Clinical impact of antithrombotic therapy in transvenous lead extraction complications: a sub-analysis from the ESC-EORP EHRA ELECTRa (European Lead Extraction ConTRolled) Registry

Aims A sub-analysis of the ESC-EHRA European Lead Extraction ConTRolled (ELECTRa) Registry to evaluate the clinical impact of antithrombotic (AT) on transvenous lead extraction (TLE) safety and efficacy. Methods and results ELECTRa outcomes were compared between patients without AT therapy (No AT Group) and with different pre-operative AT regimens, including antiplatelets (AP), anticoagulants (AC), or both (AP + AC). Out of 3510 pts, 2398 (68%) were under AT pre-operatively. AT patients were older with more comorbidities (P < 0.0001). AT subgroups, defined as AP, AC, or AP + AC, were 1096 (31.2%), 985 (28%), and 317 (9%), respectively. Regarding AP patients, 1413 (40%) were under AP, 1292 (91%) with a single AP, interrupted in 26% about 3.8 ± 3.7 days before TLE. In total, 1302 (37%) patients were under AC, 881 vitamin K antagonist (68%), 221 (17%) direct oral anticoagulants, 155 (12%) low weight molecular heparin, and 45 (3.5%) unfractionated heparin. AC was ‘interrupted without bridging’ in 696 (54%) and ‘interrupted with bridging’ in 504 (39%) about 3.3 ± 2.3 days before TLE, and ‘continued’ in 87 (7%). TLE success rate was high in all subgroups. Only overall in-hospital death (1.4%), but not the procedure-related one, was higher in the AT subgroups (P = 0.0500). Age >65 years and New York Heart Association Class III/IV, but not AT regimens, were independent predictors of death for any cause. Haematomas were more frequent in AT subgroups, especially in AC ‘continued’ (P = 0.025), whereas pulmonary embolism in the No-AT (P < 0.01). Conclusions AT minimization is safe in patients undergoing TLE. AT does not seem to predict death but identifies a subset of fragile patients with a worse in-hospital TLE outcome.

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Transcatheter Aortic Valve Replacement for Degenerated Transcatheter Aortic Valves: The TRANSIT International Project

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.120.010440 ◽

2021 ◽

Author(s):

Luca Testa ◽

Mauro Agnifili ◽

Nicolas M. Van Mieghem ◽

Didier Tchétché ◽

Anita W. Asgar ◽

...

Keyword(s):

New York ◽

Transcatheter Aortic Valve Replacement ◽

Heart Association ◽

York Heart Association Class ◽

Class Iii ◽

Transcatheter Aortic Valve ◽

Significant Difference ◽

Association Class ◽

New York Heart Association ◽

Overall Mortality

Background: Transcatheter aortic valve replacement (TAVR) has determined a paradigm shift in the treatment of patients with severe aortic stenosis. However, the durability of bioprostheses is still a matter of concern, and little is known about the management of degenerated TAV. We sought to evaluate the outcomes of patients with a degenerated TAV treated by means of a second TAVR. Methods: The TRANSIT is an international registry that included cases of degenerated TAVR from 28 centers. Among around 40 000 patients treated with TAVR in the participating centers, 172 underwent a second TAVR: 57 (33%) for a mainly stenotic degenerated TAV, 97 (56%) for a mainly regurgitant TAV, and 18 (11%) for a combined degeneration. Overall, the rate of New York Heart Association class III/IV at presentation was 73.5%. Results: Valve Academic Research Consortium 2 device success rate was 79%, as a consequence of residual gradient (14%) or regurgitation (7%). At 1 month, the overall mortality rate was 2.9%, while rates of new hospitalization and New York Heart Association class III/IV were 3.6% and 7%, respectively, without significant difference across the groups. At 1 year, the overall mortality rate was 10%, while rates of new hospitalization and New York Heart Association class III/IV were 7.6% and 5.8%, respectively, without significant difference across the groups. No cases of valve thrombosis were recorded. Conclusions: Selected patients with a degenerated TAV may be safely and successfully treated by means of a second TAVR. This finding is of crucial importance for the adoption of the TAVR technology in a lower risk and younger population. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04500964.

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Efficacy and safety of crataegus extract WS 1442 in comparison with placebo in patients with chronic stable New York Heart Association class-III heart failure

American Heart Journal ◽

10.1067/mhj.2002.121463 ◽

2002 ◽

Vol 143 (5) ◽

pp. 910-915 ◽

Cited By ~ 64

Author(s):

Michael Tauchert

Keyword(s):

Heart Failure ◽

New York ◽

Heart Association ◽

York Heart Association Class ◽

Efficacy And Safety ◽

Class Iii ◽

Association Class ◽

New York Heart Association

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CardioMEMS Implantation Using Gadolinium-based Contrast Agent: A Case Report

Cardiac Failure Review ◽

10.15420/cfr.2021.03 ◽

2021 ◽

Vol 7 ◽

Author(s):

Aniket S Rali ◽

Lynne W Stevenson ◽

Sandip K Zalawadiya

Keyword(s):

Heart Failure ◽

New York ◽

Contrast Agent ◽

Heart Association ◽

York Heart Association Class ◽

Class Iii ◽

Device Implantation ◽

Association Class ◽

New York Heart Association ◽

History Of

A 57-year-old woman with New York Heart Association Class III heart failure requiring multiple hospitalisations over the previous year presented for CardioMEMS implantation. Because of the patient’s allergy history of anaphylaxis to iodine-based contrast agent she underwent the device implantation with gadolinium-based contrast agent (Magnevist), which was successful.

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Lower Rates of Heart Failure and All-Cause Hospitalizations During Pulmonary Artery Pressure-Guided Therapy for Ambulatory Heart Failure

Circulation Heart Failure ◽

10.1161/circheartfailure.119.006863 ◽

2020 ◽

Vol 13 (8) ◽

Cited By ~ 3

Author(s):

David M. Shavelle ◽

Akshay S. Desai ◽

William T. Abraham ◽

Robert C. Bourge ◽

Nirav Raval ◽

...

Keyword(s):

Heart Failure ◽

New York ◽

Ejection Fraction ◽

Pressure Sensor ◽

Heart Association ◽

Sensor Failure ◽

Class Iii ◽

Association Class ◽

New York Heart Association ◽

Guided Therapy

Background: Ambulatory hemodynamic monitoring with an implantable pulmonary artery (PA) sensor is approved for patients with New York Heart Association Class III heart failure (HF) and a prior HF hospitalization (HFH) within 12 months. The objective of this study was to assess the efficacy and safety of PA pressure-guided therapy in routine clinical practice with special focus on subgroups defined by sex, race, and ejection fraction. Methods: This multi-center, prospective, open-label, observational, single-arm trial of 1200 patients across 104 centers within the United States with New York Heart Association class III HF and a prior HFH within 12 months evaluated patients undergoing PA pressure sensor implantation between September 1, 2014, and October 11, 2017. The primary efficacy outcome was the difference between rates of adjudicated HFH 1 year after compared with the 1 year before sensor implantation. Safety end points were freedom from device- or system-related complications at 2 years and freedom from pressure sensor failure at 2 years. Results: Mean age for the population was 69 years, 37.7% were women, 17.2% were non-White, and 46.8% had preserved ejection fraction. During the year after sensor implantation, the mean rate of daily pressure transmission was 76±24% and PA pressures declined significantly. The rate of HFH was significantly lower at 1 year compared with the year before implantation (0.54 versus 1.25 events/patient-years, hazard ratio 0.43 [95% CI, 0.39–0.47], P <0.0001). The rate of all-cause hospitalization was also lower following sensor implantation (1.67 versus 2.28 events/patient-years, hazard ratio 0.73 [95% CI, 0.68–0.78], P <0.0001). Results were consistent across subgroups defined by ejection fraction, sex, race, cause of cardiomyopathy, presence/absence of implantable cardiac defibrillator or cardiac resynchronization therapy and ejection fraction. Freedom from device- or system-related complications was 99.6%, and freedom from pressure sensor failure was 99.9% at 1 year. Conclusions: In routine clinical practice as in clinical trials, PA pressure-guided therapy for HF was associated with lower PA pressures, lower rates of HFH and all-cause hospitalization, and low rates of adverse events across a broad range of patients with symptomatic HF and prior HFH. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02279888.

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Cardiac Resynchronization Therapy With and Without Defibrillator in a Commercial Truck Driver with Ischemic Cardiomyopathy and New York Heart Association Class III Heart Failure

Cardiac Electrophysiology Clinics ◽

10.1016/j.ccep.2012.02.007 ◽

2012 ◽

Vol 4 (2) ◽

pp. 169-180

Author(s):

Jacob C. Jentzer ◽

John H. Jentzer

Keyword(s):

Heart Failure ◽

New York ◽

Ischemic Cardiomyopathy ◽

Heart Association ◽

Cardiac Resynchronization ◽

York Heart Association Class ◽

Class Iii ◽

Resynchronization Therapy ◽

Association Class ◽

New York Heart Association

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Pulmonary Artery Involvement in Patients with Takayasu Arteritis

The Journal of Rheumatology ◽

10.3899/jrheum.190045 ◽

2019 ◽

Vol 47 (2) ◽

pp. 264-272 ◽

Cited By ~ 11

Author(s):

Yanru He ◽

Naqiang Lv ◽

Aimin Dang ◽

Nan Cheng

Keyword(s):

New York ◽

Pulmonary Artery ◽

Takayasu Arteritis ◽

Systolic Dysfunction ◽

Clinical Manifestations ◽

Heart Association ◽

Lower Limbs ◽

Class Iii ◽

Association Class ◽

New York Heart Association

Objective.This study was performed to explore the clinical manifestations and longterm prognosis in patients with Takayasu arteritis (TA) with pulmonary artery involvement (PAI).Methods.The medical records of 194 patients with TA who underwent traditional catheter angiography or computed tomography of pulmonary artery from 2009 to 2016 were retrospectively reviewed. The clinical manifestations, angiographic features, and mortality of 128 patients with TA with PAI were further analyzed.Results.Patients with TA with PAI had a higher risk of pulmonary hypertension (PH) than patients with TA alone (61.7% vs 7.6%, p < 0.001). Patients with PAI and PH more frequently developed dyspnea, hemoptysis, and lower limbs edema (all p < 0.05) than those without PH. Patients with PH also had a higher incidence of bilateral PAI (84.8% vs 34.7%, p < 0.001) and a higher pulmonary artery obstruction index [23 (interquartile range 20–27) vs 10 (6–15), p < 0.001]. Left heart disease was presented in 39 (30.5%) patients with TA with PAI. During the median followup of 38 (21–58) months, 19 and 2 deaths occurred among patients with and without PH, respectively. Among patients with PAI, the mortality rate was 7 times higher in patients with than without PH (p = 0.009). Independent predictors of mortality were the disease duration (p = 0.047), New York Heart Association class III/IV (p = 0.019), right ventricular systolic dysfunction (p = 0.019), and respiratory failure (p = 0.007).Conclusion.Patients with TA with PAI have a higher risk of developing PH than patients with TA alone. The presence of PH in patients with PAI increases the risk of early mortality.

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