: 0.950, CI: 0.910–0.993), New York Heart Association score (HR: 1.839, CI: 1.159–2.917), total venous grafting (HR: 2.833, CI: 1.054–7.614) and cTnT peak occurrence within 24 h (HR: 0.362, CI: 0.196–0.668) were independent predictors of mid-term mortality. Conclusion cTnT is a better indicator than CK-MB. The peak value and peak occurrence of cTnT are related to mid-term mortality in patients undergoing OPCABG, and the peak phases have stronger predictive ability. Trial registration: Chinese Clinical Trial Registry, ChiCTR2000033850. Registered 14 June 2020, http://www.chictr.org.cn/edit.aspx?pid=55162&htm=4.

Abstract 16974: Gender Differences in Patients Undergoing Transcatheter Aortic Valve Replacement: a Single Center Experience

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Josephine L Warren ◽  
Usman Baber ◽  
Jennifer Yu ◽  
Melissa Aquino ◽  
Arjun Bhat ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Mortality Rates ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Transcatheter Aortic Valve ◽  
Mount Sinai

Background: Current data suggest that women experience different outcomes to men following transcatheter aortic valve replacement (TAVR). We reviewed the Mount Sinai valve database to compare men and women undergoing TAVR according to procedural characteristics and outcomes. Methods: 124 patients underwent TAVR at Mount Sinai from May 2012-2014. All patients received Edwards Sapien valves. Follow-up was conducted at 30-days. Results: Women accounted for 61% (n=76) of the TAVR cohort. The mean age of women was 80.7, and 82.2 for men (p=0.30). Men were more likely to have undergone previous cardiac bypass surgery and were more likely to be on dialysis and have a pacemaker or intra-cardiac defibrillator in-situ (27.1% vs. 7.9%, p=0.004). Women had lower baseline hemoglobin. These disparities did not translate to differences in STS Risk Score or EuroScore. In women, the aortic annulus (21.2mm vs. 23.4mm, p<0.0001), left atrial (24.6mm vs. 27.2mm, p = 0.02) and left ventricular (3.09mm vs. 4.11mm, p<0.001) areas were smaller, as was the ilio-femoral artery diameter (7.4mm vs. 8.03mm, p=0.02). In contrast, men had a lower left ventricular ejection fraction (49.9% vs. 57.6%, p=0.004) and mean aortic valve gradient (43.5mmHg vs. 48.8mmHg, p=0.004). Procedural length did not differ between genders, nor did the method of approach. Women were less likely to experience conduction complications requiring pacemaker insertion both intra-procedurally (2.6% vs. 12.5%, p=0.03) and 30-days post-discharge (2.7% vs. 13.2%, p = 0.03). Women were more likely to receive in-hospital transfusion (51.3% vs. 18.8%, p=0.0003), but mortality rates did not differ between genders (7.0% vs. 6.7%, p=0.5). Conclusion: Despite discrepancies in some important pre-procedural parameters, as well as rates of post-procedural conduction abnormalities and in-hospital transfusion, these did not translate into differences in mortality rates between genders in patients undergoing TAVR.

scholarly journals 566 Myocardial left ventricular mechanical uniformity and adverse cardiac events following myocardial infarction

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
T Stiermaier ◽  
S J Backhaus ◽  
T Lange ◽  
A Koschalka ◽  
J L Navarra ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cox Regression ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Events ◽  
Prognostic Information ◽  
Ventricular Ejection Fraction ◽  
Cox Regression Analysis ◽  
Multicenter Observational Study ◽  
Adverse Cardiac Events

Abstract Background Despite limitations as a standalone parameter, left ventricular ejection fraction (LVEF) is the preferred measure of myocardial function and marker for post-infarction risk stratification. LV myocardial uniformity may provide superior prognostic information after acute myocardial infarction (AMI), which was subject of this study. Methods and Results: Consecutive patients with AMI (n = 1082; median age 63 years; 75% male) undergoing cardiac magnetic resonance (CMR) in median 3 days after infarction were included in this multicenter, observational study. Circumferential and radial uniformity ratio estimates (CURE and RURE) were derived from CMR feature-tracking as markers of mechanical uniformity (values between 0 and 1 with 1 reflecting perfect uniformity). The clinical endpoint was the 12-month rate of major adverse cardiac events (MACE), consisting of all-cause death, re-infarction, and new congestive heart failure. Patients with MACE (n = 73) had significantly impaired CURE [0.76 (IQR 0.67-0.86) versus 0.84 (IQR 0.76-0.89); p &lt; 0.001] and RURE [0.69 (IQR 0.60-0.79) versus 0.76 (IQR 0.67-0.83); p &lt; 0.001] compared to patients without events. While uniformity estimates did not provide independent prognostic information in the overall cohort, CURE below the median of 0.84 emerged as an independent predictor of outcome in post-infarction patients with LVEF &gt;35% (n = 959) even after adjustment for established prognostic markers (hazard ratio 1.99; 95% confidence interval 1.06-3.74; p = 0.033 in stepwise multivariable Cox regression analysis). In contrast, LVEF was not associated with adverse events in this subgroup of AMI patients. Conclusions CMR-derived estimates of mechanical uniformity are novel markers for risk assessment after AMI and CURE provides independent prognostic information in patients with preserved or only moderately reduced LVEF.

P3451Female gender is an independent predictor of one-year mortality following primary angioplasty for ST-segment elevation myocardial infarction, regardless of age, clinical severity and frailty

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M C Viana-Llamas ◽  
A Silva-Obregon ◽  
R Arroyo Espliguero ◽  
A Estrella-Alonso ◽  
S Saboya-Sanchez ◽  
...  
Keyword(s):  
Cox Regression ◽  
Female Gender ◽  
Left Ventricular ◽  
Clinical Severity ◽  
Left Ventricular Ejection ◽  
Clinical Frailty Scale ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Gender Based ◽  
One Year

Abstract Background Gender-based differences in mortality of patients with ST-segment elevation myocardial infarction (STEMI) have been reported. However, controversy exists about the impact of female gender on mortality after correcting for baseline risk differences. Purpose Assess gender-based mortality in a cohort of STEMI patients following primary angioplasty. Methods Retrospective cohort of 427 consecutive STEMI patients (64 years [55–75]; 78% men) admitted to a general ICU between November-2013 and February-2017. We used Kaplan-Meier and Cox regression models for survival analysis. The Clinical Frailty Scale (CFS) was used to assess frailty. Results Women were older and had a higher GRACE 2.0 and frailty (CFS≥4). Women had lower creatine-phosphokinase and albumin levels and higher B-natriuretic peptide levels, despite the lack of gender-based differences in left ventricular ejection fraction (LVEF) and MI size and location. One-year mortality rate was higher in women, most often from cardiogenic shock during admission and at 30-day follow-up (Table). After Cox regression analysis, women had a 2.23-fold higher risk of one-year mortality compared with men (Figure), independently of age, frailty, GRACE 2.0, LVEF and inotropic agents requirements. Baseline characteristics Women (n=93) Men (n=334) P value One-year mortality, n (%) 15 (16.1) 15 (4.5) <0.001 Cardiogenic shock, n (%) 10 (62.5) 6 (37.5) <0.001 Age (years) 70.8 [51.2–80.3] 61.9 [54.2–71.8] <0.001 Hypertension, n (%) 54 (58.1) 149 (44.6) 0.022 GRACE 2.0 129 [104.5–156] 112 [94–139] 0.001 Clinical Frailty Scale≥4, n (%) 28 (30.1) 32 (9.6) <0.001 MI location (anterior), n (%) 42 (45.2) 152 (45.5) 0.953 Creatin-phosphokinase (UI/L) 1040 [300.5–2134] 1517 [620.5–2852.8] 0.004 High-sensitivity troponin I (pg/mL) 4003 [62.1–48526.6] 9070 [65.8–65893] 0.473 Left ventricular ejection fraction (%) 52 [40–60] 55 [45–60] 0.465 B-natriuretic peptide (pg/mL) 241.1 [99.9–896.9] 103.6 [28.3–259.2] <0.001 Albumin (g/L) 36.1 [34.3–38.5] 38.4 [35.6–40.5] <0.001 Inotropic agents, n (%) 14 (15.1) 26 (7.8) 0.033 Kaplan-Meier and Cox survival curves. Conclusions Female gender is an independent predictor of one-year mortality in STEMI patients, regardless of age, clinical severity and frailty. A potential myocardial disfunction probably mediated by an increased frailty, may play a role in the high mortality rate among women after STEMI.

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