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Echocardiography (Mount Kisco, N.Y.) Sep 2023The present guidelines advise replacing the aortic valve for individuals with severe aortic stenosis (AS) based on various echocardiographic parameters. Accurate... (Review)
Review
AIMS
The present guidelines advise replacing the aortic valve for individuals with severe aortic stenosis (AS) based on various echocardiographic parameters. Accurate measurements are essential to avoid misclassification and unnecessary interventions. The objective of this study was to evaluate the influence of measurement error on the echocardiographic evaluation of the severity of AS.
METHODS AND RESULTS
A systematic review was performed to examine whether measurement errors are reported in studies focusing on the prognostic value of peak aortic jet velocity (V ), mean pressure gradient (MPG), and effective orifice area (EOA) in asymptomatic patients with AS. Out of the 37 studies reviewed, 17 (46%) acknowledged the existence of measurement errors, but none of them utilized methods to address them. Secondly, the magnitude of potential errors was collected from available literature for use in clinical simulations. Interobserver variability ranged between 0.9% and 8.3% for V and MPG but was higher for EOA (range 7.7%-12.7%), indicating lower reliability. Assuming a circular left ventricular outflow tract area led to a median underestimation of EOA by 23% compared to planimetry by other modalities. A clinical simulation resulted in the reclassification of 42% of patients, shifting them from a diagnosis of severe AS to moderate AS.
CONCLUSIONS
Measurement errors are underreported in studies on echocardiographic assessment of AS severity. These errors can lead to misclassification and misdiagnosis. Clinicians and scientists should be aware of the implications for accurate clinical decision-making and assuring research validity.
Topics: Humans; Reproducibility of Results; Aortic Valve Stenosis; Echocardiography; Aortic Valve; Stroke Volume; Severity of Illness Index
PubMed: 37519290
DOI: 10.1111/echo.15664 -
American Journal of Cardiovascular... 2023Despite high surgical risk among heart transplant (HTx) recipients, who develop aortic valve diseases (AVD), transcutaneous aortic valve replacement (TAVR) has been...
BACKGROUND
Despite high surgical risk among heart transplant (HTx) recipients, who develop aortic valve diseases (AVD), transcutaneous aortic valve replacement (TAVR) has been scarcely reported as a viable option in this patient population.
METHODS
A systematic review was conducted to identify studies reporting the outcomes of HTx recipients who developed AVD of the donor heart and underwent TAVR. Studies were eligible if they provided individual-level data for HTx recipients, who underwent TAVR on the donor heart. Review articles, editorials or commentaries, studies lacking original data, or those reporting surgical valve replacement for AVD in HTx recipients were excluded.
RESULTS
A total of 15 case reports, encompassing 15 patients, describing characteristics and outcomes of HTx recipients undergoing TAVR were included. These included 13 males and 2 females with an average age of 63.6±15 years. The indications for HTx were non-ischemic dilated cardiomyopathy, ischemic cardiomyopathy and ischemic dilated cardiomyopathy in 42.9%, 35.7%, and 21.4% of the patients, respectively. The main indication for aortic valve replacement (AVR) among HTx recipients was aortic stenosis (73.3%). The transcutaneous approach was preferred over surgical AVR due to high surgical risk in > 50% of the patients. Both pre-TAVR transvalvular pressure gradient and the peak aortic pressure gradient decreased after the TAVR. Paravalvular leak was minimal/none to mild in all the patients post-TAVR. Most patients had an uneventful post-TAVR recovery with no recurrence of the symptoms or echocardiographic finings at a median follow-up of 6 months.
CONCLUSIONS
TAVR seems to be a viable option for HTx recipients who develop donor aortic valve diseases. However, there is a paucity of knowledge on the long-term survivability of the replaced aortic valves and the clinical and echocardiographic outcomes of HTx recipients undergoing TAVR.
PubMed: 37736356
DOI: No ID Found -
Journal of the American Heart... May 2024Coronary pressure indices to assess coronary artery disease are currently underused in patients with aortic stenosis due to many potential physiological effects that... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Coronary pressure indices to assess coronary artery disease are currently underused in patients with aortic stenosis due to many potential physiological effects that might hinder their interpretation. Studies with varying sample sizes have provided us with conflicting results on the effect of transcatheter aortic valve replacement (TAVR) on these indices. The aim of this meta-analysis was to study immediate and long-term effects of TAVR on fractional flow reserve (FFR) and nonhyperemic pressure ratios (NHPRs).
METHODS AND RESULTS
Lesion-specific coronary pressure data were extracted from 6 studies, resulting in 147 lesions for immediate change in FFR analysis and 105 for NHPR analysis. To investigate the long-term changes, 93 lesions for FFR analysis and 68 for NHPR analysis were found. Lesion data were pooled and compared with paired tests. Immediately after TAVR, FFR decreased significantly (-0.0130±0.0406 SD, : 0.0002) while NHPR remained stable (0.0003±0.0675, : 0.9675). Long-term after TAVR, FFR decreased significantly (-0.0230±0.0747, : 0.0038) while NHPR increased nonsignificantly (0.0166±0.0699, : 0.0543). When only borderline NHPR lesions were considered, this increase became significant (0.0249±0.0441, : 0.0015). Sensitivity analysis confirmed our results in borderline lesions.
CONCLUSIONS
TAVR resulted in small significant, but opposite, changes in FFR and NHPR. Using the standard cut-offs in patients with severe aortic stenosis, FFR might underestimate the physiological significance of a coronary lesion while NHPRs might overestimate its significance. The described changes only play a clinically relevant role in borderline lesions. Therefore, even in patients with aortic stenosis, an overtly positive or negative physiological assessment can be trusted.
Topics: Humans; Aortic Valve; Aortic Valve Stenosis; Coronary Artery Disease; Coronary Vessels; Fractional Flow Reserve, Myocardial; Hyperemia; Severity of Illness Index; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 38761080
DOI: 10.1161/JAHA.124.034401 -
Current Problems in Cardiology Jul 2024Aortic stenosis (AS) is very common in mid-aged and elderly patients, and it has been reported to have a negative impact on both short and long-term survival with a high...
Aortic stenosis (AS) is very common in mid-aged and elderly patients, and it has been reported to have a negative impact on both short and long-term survival with a high mortality rate. The current study identified methods of diagnosis, incidence, and causes of AS, pathogenesis, intervention and management and future perspectives of Asymptomatic and Symptomatic Aortic stenosis. A systematic literature search was conducted using PubMed, Scopus and CINAHL, using the Mesh terms and key words "Aortic stenosis", "diagnostic criteria", "pathogenesis", "incidence and causes of AS" and" intervention and management strategies". Studies were retained for review after meeting strict inclusion criteria that included studies evaluating Asymptomatic and Symptomatic AS. Studies were excluded if duplicate publication, overlap of patients, subgroup studies of a main study, lack of data on AS severity, case reports and letters to editors. Forty-five articles were selected for inclusion. Incidence of AS across the studies ranged from 3 % to 7 %. Many factors have been associated with incidence and increased risk of AS, highest incidence of AS was described after aortic valve calcification, rheumatic heart disease, degenerative aortic valve disease, bicuspid aortic valve and other factors. AS is common and can be predicted by aortic root calcification volume, rheumatic heart disease, degenerative aortic valve disease, bicuspid aortic valve. Intervention and management for AS patients is a complex decision that takes into consideration multiple factors. On the other hand, there is not enough progress in preventive pharmacotherapy to slow the progression of AS.
Topics: Humans; Aortic Valve; Aortic Valve Stenosis; Asymptomatic Diseases; Disease Management; Incidence; Risk Factors
PubMed: 38729278
DOI: 10.1016/j.cpcardiol.2024.102631 -
The American Journal of Cardiology Aug 2023There is a paucity of data on the prognostic impact of mitral annular calcification (MAC) in patients who underwent transcatheter aortic valve implantation (TAVI) with... (Meta-Analysis)
Meta-Analysis
A Systematic Review and Meta-Analysis of Prevalence, Characteristics, and Impact of Mitral Annular Calcification on Outcomes After Transcatheter Aortic Valve Implantation.
There is a paucity of data on the prognostic impact of mitral annular calcification (MAC) in patients who underwent transcatheter aortic valve implantation (TAVI) with conflicting results being reported by the studies that are published. Therefore, we performed a meta-analysis to assess the short-term and long-term outcomes of MAC in patients after TAVI. Of 25,407 studies identified after the initial database search, 4 observational studies comprising 2,620 patients (2,030 patients in the nonsevere MAC arm and 590 patients in the severe MAC arm) were included in the final analysis. Compared with patients with nonsevere MAC, the severe MAC group was associated with significantly higher incidences of overall bleeding (0.75 [0.57 to 0.98], p = 0.03, I = 0%) at 30 days. However, no significant difference was observed between the 2 groups for the rest of the 30-day outcomes: all-cause mortality (0.79 [0.42 to 1.48], p = 0.46, I = 9%), myocardial infarction (1.62 [0.37 to 7.04], p = 0.52, I = 0%), cerebrovascular accident or stroke (1.22 [0.53 to 2.83], p = 0.64, I = 0%), acute kidney injury (1.48 [0.64 to 3.42], p = 0.35, I = 0%), and pacemaker implantation (0.70 [0.39 to 1.25], p = 0.23, I = 68%). Similarly, follow-up outcomes also showed no significant difference between the 2 groups: all-cause mortality (0.69 [0.46 to 1.03], p = 0.07, I = 44%), cardiovascular mortality (0.52 [0.24 to 1.13], p = 0.10, I = 70%) and stroke (0.83 [0.41 to 1.69], p = 0.61, I = 22%). The sensitivity analysis, however, demonstrated significant results for all-cause mortality (0.57 [0.39 to 0.84], p = 0.005, I = 7%) by removing the study by Okuno et al and cardiovascular mortality (0.41 [0.21 to 0.82], p = 0.01, I = 66%) by removing the study by Lak et al. In conclusion, our meta-analysis corroborates the notion that isolated MAC is not an independent predictor of long-term mortality after TAVI and determines severe MAC to be a predictor of mortality at follow-up because of the higher incidence of mitral valve dysfunction associated with it.
Topics: Humans; Transcatheter Aortic Valve Replacement; Mitral Valve; Prevalence; Heart Valve Diseases; Calcinosis; Stroke; Heart Defects, Congenital; Aortic Valve Stenosis; Treatment Outcome; Aortic Valve; Heart Valve Prosthesis Implantation
PubMed: 37385163
DOI: 10.1016/j.amjcard.2023.05.069 -
The Journal of Cardiovascular NursingAortic stenosis (AS) without surgical intervention is associated with morbidity and mortality and is the most common valvular disease in the western world. Transcatheter...
BACKGROUND
Aortic stenosis (AS) without surgical intervention is associated with morbidity and mortality and is the most common valvular disease in the western world. Transcatheter aortic valve implantation (TAVI) is a minimally invasive surgical option that has become a common treatment for people unable to undergo open aortic valve replacement; despite the increase in TAVI offerings in the last decade, patient quality of life (QoL) outcomes postoperatively are poorly understood.
OBJECTIVE
The aim of this review was to determine whether TAVI is effective in improving QoL.
METHOD
A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted, and the protocol was registered on PROSPERO (CRD42019122753). MEDLINE, CINAHL, EMBASE, and PsycINFO were searched for studies published between 2008 and 2021. Search terms included "transcatheter aortic valve replacement" and "quality of life" and their synonyms. Included studies were evaluated, dependent on study design, using either the Risk of Bias-2 or the Newcastle-Ottawa Scale. Seventy studies were included in the review.
RESULTS
Authors of the studies used a wide variety of QoL assessment instruments and follow-up durations; authors of most studies identified an improvement in QoL, and a small number identified a decline in QoL or no change from baseline.
CONCLUSION
Although authors of the vast majority of studies identified an improvement in QoL, there was very little consistency in instrument choice or follow-up duration; this made analysis and comparison difficult. A consistent approach to measuring QoL for patients who undergo TAVI is needed to enable comparison of outcomes. A richer, more nuanced understanding of QoL outcomes after TAVI could help clinicians support patient decision making and evaluate outcomes.
Topics: Humans; Transcatheter Aortic Valve Replacement; Quality of Life; Aortic Valve Stenosis
PubMed: 37306426
DOI: 10.1097/JCN.0000000000001007 -
Archives of Gerontology and Geriatrics Dec 2023We conducted this systematic review and meta-analysis to summarize the prevalence of sarcopenia and its impact on mortality in patients undergoing TAVI. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
We conducted this systematic review and meta-analysis to summarize the prevalence of sarcopenia and its impact on mortality in patients undergoing TAVI.
METHOD
Medline, EMBASE, and PubMed were searched from inception to October 14, 2022 to retrieve eligible studies that assessed sarcopenia in patients undergoing TAVI. Pooled sarcopenia prevalence was calculated with 95% confidence interval (CI), and heterogeneity was estimated using the I test. Associations of sarcopenia with mortality of post-TAVI were expressed as hazard ratio (HR) or odds ratios (OR) and 95% CI.
RESULTS
13 studies involving 5248 patients (mean age from 78.1 to 84.9 years) undergoing TAVI were included. There were eleven studies defined sarcopenia based on loss of skeletal muscle mass index (SMI), while only two studies used low muscle mass plus low muscle strength and/or low physical performance. Overall, the pooled prevalence of sarcopenia in patients undergoing TAVI was 49% (95% CI 41%-58%). Sarcopenia was associated with an increased risk of long-term (≥1 year) mortality in patients after TAVI (HR 1.57, 95% CI 1.33-1.85, P < 0.001), with similar findings in the subgroups stratified by follow-up time, definition of sarcopenia, study location, and study design. Furthermore, the 1-, 2-, and 3-year cumulative probabilities of survival in patients with sarcopenia were significantly lower than non-sarcopenia (74.0% vs 91.0%, 68.3% vs 78.0%, and 72.6% vs 79.8%, all P < 0.05).
CONCLUSIONS
Although there are substantial differences in diagnostic criteria, sarcopenia is highly prevalent in patients undergoing TAVI and its linked to increased long-term mortality after TAVI.
Topics: Aged; Aged, 80 and over; Humans; Aortic Valve Stenosis; Prognosis; Risk Factors; Sarcopenia; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 37481845
DOI: 10.1016/j.archger.2023.105125 -
Cureus Apr 2024Prosthetic valve endocarditis (PVE) is a rare but serious complication following aortic valve replacement using either a transcatheter aortic valve implantation (TAVI)... (Review)
Review
Clinical Profiles and Outcomes of Prosthesis-Specific Infective Endocarditis Subsequent to Transcatheter Versus Surgical Aortic Valve Replacement: A Systematic Review and Meta-Analysis.
Prosthetic valve endocarditis (PVE) is a rare but serious complication following aortic valve replacement using either a transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR). This study aims to review the profiles and outcomes of PVE after surgical versus transcatheter aortic valve replacement. Electronic searches were performed on Scopus, EMBASE, and PubMed to retrieve related articles. To be included, study designs had to be randomized controlled trials (RCT) or observational cohort studies (in English) with PVE patients that compared differences based on TAVI or SAVR. This review included data for 13,221 patients with PVE diagnoses. Of those, 2,109 patients had an initial SAVR, and 11,112 patients had an initial TAVI. There was no difference in the incidence of PVE in patients who had initial TAVI versus SAVR (1.05% versus 1.01% per person-year, p=0.98). However, the onset of early PVE was more frequently observed in the TAVI group (risk ratio (RR): 1.54, 95% confidence interval (CI) [1.14, 2.08], p=0.005). Patients in the TAVI group had a lower indication for surgery to treat PVE when compared to SAVR (RR: 0.55, 95%CI [0.44, 0.69], p<0.001). was more likely to be the source of PVE in patients who had previous TAVI (RR: 1.34, 95%CI [1.17, 1.54], p<0.001). Also, was more frequently observed as a cause of PVE in the TAVI group (RR: 1.49, 95%CI [1.21, 1.82], p<0.001). Patients who underwent SAVR and TAVI had similar incidences of PVE. However, patients who underwent SAVR had a greater indication for surgery to treat PVE, while those who underwent TAVI had higher comorbidities, a higher likelihood of early PVE, and a trend towards higher one-year mortality.
PubMed: 38817491
DOI: 10.7759/cureus.59398 -
Academic Radiology Jun 2024This study aimed to investigate the prognostic value of preoperative CT scan-derived myocardial biomarkers in patients with severe aortic stenosis (AS) undergoing... (Review)
Review
Prognostic Value of CT-Derived Myocardial Biomarkers: Extracellular Volume Fraction and Strain in Patients with Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-analysis.
RATIONALE AND OBJECTIVES
This study aimed to investigate the prognostic value of preoperative CT scan-derived myocardial biomarkers in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).
MATERIALS AND METHODS
In April 2024, three databases (PubMed, Web of Science and Embase) were searched to identify studies. A random-effects model for meta-analysis was conducted to calculate pooled hazard ratios (HR) and 95% confidence intervals (CI) to assess the prognostic value. The I statistic was used to assess heterogeneity. Meta-regression analysis was conducted to appraise which variables yielded a significant impact on the HR of included biomarkers.
RESULTS
11 studies were identified, of which six studies involved 678 patients reporting extracellular volume fraction (ECV), one study involved 300 patients reporting ECV and left ventricular global longitudinal strain (LVGLS), three studies involved 868 patients reporting LVGLS and one study involved 376 patients reporting LVGLS and peak left atrial longitudinal strain (PALS). The endpoints included all-cause mortality, major adverse cardiovascular events (MACE) and a composite outcome of the previous two. The meta-analysis revealed that ECV, whether considered as a dichotomous variable (pooled HR: 3.87, 95% CI: 2.63-5.70, I = 0%), or as a continuous variable (pooled HR: 1.12, 95% CI: 1.05-1.19, I = 66%), and LVGLS, whether considered as a dichotomous variable (pooled HR: 1.70, 95% CI: 1.30-2.22, I = 0%) or a continuous variable (pooled HR: 1.07, 95% CI: 1.04-1.10, I = 0%) were all significant predictors for outcomes in patients with severe AS after TAVR. Age, sex, follow-up time and mean pressure gradient had a significant impact on the model of ECV (continuous).
CONCLUSION
The higher CT-derived ECV and impaired LVGLS are able to predict worse outcomes in patients with severe AS who have undergone TAVR.
PubMed: 38906780
DOI: 10.1016/j.acra.2024.06.009 -
European Heart Journal. Quality of Care... Aug 2023Standardized data definitions are necessary for the quantification of quality of care and patient outcomes in observational studies and randomised controlled trials...
AIMS
Standardized data definitions are necessary for the quantification of quality of care and patient outcomes in observational studies and randomised controlled trials (RCTs). The European Unified Registries for Heart Care Evaluation and Randomised Trials (EuroHeart) project of the European Society of Cardiology (ESC) aims to create pan-European data standards for cardiovascular diseases and interventions, including transcatheter aortic valve implantation (TAVI).
METHODS AND RESULTS
We followed the EuroHeart methodology for cardiovascular data standard development. A Working Group of 29 members representing 12 countries was established and included a patient representative, as well as experts in the management of valvular heart disease from the European Association of Percutaneous Cardiovascular Interventions (EAPCI), the European Association of Cardiovascular Imaging (EACVI) and the Working Group on Cardiovascular Surgery. We conducted a systematic review of the literature and used a modified Delphi method to reach consensus on a final set of variables. For each variable, the Working Group provided a definition, permissible values, and categorized the variable as mandatory (Level 1) or additional (Level 2) based on its clinical importance and feasibility. In total, 93 Level 1 and 113 Level 2 variables were selected, with the level 1 variables providing the dataset for registration of patients undergoing TAVI on the EuroHeart IT platform.
CONCLUSION
This document provides details of the EuroHeart data standards for TAVI processes of care and in-hospital outcomes. In the context of EuroHeart, this will facilitate quality improvement, observational research, registry-based RCTs and post-marketing surveillance of devices, and pharmacotherapies.
ONE-SENTENCE SUMMARY
The EuroHeart data standards for transcatheter aortic valve implantation (TAVI) are a set of internationally agreed data variables and definitions that once implemented will facilitate improvement of quality of care and outcomes for patients receiving TAVI.
Topics: Humans; Transcatheter Aortic Valve Replacement; Aortic Valve; Aortic Valve Stenosis; Heart Valve Prosthesis Implantation; Registries; Randomized Controlled Trials as Topic
PubMed: 36195332
DOI: 10.1093/ehjqcco/qcac063