Clinical Research in Cardiology最新文献

{"title":"Patient risk evaluation for transcatheter aortic valve replacement (PRE-TAVR) - identification of real-time predictors of short- and long-term mortality.","authors":"Julian Kreutz, Philipp Lauten, Georgios Chatzis, Marie Nabrotzki, Nikolaos Patsalis, Styliani Syntila, Harald Lapp, Bernhard Schieffer, Birgit Markus","doi":"10.1007/s00392-025-02704-6","DOIUrl":"10.1007/s00392-025-02704-6","url":null,"abstract":"<p><strong>Background: </strong>The steadily increasing number of transcatheter aortic valve replacement (TAVR) procedures being performed on a heterogeneous patient population highlights the need for robust risk assessment. While EuroSCORE II is well established for surgical risks, it is less effective for TAVR, and the newer STS/ACC TAVR score has so far been validated mainly for in-hospital and 30-day mortality.</p><p><strong>Aims: </strong>This study aims to improve risk stratification for TAVR patients by identifying real-time predictors of 30-day and 1-year mortality that incorporate comprehensive, procedure-specific factors.</p><p><strong>Methods: </strong>Five-year data from 2256 transfemoral TAVR procedures performed at two German Heart Centers (2017-2022) were retrospectively analyzed. Predictors of 1-year and 30-day mortality were assessed using multivariable logistic and LASSO regression, considering a broad spectrum of patient demographics, comorbidities, and peri-procedural factors.</p><p><strong>Results: </strong>The analyses revealed a predictor model (PRE-TAVR predictors) for 1-year mortality (AUC 0.770; 95% CI 0.731-0.809), including age (> 81.5 years), NYHA stage IV, COPD (GOLD ≥ 2), atrial fibrillation, previous stroke or malignancy, elevated C-reactive protein (≥ 9.5 mg/L), aortic valve ΔP mean ≥ 48.5 mmHg, peripheral arterial disease (> stage 2) and low platelet count (≤ 228.5 g/L). The accuracy of the model exceeded the EuroSCORE II (AUC 0.645; 95% CI 0.599-0.691) and the STS/ACC TAVR score (AUC 0.714; 95% CI 0.670-0.758). For 30-day mortality, NYHA class IV was the only significant predictor in the bivariate analyses. However, additional LASSO analyses identified pre-existing renal insufficiency (KDIGO stage ≥ 3) and pre-TAVR sodium levels as further significant predictors. The AUC was 0.699 (95% CI 0.611-0.788) compared to an AUC of 0.680 (95% CI 0.604-0.756) for EuroSCORE II and 0.7129 (95% CI 0.633-0.793) for the STS/ACC TAVR score.</p><p><strong>Conclusion: </strong>The PRE-TAVR study developed a robust model, particularly for predicting 1-year mortality. This model outperformed the EuroSCORE II and STS/ACC TAVR scores, despite requiring fewer variables. It provides a solid basis for future risk scores and enables more precise patient selection.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1574-1584"},"PeriodicalIF":3.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12540637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients with paradoxical low-flow, low-gradient aortic stenosis gain the least benefit from TAVI among all hemodynamic subtypes.","authors":"Miriam Puls, Bo Eric Beuthner, Rodi Topci, Christoph Friedemann Jacob, Kristin Elisabeth Steinhaus, Niels Paul, Tim Beißbarth, Karl Toischer, Claudius Jacobshagen, Gerd Hasenfuß","doi":"10.1007/s00392-024-02482-7","DOIUrl":"10.1007/s00392-024-02482-7","url":null,"abstract":"<p><strong>Background: </strong>Substantial controversy exists regarding the clinical benefit of patients with severe paradoxical low-flow, low-gradient aortic stenosis (PLF-LG AS) from TAVI. Therefore, we compared post-TAVI benefit by long-term mortality (all-cause, CV and SCD), clinical improvement of heart failure symptoms, and cardiac reverse remodelling in guideline-defined AS subtypes.</p><p><strong>Methods: </strong>We prospectively included 250 consecutive TAVI patients. TTE, 6mwt, MLHFQ, NYHA status and NT-proBNP were recorded at baseline and 6 months. Long-term mortality and causes of death were assessed.</p><p><strong>Results: </strong>107 individuals suffered from normal EF, high gradient AS (NEF-HG AS), 36 from low EF, high gradient AS (LEF-HG), 52 from \"classic\" low-flow, low-gradient AS (LEF-LG AS), and 38 from paradoxical low-flow, low-gradient AS (PLF-LG AS). TAVI lead to a significant decrease in MLHFQ score and NT-proBNP levels in all subtypes except for PLF-LG. Regarding reverse remodelling, a significant increase in EF and decrease in LVEDV was present only in subtypes with reduced baseline EF, whereas a significant decrease in LVMI and LAVI could be observed in all subtypes except for PLF-LG. During a follow-up of 3-5 years, PLF-LG patients exhibited the poorest survival among all subtypes (HR 4.2, P = 0.0002 for CV mortality; HR 7.3, P = 0.004 for SCD, in comparison with NEF-HG). Importantly, PLF-LG was independently predictive for CV mortality (HR 2.9 [1.3-6.9], P = 0.009).</p><p><strong>Conclusions: </strong>PLF-LG patients exhibit the highest mortality (particularly CV and SCD), the poorest symptomatic benefit and the least reverse cardiac remodelling after TAVI among all subtypes. Thus, this cohort seems to gain the least benefit.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1479-1490"},"PeriodicalIF":3.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12540541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141491164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High residual gradients after transcatheter aortic valve implantation in raphe-type bicuspid aortic valve stenosis: insights from the AD-HOC registry.","authors":"Francesco Tartaglia, Mauro Gitto, Won-Keun Kim, Pier Pasquale Leone, Tommaso Fabris, Chiara De Biase, Giuliano Costa, Nicholas Montarello, Andrea Scotti, Michele Bellamoli, Mesfer Alfadhel, Ofir Koren, Simone Fezzi, Barbara Bellini, Mauro Massussi, Giulia Costa, Chiara Fraccaro, Alessandro Mazzapicchi, Enrico Giacomin, Francesco Burzotta, Andrea Zito, Riccardo Gorla, Marco Angelillis, Karsten Hug, Carlo Briguori, Luca Bettari, Antonio Messina, Michele Galasso, Damiano Regazzoli, Greta Cattaneo, Mauro Boiago, Gianmaria Calamita, Giulia Laterra, Matthias Renker, Mario Garcia Gomez, Alfonso Ielasi, Uri Landes, Tobias Rheude, Francesco Bedogni, Ignacio Amat Santos, Francesco Saia, Lin Bai, Mao Chen, Marianna Adamo, Marco De Carlo, Matteo Montorfano, Raj R Makkar, Darren Mylotte, Daniel J Blackman, Marco Barbanti, Didier Tchetche, Giuseppe Tarantini, Azeem Latib, Diego Maffeo, Ole De Backer, Andrea Buono, Antonio Mangieri","doi":"10.1007/s00392-025-02726-0","DOIUrl":"10.1007/s00392-025-02726-0","url":null,"abstract":"<p><strong>Background: </strong>Bicuspid aortic valve (BAV) stenosis poses several challenges when transcatheter aortic valve implantation (TAVI) is performed, including the risk of high residual gradients (HRG).</p><p><strong>Objective: </strong>To identify incidence, predictors and outcomes of HRG after TAVI in Sievers type 1 BAV stenosis.</p><p><strong>Methods: </strong>Consecutive patients with Sievers type 1 BAV stenosis undergoing TAVI at 24 international centers from 2016 to 2023 were enrolled. HRG were defined as a mean transvalvular gradient ≥ 20 mmHg at 30 days, according to Valve Academic Research Consortium-3 (VARC-3) criteria. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of all-cause death, neurologic events or hospitalization for heart failure, assessed at 3 years after TAVI. Secondary endpoints included the single components of the primary outcome. Endpoints were assessed according to the presence of HRG, before and after covariate adjustment for clinically relevant confounders.</p><p><strong>Results: </strong>A total of 972 patients were enrolled. HRG post-TAVI were found in 35 patients (3.6%). Patients with HRG had a higher preprocedural aortic valve gradient (57.0 [interquartile range: 49.0-69.0] mmHg vs 48.0 [40.0-58.0] mmHg, p < 0.001) and received smaller transcatheter heart valve (THV) (26.0 [23.0-29.0] mm vs 29.0 [26.0-29.0] mm, p < 0.001) when compared to patients with normal residual gradients (NRG). The only independent predictor of HRG was a bioprosthesis size ≤ 23 mm. At 3 years, MACE occurred in 35.0% of HRG patients and 22.3% of NRG patients (adjusted hazard ratio [HR]: 2.41, 95% confidence interval [CI]: 1.15-5.04; p = 0.019). HRG patients had a higher risk of neurologic events as compared to NRG patients (13.3% versus 4.5%, adjusted HR: 4.50, 95% CI: 1.52-13.30, p = 0.007).</p><p><strong>Conclusions: </strong>After TAVI in Sievers type 1 BAV stenosis, HRG occurred in around 4% of cases and were associated with an increased risk of MACE and neurologic events.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1595-1605"},"PeriodicalIF":3.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-related hormonal variances and clinical outcomes in TAVR patients.","authors":"Mustafa Mousa Basha, Baravan Al-Kassou, Marcel Weber, Thomas Beiert, Farhad Bakhtiary, Sebastian Zimmer, Georg Nickenig, Philip Roger Goody, Jasmin Shamekhi","doi":"10.1007/s00392-025-02623-6","DOIUrl":"10.1007/s00392-025-02623-6","url":null,"abstract":"<p><strong>Background: </strong>Sex-related differences play a pivotal role in disease manifestation and outcome in patients with cardiovascular disease, including aortic valve stenosis (AS). However, data regarding sex-related hormonal differences in AS patients undergoing transcatheter aortic valve replacement (TAVR) is lacking.</p><p><strong>Objectives: </strong>We aimed to assess sex-related hormonal variances in patients with severe symptomatic AS and to evaluate the impact of these hormonal differences on the clinical outcomes after TAVR.</p><p><strong>Methods: </strong>In a total of 361 TAVR patients, we assessed the hormonal status, including cortisol, parathormone (PTH), insulin-like growth factor 1 (IGF-1), dehydroepiandrosterone sulfate (DHEAs), estradiol, progesterone and testosterone prior to TAVR. We compared baseline characteristics and outcome data according to sex and hormonal parameters. The primary endpoint was 1-year all-cause mortality according to sex; secondary endpoints included the risk of 1-year all-cause mortality in conjunction with hormone levels, with pre-specified cut-off values.</p><p><strong>Results: </strong>Rates of 1-year all-cause mortality were comparable between the sexes (p = 0.285). Cox regression analysis revealed significant associations between 1-year mortality and levels of cortisol (HR 2.30; p = 0.007), PTH (HR 2.09; p = 0.019), DHEA-S (HR 0.47; p = 0.016), and IGF-1 (HR 0.42; p = 0.004) in the overall cohort. Elevated cortisol levels (p = 0.011), decreased DHEA-S levels (p = 0.007), and lower IGF-1 levels (p = 0.017) were significantly associated with higher rates of 1-year all-cause mortality in males. Conversely, higher PTH levels were significantly associated with an increased risk of 1-year mortality in females (p = 0.012).</p><p><strong>Conclusion: </strong>Sex-specific hormonal differences significantly impact the prognosis of severe AS patients undergoing TAVR. Elevated cortisol levels and decreased DHEA-S and IGF-1 levels in males, as well as higher levels of PTH in females, were associated with an increased mortality risk.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1527-1536"},"PeriodicalIF":3.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12540518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive performance of the TRI-SCORE in patients with severe aortic stenosis and concomitant tricuspid regurgitation undergoing TAVR.","authors":"Mustafa Mousa Basha, Baravan Al-Kassou, Christopher Gestrich, Marcel Weber, Thomas Beiert, Sebastian Zimmer, Farhad Bakhtiary, Georg Nickenig, Jasmin Shamekhi","doi":"10.1007/s00392-025-02671-y","DOIUrl":"10.1007/s00392-025-02671-y","url":null,"abstract":"<p><strong>Background: </strong>Tricuspid regurgitation (TR) is a common comorbidity in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) and represents a significant predictor of adverse outcomes. Precise risk stratification through clinical scoring systems is vital for tailoring treatment decisions in this patient population.</p><p><strong>Objectives: </strong>To assess the applicability of the TRI-SCORE for predicting adverse outcomes in patients with AS and concomitant moderate-to-severe TR undergoing TAVR and to compare its performance with established surgical risk scores like the EuroSCORE II and Society of Thoracic Surgeons score (STS-Score).</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 301 patients with severe AS and concomitant TR who underwent TAVR between 2013 and 2022 at the Heart Center Bonn. According to the TRI-SCORE, patients were stratified into a low or intermediate-risk group (TRI-SCORE 0-5) and a high-risk group (TRI-SCORE 6-12). The primary endpoint was 2-year all-cause mortality. Predictive values of the TRI-SCORE were compared to the EuroSCORE II and the STS-Score for both 30-day and 2-year mortality outcomes.</p><p><strong>Results: </strong>The 2-year mortality rate was significantly higher in the high-risk group compared to the low or intermediate-risk group (TRI-SCORE 6-12: 40.0% vs. TRI-SCORE 0-5: 17.9%; p < 0.001). For predicting 30-day mortality, the EuroSCORE II and the STS-Score demonstrated superior predictive values, with AUCs of 78.4% and 83.0%, respectively, in comparison to the TRI-SCORE, which showed an AUC of 70.0%. Conversely, the TRI-SCORE allowed a better risk prediction with regard to 2-year all-cause mortality, achieving an AUC of 69.7%, superior to the EuroSCORE II (60.6%) and the STS-Score (62.1%).</p><p><strong>Conclusion: </strong>The TRI-SCORE is effective in predicting mid-term mortality in patients with AS and moderate-to-severe TR undergoing TAVR, demonstrating greater robustness than the EuroSCORE II and the STS-Score for this timeframe.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1548-1557"},"PeriodicalIF":3.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12540613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fighting time: the critical importance of pre-TAVR mortality risk prediction.","authors":"Jasmin Shamekhi, Marius Ebert, Angelina Lorek, Irina Eckardt, Baravan Al-Kassou, Mustafa Mousa Basha, Marcel Weber, Miriam Silaschi, Farhad Bakhtiary, Georg Nickenig, Sebastian Zimmer","doi":"10.1007/s00392-025-02698-1","DOIUrl":"10.1007/s00392-025-02698-1","url":null,"abstract":"<p><strong>Background: </strong>Symptomatic severe aortic valve stenosis (AS) is a life-threatening condition requiring prompt medical attention. While transcatheter aortic valve replacement (TAVR) is an effective treatment, current scheduling practices often do not account for individual patient risk profiles due to limited data on mortality rates during the waiting period and a lack of viable risk assessment. Consequently, non-prioritized wait times may be unacceptably long for high-risk patient populations.</p><p><strong>Objective: </strong>This study aimed to evaluate the mortality rate of patients with symptomatic severe AS awaiting TAVR and identify pragmatic clinical risk predictors during this period.</p><p><strong>Methods: </strong>Between January 2019 and December 2023, 2,454 patients with symptomatic severe AS, were scheduled for TAVR after an interdisciplinary Heart Team discussion at the Heart Center Bonn. Mortality during the waiting period was assessed, and the characteristics of survivors (patients who underwent TAVR) were compared to non-survivors (patients who died before the procedure).</p><p><strong>Results: </strong>The median waiting time for TAVR was 41 days. A total of 105 (4.3%) patients died during the waiting period, with a median time to death of 29 days. By comparison, 30 day post-TAVR mortality, including the intervention, was 1.7%. Multivariate regression analysis identified independent predictors of pre-TAVR mortality including reduced left ventricular ejection fraction, decreased estimated glomerular filtration rate, mitral regurgitation, tricuspid regurgitation, and advanced heart failure symptoms. An IMPACT score, incorporating these parameters, strongly predicted outcome with a hazard ratio for mortality of 2.1 greatly outperforming both EuroSCORE II and STS-PROM. The IMPACT score of ≥ 5 identified high-risk patients with a pre-TAVR mortality rate of 12.6%.</p><p><strong>Conclusion: </strong>The mortality rate for patients with symptomatic severe AS awaiting TAVR is unacceptably high. Utilizing the IMPACT score could enable precise risk stratification, identifying patients who require urgent or prioritized intervention to improve outcomes.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1565-1573"},"PeriodicalIF":3.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12540598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144474113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fibrin clot strength is associated with increased risk of major adverse cardiac events after TAVR.","authors":"David Hesselbarth, Michelle D'Orazio, Giovanni Ciccarone, Diona Gjermeni, Carina Jülch, Marius Wessinger, Mariya Maslarska, Jonathan Rilinger, Ingo Hilgendorf, Dennis Wolf, Klaus Kaier, Daniel Duerschmied, Torben Pottgiesser, Constantin von Zur Mühlen, Dirk Westermann, Christoph B Olivier","doi":"10.1007/s00392-025-02749-7","DOIUrl":"10.1007/s00392-025-02749-7","url":null,"abstract":"<p><strong>Background: </strong>Patients after transcatheter aortic valve replacement (TAVR) are at increased risk of both major adverse cardiac events (MACE), including ischemic and thrombotic complications, as well as significant bleeding. Given this delicate balance between prothrombotic and hemorrhagic risk, the assessment of hemostatic markers might help identify patients at increased risk.</p><p><strong>Aim: </strong>To identify hemostatic markers associated with MACE and bleeding following TAVR.</p><p><strong>Methods: </strong>In this prospective single-center cohort study, of patients undergoing TAVR from November 2020 to June 2022, the association of hemostatic profiles and clinical outcomes was assessed. The profiling included thromboelastography (TEG), light transmission aggregometry (LTA), and conventional laboratory markers to assess thrombogenicity. The outcome was MACE (death, myocardial infarction, or stroke) and major/non-major clinically relevant bleeding at 6 months.</p><p><strong>Results: </strong>Of the 107 patients included, 104 completed follow-up. At 6 months, 9% experienced MACE, and 10% had clinically relevant bleeding. Platelet-fibrin clot strength, reflected by the maximum amplitude (MA-citrated kaolin) in thrombelastography, was elevated in patients with MACE (per 1 mm increase: HR 1.26 [1.02;1.56], p = 0.03). Fibrin's role in the maximum clot strength was crucial. Elevated fibrinogen levels, increased citrated functional fibrinogen (MA-CFF), and faster fibrin formation (alpha-angle[α]) associated with a higher risk of MACE (per 20 mg/dL fibrinogen increase: HR 1.15 [1.02-1.28], p = 0.02; per 5 mm MA-CFF increase: HR 1.59 [1.12-2.26], p < 0.01; per degree α-citrated rapid TEG increase: HR 1.55 [1.10-2.19], p = 0.01), respectively. High on-treatment ADP-induced platelet reactivity assessed by LTA was associated with a lower risk of major and non-major clinically relevant bleeding at 6 months (per 10% MA-ADP increase: HR 0.66 [0.47;0.93] p=0.02 ).</p><p><strong>Conclusion: </strong>Selected hemostatic markers associated with the risk of MACE and bleeding within 6 months in patients post-TAVR, with fibrin clot strength identified as a principal marker.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1606-1615"},"PeriodicalIF":3.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12540584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcome of bail-out ViV-TAVI at index procedure.","authors":"Isabel Horn, Hazem Omran, Sabine Bleiziffer, Smita Scholtz, Kai Friedrichs, Cornelia Piper, Johanna Bormann, Sara Waezsada, Max Potratz, René Schramm, Volker Rudolph, Tanja K Rudolph","doi":"10.1007/s00392-025-02640-5","DOIUrl":"10.1007/s00392-025-02640-5","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to compare in-hospital and long-term outcomes of patients with bail-out valve-in-valve TAVI due to a primarily failed transcatheter aortic valves procedure (bViV-TAVI) versus a successful transcatheter aortic valve implantation (TAVI).</p><p><strong>Methods: </strong>We recorded bViV-TAVI procedures at our center from February 2011 to March 2022. Primary endpoint was long-term mortality. In-hospital mortality, stroke, acute kidney failure, need for new permanent pacemaker, and duration of intervention were secondary endpoints.</p><p><strong>Results: </strong>4555 patients undergoing TAVI were retrospectively included. 231 matched (77:154) patients were analyzed. BViV-TAVI was a rare event (1.9%). In 76.7% of the cases transcatheter valve embolization and migration were the reasons for implanting a second valve in the same procedure. Significant PVL accounted for bViV-TAVI in 23.4% of the patients. The duration of the intervention was significantly longer for the bViV-TAVI group (p < 0.001). BViV-TAVI patients showed higher rates of a new permanent pacemaker implantation (p = 0.013) and the postprocedural mean pressure was significantly higher (p = 0.03). Concerning the other secondary endpoints there was a trend for a higher event rate in bVIV-TAVI patients which did not reach significant difference. After an average follow-up period of 4.9 ± 3.0 years, mortality was significantly higher in the bViV-TAVI group (54.5% vs. 39.0%, p = 0.025).</p><p><strong>Conclusion: </strong>The implantation of a second valve during the same procedure as bail-out is a feasible alternative treatment option in patients with failed transcatheter aortic valve procedures. However, increased long-term mortality must be taken into account.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1445-1454"},"PeriodicalIF":3.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12540624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic utility of mid-regional pro-adrenomedullin and growth differentiation factor 15 in patients undergoing transfemoral transcatheter aortic valve implantation.","authors":"Kerstin Piayda, Stanislav Keranov, Luisa Schulz, Mani Arsalan, Christoph Liebetrau, Won-Keun Kim, Felsix J Hofmann, Pascal Bauer, Sandra Voss, Christian Troidl, Samuel T Sossalla, Christian W Hamm, Holger M Nef, Oliver Dörr","doi":"10.1007/s00392-024-02560-w","DOIUrl":"10.1007/s00392-024-02560-w","url":null,"abstract":"<p><strong>Background: </strong>Risk prediction in patients with severe, symptomatic aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) remains an unsolved issue. In addition to classical risk scoring systems, novel circulating biomarkers like mid-regional pro-adrenomedullin (MR-proADM) and growth differentiation factor 15 (GDF-15) may be of value in assessing risk.</p><p><strong>Methods: </strong>Consecutive patients undergoing elective transfemoral TAVI were included in this prospective observational study. Baseline information, imaging findings, blood samples, and clinical outcomes were collected. Blood levels of the classical biomarkers interleukin-6 (IL-6) and high-sensitivity C-reactive peptide (hsCRP) and of the novel biomarkers MR-proADM and GDF-15 were measured and their predictive utility for mortality assessed.</p><p><strong>Results: </strong>The study cohort consisted of 92 patients undergoing TAVI. The median age was 80.7 years [IQR 77.2;83.3], and 48 (52.2%) were male. Analysis of the area under the curve (AUC) of the receiver-operating characteristics showed that the hsCRP levels discriminated poorly (AUC 0.66, 95% CI [0.52;0.8], p = 0.027), whereas all other biomarkers reached a higher level of discrimination (IL-6: AUC 0.76, 95% CI [0.66;0.86], p < 0.001; MR-proADM: AUC 0.73, 95% CI [0.61;0.85], p = 0.002; GDF-15: AUC 0.73, 95% CI [0.61;0.85], p = 0.002). Kaplan-Meier analysis in conjunction with Youden J-statistics yielded the optimal cutoff points for each biomarker to predict survival: IL-6 4.65 pg/mL, hsCRP 12.9 mg/L, MR-proADM 1.02 nmol/L, and GDF-15 2400.1 pg/mL.</p><p><strong>Conclusion: </strong>Novel circulating biomarkers like MR-proADM and GDF-15 may provide additional value in predicting survival after TAVI.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1508-1515"},"PeriodicalIF":3.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12540537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low-flow in aortic valve stenosis patients with reduced ejection fraction does not depend on left ventricular function.","authors":"Svante Gersch, Torben Lange, Bo Eric Beuthner, Manar Elkenani, Niels Paul, Moritz Schnelle, Elisabeth Zeisberg, Miriam Puls, Gerd Hasenfuß, Andreas Schuster, Karl Toischer","doi":"10.1007/s00392-023-02372-4","DOIUrl":"10.1007/s00392-023-02372-4","url":null,"abstract":"<p><strong>Background: </strong>Patients with severe aortic stenosis (AS) and reduced left ventricular ejection fraction (LVEF) can be distinguished into high- (HG) and low-gradient (LG) subgroups. However, less is known about their characteristics and underlying (pathophysiological) hemodynamic mechanisms.</p><p><strong>Methods: </strong>98 AS patients with reduced LVEF were included. Subgroup characteristics were analyzed by a multimodal approach using clinical and histological data, next-generation sequencing (NGS) and applying echocardiography as well as cardiovascular magnetic resonance (CMR) imaging. Biopsy samples were analyzed with respect to fibrosis and mRNA expression profiles.</p><p><strong>Results: </strong>40 patients were classified as HG-AS and 58 patients as LG-AS. Severity of AS was comparable between the subgroups. Comparison of both subgroups revealed no differences in LVEF (p = 0.1), LV mass (p = 0.6) or end-diastolic LV diameter (p = 0.12). Neither histological (HG: 23.2% vs. LG: 25.6%, p = 0.73) and circulating biomarker-based assessment (HG: 2.6 ± 2.2% vs. LG: 3.2 ± 3.1%; p = 0.46) of myocardial fibrosis nor global gene expression patterns differed between subgroups. Mitral regurgitation (MR), atrial fibrillation (AF) and impaired right ventricular function (MR: HG: 8% vs. LG: 24%; p < 0.001; AF: HG: 30% vs. LG: 51.7%; p = 0.03; RVSVi: HG 36.7 vs. LG 31.1 ml/m2, p = 0.045; TAPSE: HG 20.2 vs. LG 17.3 mm, p = 0.002) were more frequent in LG-AS patients compared to HG-AS. These pathologies could explain the higher mortality of LG vs. HG-AS patients.</p><p><strong>Conclusion: </strong>In patients with low-flow severe aortic stenosis, low transaortic gradient and cardiac output are not primarily due to LV dysfunction or global changes in gene expression, but may be attributed to other additional cardiac pathologies like mitral regurgitation, atrial fibrillation or right ventricular dysfunction. These factors should also be considered during planning of aortic valve replacement.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":"1455-1466"},"PeriodicalIF":3.7,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12540571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139485318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}