Prevalence and prognosis of mitral disease due to mitral annular calcification

Abstract Background While mitral annular calcification (MAC) is associated with valvular regurgitation or stenosis, this disease entity remains poorly understood. Purpose We sought to evaluate the prevalence and outcomes of patients with MAC. Methods Between January 2014 and December 2015, we reviewed all patients who underwent transthoracic echocardiography (TTE), and were identified as having MAC with either mitral regurgitation (MR) or stenosis (MS). Medical records were manually examined for demographics, morbidities, type and severity of mitral disease, and clinical outcomes for this cohort. Results Of 41,136 patients who had undergone TTE, MAC was identified in 2,855 (6.9%) patients, including 434 (1.0%) patients who had significant concomitant MR or MS (mean age, 78.9±10.4 years; 63% women). Severe heart failure (NYHA III or IV, 37%), renal failure (mean GFR, 47.3±15.7 ml/min), aortic stenosis (26% with severe stenosis or prior aortic intervention), diabetes (35%), and atrial fibrillation (50%) were common. The mean mitral gradient was 6.2±3.0 mmHg. Fifty-eight patients (13%) underwent surgical or transcatheter mitral valve intervention, with two procedural deaths (3.4%). Overall, the 3-year survival free of all-cause mortality was 53.9%, while freedom from all-cause mortality, hospitalization for heart failure, myocardial infarction and cerebrovascular accident was only 26.5% (Figure 1). Three-year survival free of all-cause mortality for those who had surgery or transcatheter therapy was better in comparison to those treated medically (77.6% vs. 50.3%; p<0.001). Conclusions Patients with MAC with MR or MS are common, have severe co-morbidities, and have poor long-term survival. Further study is needed to improve the clinical outcomes of these patients. KM curves for MAC and MR/MS patients Funding Acknowledgement Type of funding source: None

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Multidisciplinary Cardiac Rehabilitation and Long-Term Prognosis in Patients With Heart Failure

Circulation Heart Failure ◽

10.1161/circheartfailure.119.006798 ◽

2020 ◽

Vol 13 (10) ◽

Cited By ~ 1

Author(s):

Kentaro Kamiya ◽

Yukihito Sato ◽

Tetsuya Takahashi ◽

Miyuki Tsuchihashi-Makaya ◽

Norihiko Kotooka ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Cardiac Rehabilitation ◽

Preserved Ejection Fraction ◽

Composite Outcome ◽

Term Survival ◽

Patients With Heart Failure ◽

All Cause Mortality ◽

Related Quality

Background: Exercise-based cardiac rehabilitation (CR) improves health-related quality of life and exercise capacity in patients with heart failure (HF). However, CR efficacy in patients with HF who are elderly, frail, or have HF with preserved ejection fraction remains unclear. We examined whether participation in multidisciplinary outpatient CR is associated with long-term survival and rehospitalization in patients with HF, with subgroup analysis by age, sex, comorbidities, frailty, and HF with preserved ejection fraction. Methods: This multicenter retrospective cohort study was performed in patients hospitalized for acute HF at 15 hospitals in Japan, 2007 to 2016. The primary outcome (composite of all-cause mortality and HF rehospitalization after discharge) and secondary outcomes (all-cause mortality and HF rehospitalization) were analyzed in outpatient CR program participants versus nonparticipants. Results: Of the 3277 patients, 26% (862) participated in outpatient CR. After propensity matching for potential confounders, 1592 patients were included (n=796 pairs), of which 511 had composite outcomes (223 [14%] all-cause deaths and 392 [25%] HF rehospitalizations, median 2.4-year follow-up). Hazard ratios associated with CR participation were 0.77 (95% CI, 0.65–0.92) for composite outcome, 0.67 (95% CI, 0.51–0.87) for all-cause mortality, and 0.82 (95% CI, 0.67–0.99) for HF-related rehospitalization. CR participation was also associated with numerically lower rates of composite outcome in patients with HF with preserved ejection fraction or frail patients. Conclusions: Outpatient CR participation was associated with substantial prognostic benefit in a large HF cohort regardless of age, sex, comorbidities, frailty, and HF with preserved ejection fraction.

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Long-term survival in severe heart failure in patients treated with enalapril; ten year follow-up of CONSENSUS I

European Heart Journal ◽

10.1053/euhj.1998.1098 ◽

1999 ◽

Vol 20 (2) ◽

pp. 136-139 ◽

Cited By ~ 124

Author(s):

K Swedberg

Keyword(s):

Heart Failure ◽

Severe Heart Failure ◽

Term Survival ◽

Long Term Survival

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Early and long-term outcomes comparing neonates, infants, and preadolescents requiring extracorporeal membrane oxygenation for heart failure

Perfusion ◽

10.1177/0267659119876800 ◽

2019 ◽

Vol 35 (4) ◽

pp. 323-330

Author(s):

Anton Sabashnikov ◽

Julia Merkle ◽

Farid Azizov ◽

Ilija Djordjevic ◽

Kaveh Eghbalzadeh ◽

...

Keyword(s):

Heart Failure ◽

Extracorporeal Membrane Oxygenation ◽

Odds Ratio ◽

Pediatric Patients ◽

Elective Surgery ◽

Severe Heart Failure ◽

Term Survival ◽

Long Term Survival ◽

Membrane Oxygenation

Background: Application of extracorporeal membrane oxygenation in pediatric patients with severe heart failure steadily increases. Differentiation of outcomes and survival of diverse pediatric groups is of interest for adequate therapy. Methods: Between January 2008 and December 2016, a total of 39 pediatric patients needed veno-arterial extracorporeal membrane oxygenation support in our department. Patients were retrospectively divided into three groups: neonates (<30 days), infants (>30 days/<1 year), and toddlers/preadolescents (>1 year). Early outcomes as well as mid- and long-term survival up to 7-year follow-up were analyzed. Results: Basic demographics significantly differed in terms of age, height, and weight among the groups in accordance with the intended group categorization (p < 0.05). Survival after 30 days of extracorporeal membrane oxygenation application was equally distributed among the groups, and 44% of all patients survived. In terms of survival to discharge, no significant differences were found among groups. In total, 28% of patients survived up to 7 years. Infants were significantly more likely to undergo elective surgery (p < 0.001) and were predominantly weaned off extracorporeal membrane oxygenation, whereas need for urgent surgery (p < 0.001) was significantly higher in neonate group in comparison to other groups. Multinominal logistic regression analysis revealed significantly higher odds for need for re-exposure in infant group in comparison to toddler/preadolescent group as well as for incidence of neurological impairment of toddler/preadolescent group in comparison to neonate group (odds ratio = 14.67, p = 0.009 and odds ratio = 34.67, p = 0.004, respectively). Kaplan–Meier survival estimation analysis revealed no significant differences in terms of mid- and long-term survival among the groups (Breslow p = 0.198 and log-rank p = 0.213, respectively). Conclusion: Veno-arterial extracorporeal membrane oxygenation is a lifesaving therapeutic chance for pediatric patients in the setting of either failure to wean from cardiopulmonary bypass or failed resuscitation from cardiac arrest. A fair part of patients could be saved by using this technology. Survival rate among the groups was similar.

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Long-term clinical outcomes of troponin-positive chest pain and unobstructed coronary arteries assessed by cardiovascular magnetic resonance imaging

European Heart Journal ◽

10.1093/ehjci/ehaa946.1805 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R Ananthakrishna ◽

R Woodman ◽

S Grover ◽

C Bridgman ◽

J Selvanayagam

Keyword(s):

Heart Failure ◽

Cardiovascular Magnetic Resonance ◽

Chest Pain ◽

Magnetic Resonance ◽

Confidence Interval ◽

Clinical Outcomes ◽

Coronary Arteries ◽

Hazard Ratio ◽

All Cause Mortality

Abstract Background and introduction Troponin-positive chest pain with unobstructed coronary arteries is a distinct entity with different pathophysiological causes. We have previously reported on the incremental diagnostic capability of cardiovascular magnetic resonance (CMR) in this cohort. However, there is paucity of literature on the long-term clinical outcomes of these patients assessed with CMR. Objectives Using the unique cohort of patients previously studied, we sought to assess the long-term clinical outcomes in patients with troponin-positive chest pain and unobstructed coronary arteries, as graded by their acute CMR presentation. Methods A total of 122 consecutive patients with troponin-positive chest pain and unobstructed coronary arteries undergoing CMR assessment during the acute admission (2010–2014) were studied. The primary endpoint was major adverse cardiac event (MACE), defined as a composite of all-cause mortality and cardiovascular readmissions (heart failure, acute myocardial infarction [AMI], atrial or ventricular arrhythmia and stroke). Patients were grouped into 4 categories based on their initial CMR findings: AMI, acute myocarditis, Takotsubo cardiomyopathy and normal CMR. Results The mean age of the study cohort was 55.6±16.5 years and 56.5% were women. CMR (performed at a median of 6 days from presentation) provided a diagnosis in 87% of the patients (38% myocarditis, 28% Takotsubo cardiomyopathy and 21% AMI). Patients with a diagnosis of AMI were prescribed guideline recommended medical therapy. Over a median follow-up of 2524 days (6.9 years), 32 (26.2%) patients experienced a MACE. The all-cause mortality was 2.5%. The most common indication for cardiovascular readmissions in this cohort was heart failure (12.3%) and AMI (9%). In multivariate analysis, a CMR diagnosis of AMI (hazard ratio = 2.6; 95% confidence interval = 1.2, 5.7; p=0.019) and peak troponin (hazard ratio = 1.0003; 95% confidence interval = 1.00003, 1.0006; p=0.028) were significantly associated with MACE after adjusting for age and gender. In addition, CMR diagnosis of AMI was significantly associated with a lower event-free survival rate compared with a diagnosis of non-AMI (adjusted hazard ratio = 2.57, p=0.019) (Figure). Conclusions The long-term prognosis of patients with troponin-positive chest pain and unobstructed coronary arteries is not benign. CMR diagnosis of AMI is a significant predictor of MACE even in the absence of significant coronary artery obstruction and despite guideline recommended post AMI therapy. Figure 1 Funding Acknowledgement Type of funding source: None

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Complications and prognosis of patients undergoing apical or septal right ventricular pacing

Open Heart ◽

10.1136/openhrt-2018-000962 ◽

2019 ◽

Vol 6 (1) ◽

pp. e000962 ◽

Cited By ~ 1

Author(s):

Nick B Spath ◽

Kelvin Wang ◽

Sowmya Venkatasumbramanian ◽

Omar Fersia ◽

David E Newby ◽

...

Keyword(s):

Heart Failure ◽

Right Ventricular ◽

Clinical Outcomes ◽

Primary Endpoint ◽

Complication Rates ◽

Lead Placement ◽

Ventricular Lead ◽

All Cause Mortality ◽

Secondary Endpoints

ObjectivesOptimal right ventricular lead placement remains controversial. Large studies investigating the safety and long-term prognosis of apical and septal right ventricular lead placement have been lacking.MethodsConsecutive patients undergoing pacemaker insertion for high-degree atrioventricular block at Edinburgh Heart Centre were investigated. Periprocedural 30-day complications were defined (infection/bleeding/pneumothorax/tamponade/lead displacement). Long-term clinical outcomes were obtained from the General Register of Scotland and electronic medical records. The primary endpoint was a composite of all-cause mortality, new heart failure, hospitalisation for a major cardiovascular event, as per the CArdiac REsynchronization in Heart Failure trial. Secondary endpoints were all-cause mortality, new heart failure and their composite.Results820 patients were included, 204 (25%) paced from the septum and 616 (75%) from the apex. All baseline variables were similar with the exception of age (septal: 73.2±1.1 vs apical: 76.9±0.5 years, p<0.001). Procedure duration (58±23 vs 55±25 min, p=0.3), complication rates (18 (8.8) vs 46 (7.5)%, p=0.5) and postimplant QRS duration (152 (23) vs 154 (27) ms, p=0.4) were similar. After 1041 days (IQR 564), 278 patients met the primary endpoint, with no difference between the septal and apical groups in unadjusted (HR 0.86 (95% CIs 0.64 to 1.15)) or multivariable analysis correcting for age, gender and comorbidity (HR 0.97 (95% CI 0.72 to 1.30)). Similarly, no differences were observed in the secondary endpoints.ConclusionsThis large real-world cohort of patients undergoing right ventricular lead placement in the septum or apex demonstrated no difference in procedural complications nor long-term clinical outcomes. Both pacing strategies appear reasonable in routine practice.

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