Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease最新文献

{"title":"Feasibility, Safety, and Short‐Term Outcomes of Transcatheter Patent Ductus Arteriosus Closure in Premature Infants on High‐Frequency Jet Ventilation","authors":"K. Shibbani, Bassel Mohammad Nijres, Daniel Mclennan, A. R. Bischoff, R. Giesinger, P. McNamara, J. Klein, J. Windsor, O. Aldoss","doi":"10.1161/JAHA.122.025343","DOIUrl":"https://doi.org/10.1161/JAHA.122.025343","url":null,"abstract":"Background Prolonged exposure to a hemodynamically significant patent ductus arteriosus (PDA) is associated with major morbidity, particularly in infants born at <27 weeks’ gestation. High‐frequency jet ventilation (HFJV) is a standard of care at our center. There are no data about transcatheter PDA closure while on HFJV. The aim of this study was to assess the feasibility, safety, and outcomes of HFJV during transcatheter PDA closure. Methods and Results This is a retrospective cohort study of premature infants undergoing transcatheter device closure on HFJV. The primary outcome was successful device placement. Secondary outcomes included procedure time, fluoroscopy time and dose, time off unit, device complications, need for escalation in respiratory support, and 7‐day survival. Subgroup comparative evaluation of patients managed with HFJV versus a small cohort of patients managed with conventional mechanical ventilation was performed. Thirty‐eight patients were included in the study. Median age and median weight at PDA device closure for the HFJV cohort were 32 days (interquartile range, 25.25–42.0 days) and 1115 g (interquartile range, 885–1310 g), respectively. There was successful device placement in 100% of patients. There were no device complications noted. The time off unit and the procedure time were not significantly different between the HFJV group and the conventional ventilation group. Infants managed by HFJV had shorter median fluoroscopy times (4.5 versus 6.1 minutes; P<0.05) and no increased risk of adverse respiratory outcomes. Conclusions Transcatheter PDA closure in premature infants on HFJV is a safe and effective approach that does not compromise device placement success rate and does not lead to secondary complications.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88017436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invasive Hemodynamic Predictors of Survival in Patients With Mitral Stenosis Secondary to Mitral Annular Calcification","authors":"A. El Sabbagh, R. Nishimura, M. Eleid, S. Pislaru, P. Pellikka, C. Rihal, M. Guerrero, D. Hodge, William R. Miranda","doi":"10.1161/JAHA.121.023107","DOIUrl":"https://doi.org/10.1161/JAHA.121.023107","url":null,"abstract":"Background The aim of this study was to establish prognostic hemodynamic parameters in patients with mitral stenosis secondary to mitral annular calcification. Methods and Results A retrospective cohort of 105 patients undergoing transseptal catheterization for hemodynamic evaluation of mitral annular calcification–related mitral stenosis between 2004 and 2020 was studied. Mitral valve gradient (MVG) and mitral valve area (MVA; calculated by the Gorlin formula) were measured using direct left atrial and left ventricular pressures. The median age of the patients was 70.3 years (58.4–76.7 years), and 53.3% were women. The median MVA was 1.7 cm2 (1.3–2.3 cm2) and MVG was 7.3 mm Hg (5.3–10.3 mm Hg); left ventricular end‐diastolic pressure was 17.6±28.3 mm Hg. During a median of 2.1 years (0.7–4.5 years), there were 63 deaths; 1‐ and 5‐year survival were 76% and 40%, respectively. There was no association between left ventricular end‐diastolic pressure and survival. After adjusting for age and comorbidities, both MVA (hazard ratio [HR], 0.50 per cm2; 95% CI, 0.34–0.73) and MVG (HR, 1.1 per mm Hg; 95% CI, 1.05–1.20) were independent predictors of death. Atrial fibrillation was also independently associated with mortality. When added to a combined model, MVA remained associated with death (HR, 0.51 per cm2; 95% CI, 0.33–0.79) while MVG was not. Conclusions In patients with mitral annular calcification–related mitral stenosis, survival was poor. MVA and MVG were independently associated with death, but MVA was a better predictor of outcomes.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"50 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80779462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrashort Door‐to‐Needle Time for Intravenous Thrombolysis Is Safer and Improves Outcome in the Czech Republic: Nationwide Study 2004 to 2019","authors":"R. Mikulík, M. Bar, S. Belaskova, D. Černík, J. Fiksa, R. Herzig, R. Jura, L. Jurák, Lukáš Klečka, J. Neumann, S. Ostrý, D. Šaňák, P. Ševčík, O. Škoda, M. Šrámek, A. Tomek, D. Václavík","doi":"10.1161/JAHA.121.023524","DOIUrl":"https://doi.org/10.1161/JAHA.121.023524","url":null,"abstract":"Background The benefit of intravenous thrombolysis is time dependent. It remains unclear, however, whether dramatic shortening of door‐to‐needle time (DNT) among different types of hospitals nationwide does not compromise safety and still improves outcome. Methods and Results Multifaceted intervention to shorten DNT was introduced at a national level, and prospectively collected data from a registry between 2004 and 2019 were analyzed. Generalized estimating equation was used to identify the association between DNT and outcomes independently from prespecified baseline variables. The primary outcome was modified Rankin score 0 to 1 at 3 months, and secondary outcomes were parenchymal hemorrhage/intracerebral hemorrhage (ICH), any ICH, and death. Of 31 316 patients treated with intravenous thrombolysis alone, 18 861 (60%) had available data: age 70±13 years, National Institutes of Health Stroke Scale at baseline (median, 8; interquartile range, 5–14), and 45% men. DNT groups 0 to 20 minutes, 21 to 40 minutes, 41 to 60 minutes, and >60 minutes had 3536 (19%), 5333 (28%), 4856 (26%), and 5136 (27%) patients. National median DNT dropped from 74 minutes in 2004 to 22 minutes in 2019. Shorter DNT had proportional benefit: it increased the odds of achieving modified Rankin score 0 to 1 and decreased the odds of parenchymal hemorrhage/ICH, any ICH, and mortality. Patients with DNT ≤20 minutes, 21 to 40 minutes, and 41 to 60 minutes as compared with DNT >60 minutes had adjusted odds ratios for modified Rankin score 0 to 1 of the following: 1.30 (95% CI, 1.12–1.51), 1.33 (95% CI, 1.15–1.54), and 1.15 (95% CI, 1.02–1.29), and for parenchymal hemorrhage/ICH: 0.57 (95% CI, 0.45–0.71), 0.76 (95% CI, 0.61–0.94), 0.83 (95% CI, 0.70–0.99), respectively. Conclusions Ultrashort initiation of thrombolysis is feasible, improves outcome, and makes treatments safer because of fewer intracerebral hemorrhages. Stroke management should be optimized to initiate thrombolysis as soon as possible optimally within 20 minutes from arrival to a hospital.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78715623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nitrite Generating and Depleting Capacity of the Oral Microbiome and Cardiometabolic Risk: Results from ORIGINS","authors":"C. E. Goh, B. Bohn, C. Marotz, Rebecca L Molinsky, Sumith Roy, B. Paster, Ching-Yuan Chen, M. Rosenbaum, M. Yuzefpolskaya, P. Colombo, M. Desvarieux, P. Papapanou, D. Jacobs, R. Knight, R. Demmer","doi":"10.1161/JAHA.121.023038","DOIUrl":"https://doi.org/10.1161/JAHA.121.023038","url":null,"abstract":"Background The enterosalivary nitrate–nitrite–nitric oxide (NO3–NO2–NO) pathway generates NO following oral microbiota‐mediated production of salivary nitrite, potentially linking the oral microbiota to reduced cardiometabolic risk. Nitrite depletion by oral bacteria may also be important for determining the net nitrite available systemically. We examine if higher abundance of oral microbial genes favoring increased oral nitrite generation and decreased nitrite depletion is associated with a better cardiometabolic profile cross‐sectionally. Methods and Results This study includes 764 adults (mean [SD] age 32 [9] years, 71% women) enrolled in ORIGINS (Oral Infections, Glucose Intolerance, and Insulin Resistance Study). Microbial DNA from subgingival dental plaques underwent 16S rRNA gene sequencing; PICRUSt2 was used to estimate functional gene profiles. To represent the different components and pathways of nitrogen metabolism in bacteria, predicted gene abundances were operationalized to create summary scores by (1) bacterial nitrogen metabolic pathway or (2) biochemical product (NO2, NO, or ammonia [NH3]) formed by the action of the bacterial reductases encoded. Finally, nitrite generation‐to‐depletion ratios of gene abundances were created from the above summary scores. A composite cardiometabolic Z score was created from cardiometabolic risk variables, with higher scores associated with worse cardiometabolic health. We performed multivariable linear regression analysis with cardiometabolic Z score as the outcome and the gene abundance summary scores and ratios as predictor variables, adjusting for sex, age, race, and ethnicity in the simple adjusted model. A 1 SD higher NO versus NH3 summary ratio was inversely associated with a −0.10 (false discovery rate q=0.003) lower composite cardiometabolic Z score in simple adjusted models. Higher NH3 summary score (suggestive of nitrite depletion) was associated with higher cardiometabolic risk, with a 0.06 (false discovery rate q=0.04) higher composite cardiometabolic Z score. Conclusions Increased net capacity for nitrite generation versus depletion by oral bacteria, assessed through a metagenome estimation approach, is associated with lower levels of cardiometabolic risk.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73918640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke Risk Stratification in Patients With Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting","authors":"A. Taha, S. Nielsen, S. Franzén, Mary Rezk, A. Ahlsson, L. Friberg, Staffan Björck, A. Jeppsson, L. Bergfeldt","doi":"10.1161/JAHA.121.024703","DOIUrl":"https://doi.org/10.1161/JAHA.121.024703","url":null,"abstract":"Background The CHA2DS2‐VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, previous stroke or TIA [transient ischemic attack], vascular disease, age 65 to 74 years, sex category female; 2 indicates 2 points, otherwise 1 point) scoring system is recommended to guide decisions on oral anticoagulation therapy for stroke prevention in patients with nonsurgery atrial fibrillation. A score ≥1 in men and ≥2 in women, corresponding to an annual stroke risk exceeding 1%, warrants long‐term oral anticoagulation provided the bleeding risk is acceptable. However, in patients with new‐onset postoperative atrial fibrillation, the optimal risk stratification method is unknown. The aim of this study was therefore to evaluate the CHA2DS2‐VASc scoring system for estimating the 1‐year ischemic stroke risk in patients with new‐onset postoperative atrial fibrillation after coronary artery bypass grafting. Methods and Results All patients with new‐onset postoperative atrial fibrillation and without oral anticoagulation after first‐time isolated coronary artery bypass grafting performed in Sweden during 2007 to 2017 were eligible for this registry‐based observational cohort study. The 1‐year ischemic stroke rate at each step of the CHA2DS2‐VASc score was estimated using a Kaplan‐Meier estimator. Of the 6368 patients included (mean age, 69.9 years; 81% men), >97% were treated with antiplatelet drugs. There were 147 ischemic strokes during the first year of follow‐up. The ischemic stroke rate at 1 year was 0.3%, 0.7%, and 1.5% in patients with CHA2DS2‐VASc scores of 1, 2, and 3, respectively, and ≥2.3% in patients with a score ≥4. A sensitivity analysis, with the inclusion of patients on anticoagulants, was performed and supported the primary results. Conclusions Patients with new‐onset atrial fibrillation after coronary artery bypass grafting and a CHA2DS2‐VASc score <3 have such a low 1‐year risk for ischemic stroke that oral anticoagulation therapy should probably be avoided.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74331219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differences in Characteristics and Outcomes Between Patients With Hypertrophic Cardiomyopathy From Asian and European Centers","authors":"C. Tjahjadi, S. Butcher, T. Zegkos, C. Sia, K. Hirasawa, V. Kamperidis, J. N. Ngiam, R. Wong, G. Efthimiadis, Jeroen J. Bax, V. Delgado, N. Ajmone Marsan","doi":"10.1161/JAHA.121.023313","DOIUrl":"https://doi.org/10.1161/JAHA.121.023313","url":null,"abstract":"Hypertrophic cardiomyopathy (HCM) is a common form of inherited cardiomyopathy with a prevalence in the general population reported as 0.2% in different international studies.1 Although differences in disease expression and outcome are described among White and Black patients with HCM,2 it is largely unknown whether Asian patients present also a different HCM phenotype. Only 1 study included 133 Asian patients and highlighted health disparities among ethnicities relating to access to genetic testing and implantable cardioverterdefibrillator (ICDs) use.3 In our study, a total of 1661 consecutive patients (1210 European patients; 451 Asian patients including 308 Chinese, 83 Malay, and 60 South Asian patients) diagnosed with HCM according to current criteria1 were included from 3 centers (Leiden University Medical Center, The Netherlands; National University Hospital, Singapore; Aristoteleio University of Thessaloniki, Greece). This study aimed to evaluate the differences between patients with HCM from the European centers (n=1214, 1% Asian ethnicities) and the Asian center (n=447, 97% Asian ethnicities), to elucidate the influence of ethnicity, differences in care patterns, and sociocultural factors on patient outcome. The institutional review boards approved this retrospective analysis and waived the need for informed consent. The data that support the findings of this study are available from the corresponding author upon reasonable request. At the time of diagnosis, patients from the Asian center were older than those from the European centers (59 [47– 68] years versus 52 [41– 62] years, P<0.001), with similar proportion of men (71% versus 67%, P=0.093) and lower body surface area (1.7±0.2 m2 versus 2.0±0.2 m2, P<0.001). Diabetes (22% versus 16%, P=0.004) was more frequent in European centers, whereas hypertension (23% versus 49%, P<0.001) and coronary artery disease (8% versus 28%, P<0.001) were more prevalent in the Asian center. New York Heart Association functional class (class III– IV 7% versus 10%, P=0.096) at presentation was not significantly different between patients from Asian and European centers. By echocardiography, patients from the Asian center presented with smaller septal wall thickness (16 [13– 19] mm versus 18 [16– 22] mm, P<0.001) but the maximum wall thickness (19 [17– 22] mm versus 19 [16– 22] mm,","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89481369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scores for Chronic Total Occlusion Percutaneous Coronary Intervention: A Window to the Future?","authors":"Bahadir Simsek, Spyridon Kostantinis, J. Karacsonyi, E. Brilakis","doi":"10.1161/JAHA.122.026070","DOIUrl":"https://doi.org/10.1161/JAHA.122.026070","url":null,"abstract":"Symptom relief is currently the main indication for CTO PCI.2,5 Several observational studies and 36– 8 of 49 randomizedcontrolled trials showed symptom improvement with CTO PCI compared with optimal medical therapy (OMT) alone. In the EuroCTO (randomized multicenter trial to compare revascularization with OMT for the treatment of chronic total coronary occlusions) trial, 396 patients were randomized to OMT versus OMT+PCI. At 12 months, patients who underwent CTO PCI had greater improvements in angina frequency, quality of life, and physical limitation, as assessed by Seattle Angina Questionnaire.3 In the ImpactorCTO (Impact on Inducible Myocardial Ischemia of Percutaneous Coronary Intervention Versus Optimal Medical Therapy in Patients With Right Coronary Artery Chronic Total Occlusion) trial, 94 patients with angina and isolated dominant right coronary artery CTOs were randomized to OMT versus OMT+PCI. At 12 months, the CTO PCI group had significantly lower myocardial ischemia burden, improved 6minute walk distance, and improved health, as assessed by the 36Item Short Form Survey.4 In the COMETCTO (Randomized Controlled Comparison of Optimal Medical Therapy With Percutaneous Recanalization of Chronic Total Occlusion) trial, 100 patients were randomized to OMT versus OMT+PCI; at 9month followup, patients who underwent CTO PCI had significantly improved physical limitation, angina, treatment satisfaction,","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"158 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83841549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Per‐Protocol Versus Intention‐to‐Treat in Clinical Trials: The Example of GLOBAL‐LEADERS Trial","authors":"C. Santos-Gallego, J. A. Requena-Ibáñez, J. Badimón","doi":"10.1161/JAHA.122.025561","DOIUrl":"https://doi.org/10.1161/JAHA.122.025561","url":null,"abstract":"fter drug- eluting stent implantation, the classic therapy was dual antiplatelet therapy (DAPT) for 1 year and then stopping P2Y12 inhibitor while maintaining aspirin forever. The main limitation is the in-creased risk of bleeding with prolonged DAPT strategy might offset the ischemic benefit. Given that ischemic risk is higher in the initial phase whereas bleeding risk is maintained in the long term, deescalation therapies have been proposed, either with shorter DAPT durations or with aspirin- free strategies. 1 In fact, DAPT should follow the Goldilocks principle 2 (not too short, not too long). Recent studies (GLOBAL- LEADERS, 3 TWILIGHT [Ticagrelor with Aspirin or Alone in High- Risk Patients after Coronary Intervention], 4 TICO [Ticagrelor Monotherapy After 3 Months in the Patients Treated With New Generation Sirolimus- Eluting Stent for Acute Coronary Syndrome], 5 STOP- DAPT [Short and Optimal Duration of Dual Antiplatelet Therapy After Everolimus- Eluting Cobalt-Chromium Stent], 6 SMART- CHOICE [Smart Angioplasty Research Team: Comparison Between P2Y12 Antagonist Monotherapy vs Dual Anti- platelet Therapy in Patients Undergoing Implantation of Coronary Drug- Eluting Stents] 7 ) suggest that the deescalation strategy with an abbreviated DAPT period after percutaneous coronary intervention (1– 3 months) followed by aspirin cessation and P2Y12 inhibitor monotherapy mitigates bleeding risk without losing efficacy for ischemic prevention. Among all these trials, GLOBAL- LEADERS 3 offers the largest sample size and is the only one designed as a superiority trial.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"98 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83938131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous Edge‐to‐Edge Repair for Systemic Atrioventricular Valve Regurgitation in Patients With Congenital Heart Disease: The First Descriptive Cohort","authors":"P. Guérin, Z. Jalal, R. Le Ruz, C. Cueff, S. Hascoet, H. Bouvaist, M. Ladouceur, F. Levy, N. Hugues, S. Malekzadeh-Milani, L. Leroux, T. Modine, A. Silini, J. Gallet, C. Saunier, Karine Warin Fresse, N. Karam, P. Vouhé, L. Iserin, S. Ghostine, X. Iriart, Laurianne Le Gloan, J. Thambo","doi":"10.1161/JAHA.122.025628","DOIUrl":"https://doi.org/10.1161/JAHA.122.025628","url":null,"abstract":"Patrice Guerin , MD, PhD; Zakaria Jalal , MD, PhD; Robin Le Ruz , MD; Caroline Cueff, MD; Sebastien Hascoet , MD, PhD; Hélène Bouvaist, MD; Magalie Ladouceur , MD, PhD; Franck Levy, MD; Nicolas Hugues, MD; SophieGuiti MalekzadehMilani, MD, PhD; Lionel Leroux, MD, PhD; Thomas Modine , MD, PhD; Alexandre Silini, MD; Jean Gallet, MD; Carole Saunier, MD; Karine Warin Fresse, MD; Nicole Karam, MD, PhD; Pascal Vouhe, MD, PhD; Laurence Iserin , MD; Said Ghostine, MD, PhD; Xavier Iriart , MD; Laurianne Le Gloan, MD; Jean Benoit Thambo, MD, PhD","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81091645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concomitant Hepatorenal Dysfunction and Malnutrition in Valvular Heart Surgery: Long‐Term Prognostic Implications for Death and Heart Failure","authors":"Y. Tse, C. Chandramouli, H. Li, Siyun Yu, Mei-Zhen Wu, Q. Ren, Yan Chen, P. Wong, Ko-Yung Sit, D. Chan, C. K. Ho, W. Au, Xin-li Li, H. Tse, C. Lam, K. Yiu","doi":"10.1161/JAHA.121.024060","DOIUrl":"https://doi.org/10.1161/JAHA.121.024060","url":null,"abstract":"Background Strategies to improve long‐term prediction of heart failure and death in valvular surgery are urgently needed because of an increasing number of procedures globally. This study sought to report the prevalence, changes, and prognostic implications of concomitant hepatorenal dysfunction and malnutrition in valvular surgery. Methods and Results In 909 patients undergoing valvular surgery, 3 groups were defined based on hepatorenal function (the modified model for end‐stage liver disease excluding international normalized ratio score) and nutritional status (Controlling Nutritional Status score): normal hepatorenal function and nutrition (normal), hepatorenal dysfunction or malnutrition alone (mild), and concomitant hepatorenal dysfunction and malnutrition (severe). Overall, 32%, 46%, and 19% of patients were classified into normal, mild, and severe groups, respectively. Over a 4.1‐year median follow‐up, mild and severe groups incurred a higher risk of mortality (hazard ratio [HR], 3.17 [95% CI, 1.40–7.17] and HR, 9.30 [95% CI, 4.09–21.16], respectively), cardiovascular death (subdistribution HR, 3.29 [95% CI, 1.14–9.52] and subdistribution HR, 9.29 [95% CI, 3.09–27.99]), heart failure hospitalization (subdistribution HR, 2.11 [95% CI, 1.25–3.55] and subdistribution HR, 3.55 [95% CI, 2.04–6.16]), and adverse outcomes (HR, 2.11 [95% CI, 1.25–3.55] and HR, 3.55 [95% CI, 2.04–6.16]). Modified model for end‐stage liver disease excluding international normalized ratio and controlling nutritional status scores improved the predictive ability of European System for Cardiac Operative Risk Evaluation (area under the curve: 0.80 versus 0.73, P<0.001) and Society of Thoracic Surgeons score (area under the curve: 0.79 versus 0.72, P=0.004) for all‐cause mortality. One year following surgery (n=707), patients with persistent concomitant hepatorenal dysfunction and malnutrition (severe) experienced worse outcomes than those without. Conclusions Concomitant hepatorenal dysfunction and malnutrition was frequent and strongly linked to heart failure and mortality in valvular surgery.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80752454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}