The mitral-to-aortic flow-velocity integral ratio in the real world echocardiographic evaluation of functional mitral regurgitation before and after percutaneous repair

Introduction: In this study, we examined the real-world impact of research evidence on the use of and indications for percutaneous coronary intervention (PCI) (before and after COURAGE Trial publication) and the choice of drug eluting stents (DES) vs. bare metal stents (BMS) (before and after FDA warnings about risk of DES thrombosis). Methods: We used hospital discharge data from Florida to calculate the distribution of primary indication for PCI and the % of PCI patients who received DES, BMS, or no stent on a quarterly basis from Jan 2006 - Jun 2012. We plotted stent trends separately for patients with principal diagnosis of STEMI (n=66,054), NSTEMI/ICS (n=140,886), and stable CHD (n=117,307). Results: Since 2006, the % of PCIs with a primary indication of either STEMI or NSTEMI has steadily increased, while the % with an indication of stable CHD declined from 45% to 28%. In early 2006, DES were used in 86.9% of NSTEMI patients, 87.5% of stable CHD patients, and 81.4% of STEMI patients. DES use first declined in all diagnosis groups in Q3 2006, coinciding with the release of meta-analysis results showing higher risk of late stent thrombosis for DES vs. BMS. The lowest rate of DES usage was reached in Q1 2008 (45% for STEMI, 63% for NSTEMI, 67% for stable CHD). However, by Q2 2012, DES use had increased to 60% in STEMI cases, 75% in NSTEMI cases, and 76% in stable CHD cases. The percent of PCI patients who received no stent has remained stable at < 9% since 2006, regardless of diagnosis. Conclusions: The COURAGE Trial showed no benefit of PCI over medical treatment in stable coronary heart disease (CHD). From 2006-2012, the proportion of PCIs with an indication of stable CHD declined from 45% to 28%, indicating a real-world response to evidence. Similarly, following controversy about long-term effects of DES, off-label use, and patient compliance with thienopyridines which began in late 2006, there was an immediate resurgence in use of BMS, especially for STEMI. However, the proportion of patients receiving DES has steadily increased since early 2008, regardless of primary indication. More research on the influence of provider and hospital characteristics on response to evidence is needed.

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Disproportionate functional mitral regurgitation predicts a favourable response after MitraClip implant in patients with advanced heart failure. Real-world evidence of a new conceptual framework.

International Journal of Cardiology ◽

10.1016/j.ijcard.2020.08.026 ◽

2021 ◽

Vol 323 ◽

pp. 208-212 ◽

Cited By ~ 1

Author(s):

Simone Frea ◽

Stefano Pidello, MD ◽

Paolo Boretto, MD ◽

Sara Rettegno, MD ◽

Francesca Giordana, MD ◽

...

Keyword(s):

Heart Failure ◽

Mitral Regurgitation ◽

Conceptual Framework ◽

Real World ◽

Advanced Heart Failure ◽

Functional Mitral Regurgitation ◽

Favourable Response ◽

Real World Evidence

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TCT-798 Transcatheter Edge-to-edge Repair for Functional Mitral Regurgitation: Real-World Clinical Outcomes

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2014.07.872 ◽

2014 ◽

Vol 64 (11) ◽

pp. B233

Author(s):

Xavier Millán ◽

Lorenzo Azzalini ◽

Razi Khan ◽

Anique Ducharme ◽

Arsene Basmadjian ◽

...

Keyword(s):

Mitral Regurgitation ◽

Clinical Outcomes ◽

Real World ◽

Functional Mitral Regurgitation

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Transfer of Calibration in Virtual Reality to both Real and Virtual Environments

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/1071181319631224 ◽

2019 ◽

Vol 63 (1) ◽

pp. 1943-1947 ◽

Cited By ~ 1

Author(s):

Hannah M. Solini ◽

Ayush Bhargava ◽

Christopher C. Pagano

Keyword(s):

Virtual Reality ◽

Virtual Environments ◽

Virtual Environment ◽

Real World ◽

Optic Flow ◽

Calibration Transfer ◽

The Real ◽

Before And After ◽

Virtual Display ◽

World Environment

It is often questioned whether task performance attained in a virtual environment can be transferred appropriately and accurately to the same task in the real world. With advancements in virtual reality (VR) technology, recent research has focused on individuals’ abilities to transfer calibration achieved in a virtual environment to a real-world environment. Little research, however, has shown whether transfer of calibration from a virtual environment to the real world is similar to transfer of calibration from a virtual environment to another virtual environment. As such, the present study investigated differences in calibration transfer to real-world and virtual environments. In either a real-world or virtual environment, participants completed blind walking estimates before and after experiencing perturbed virtual optic flow via a head-mounted virtual display (HMD). Results showed that individuals calibrated to perturbed virtual optic flow and that this calibration carried over to both real-world and virtual environments in a like manner.

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The real-world benefit of novel androgen receptor-targeting agents (ARTA) before and after docetaxel in CRPC with bone metastases in Japan: A subanalysis of the PROSTAT-BSI, a prospective observational study before and after approval of novel ARTAs.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.6_suppl.43 ◽

2021 ◽

Vol 39 (6_suppl) ◽

pp. 43-43

Author(s):

Atsushi Mizokami ◽

Rie Fukuda ◽

Taiki Kamijima ◽

Kouji Izumi ◽

Yoshifumi Kadono ◽

...

Keyword(s):

Clinical Practice ◽

Observational Study ◽

Hormonal Therapy ◽

Real World ◽

Prospective Observational Study ◽

Favorable Effect ◽

The Real ◽

Significant Difference ◽

Before And After ◽

Psa Progression

43 Background: ARTAs (enzalutamide and abiraterone) have been approved for relapse of prostate cancer in Japan since 2014. However, the efficacy of ARTAs for overall survival (OS) has not yet been proven in Japanese real-world clinical practice. Bone Scan Index (BSI), amount of bone metastasis in a unit of %, has become available for bone scintigraphy using software of BONENAVI (EXINIbone) in Japan. To confirm the benefit of BSI, we conducted a prospective observational study from 2012 to 2017 on mHSPC and mCRPC prior to docetaxel (presented at ASCO-GU 2020). Then we conducted this subanalysis to investigate the real-world benefit of ARTAs on OS before and after docetaxel. Methods: Patients enrolled as the mHSPC (N = 148) and mCRPC (N = 99) groups in the PROSTAT-BSI registry over a 3-year observation period were analyzed with or without ARTAs or flutamide. Patients were evaluated for PSA progression, BSI progression, and OS during hormonal therapy or chemotherapy. Results: In the mHSPC group, 123 patients were treated with combined androgen blockade (androgen deprivation + 80 mg bicalutamide) as an initial hormonal therapy. Thirty-seven patients were treated with flutamide after PSA progression. Thirty-seven patients were also treated with ARTAs as 2nd or later. Docetaxel was used in 25 patients. There was no significant difference in PSA (median: 265.5 and 248.0 ng/mL; P = 0.877) and BSI (median: 1.28% and 1.68%; P = 0.131) between the ARTA (-) and ARTA (+) groups at the start of hormonal therapy, respectively. Despite a median PSA-PFS disadvantage of 16 months in the ARTA (+) group compared to the ARTA (-) group (median: 8.9 and 25.2 months), OS of both groups were comparable (3-year survival rate: 84.0% and 75.7%; HR [95% CI]:0.556 [0.238-1.299], P = 0.232), respectively, indicating favorable effect of ARTA on OS. Furthermore, OS tended to be more extended in patients who received flutamide prior to ARTAs (N = 21) (HR [95% CI]:0.3175 [0.050-2.026], P = 0.225). In the mCRPC group, 8 patients who used ARTA prior to docetaxel were excluded from this analysis. ARTAs were used to treat relapse after docetaxel in 44 patients. Cabazitaxel was used in 14 patients. There was no significant difference in PSA (median: 16.8 and 26.8 ng/mL; P = 0.240) and BSI (median: 2.43% and 1.48%; P = 0.105) between the ARTA (-) and ARTA (+) groups at the start of docetaxel, respectively. There was no significant difference in PSA-PFS between the ARTA (-) and ARTA (+) groups (median PSA-PFS: 4.3 months and 7.0 months; P = 0.999), but OS was significantly better in the ARTA (+) group in the ARTA (-) group (median OS: 28.9 months vs 21.1 months; HR [95% CI]: 0.484 [0.264-0.888]; P = 0.019). Conclusions: This subanalysis demonstrates the benefit of ARTAs for OS before and after docetaxel in clinical practice.

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P4725Prognostic relevance of the COAPT inclusion criteria in real-world patients with secondary mitral regurgitation undergoing mitraclip implantation

European Heart Journal ◽

10.1093/eurheartj/ehz745.1102 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C Iliadis ◽

C Metze ◽

M I Koerber ◽

S Baldus ◽

R Pfister

Keyword(s):

Heart Failure ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Real World ◽

Composite Endpoint ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Functional Mitral Regurgitation ◽

Inclusion Criteria ◽

Heart Failure Hospitalization

Abstract Background The recently published Cardiovascular Outcomes Assessment of the mitraclip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT) randomized trial has shown a huge benefit in the survival of patients with systolic heart failure and functional mitral regurgitation treated with MitraClip. However, patients in COAPT were highly selected and the clinical course in real-world patients with and without fulfilment of the trial inclusion criteria is unclear. Methods Our study examined the clinical outcome in consecutive patients from our Heart Centre with reduced left-ventricular ejection fraction (EF<50%) undergoing mitraclip for mitral regurgitation of dominant functional etiology by the presence of the inclusion criteria of the COAPT trial (left ventricular ejection fraction >20%, left ventricular end-systolic dimension <70 mm, non-commissural primary jet, estimated pulmonary artery systolic pressure <70 mmHg, mitral valve orifice area >4 cm2, no prior mitral valve leaflet surgery or any currently implanted prosthetic mitral valve or any prior transcatheter mitral valve procedure). The composite endpoint of all-cause mortality or heart failure hospitalization and the endpoint of heart failure hospitalization were analysed. Results Among 123 patients who underwent mitraclip implantation 60.2% fulfilled the inclusion criteria of COAPT. Overall, 54 patients (46.6%) died or were hospitalized for heart failure during a median follow-up time of 19 months. The composite endpoint was significantly less frequent (p=0.01) in patients fulfilling the COAPT selection criteria than in those not fulfilling the criteria, with an estimated 1-year event rate of 24.6% vs 49.1%. Patients with COAPT inclusion criteria had a 49% lower hazard of the composite endpoint (95% CI 12–70%, p=0.015). Heart failure hospitalization was significantly less frequent (p=0.039) in patients fulfilling COAPT selection criteria than in those who did not, with an estimated 1-year event rate of 19% vs. 36.8%. Patients with COAPT inclusion criteria had a 50% lower hazard for heart failure hospitalization (95% CI 1–75%, p=0.046). Of note, the 1-year all-cause mortality in our patients fulfilling COAPT inclusion criteria was lower compared to the renowned COAPT trial (10% vs. 19%). Conclusion In this single center study the outcome of patients with functional mitral regurgitation undergoing mitraclip therapy was significantly worse in patients not fulfilling COAPT inclusion criteria, indicating that these criteria might help identify futility. The remarkable difference in outcome between real-world patients and COAPT trial patients warrants further study to elucidate underlying causes, which might affect the transferability of the COAPT results.

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