American heart journal最新文献

{"title":"Current practices in the management of temporary mechanical circulatory support: A survey of CICU directors in North America","authors":"Amrita Balgobind MD ,&nbsp;Matthew Pierce MD ,&nbsp;Carlos Alviar MD ,&nbsp;Christopher Barnett MD ,&nbsp;Gregory Barsness MD ,&nbsp;Sunit-preet Chaudhry MD ,&nbsp;Meshe Chonde MD ,&nbsp;Howard Cooper MD ,&nbsp;Lori Daniels MD ,&nbsp;Umesh Gidwani MD ,&nbsp;Christopher Fordyce MD ,&nbsp;Michael Goldfarb MD ,&nbsp;Jason N. Katz MD ,&nbsp;Michael Kontos MD ,&nbsp;Younghoon Kwon MD ,&nbsp;Evan Liebner MD, PhD ,&nbsp;Shuangbo Liu MD ,&nbsp;P. Elliott Miller MD, MHS ,&nbsp;L.K. Newby MD ,&nbsp;Connor O'Brien MD ,&nbsp;Miguel Alvarez Villela MD","doi":"10.1016/j.ahj.2024.05.018","DOIUrl":"10.1016/j.ahj.2024.05.018","url":null,"abstract":"<div><h3>Introduction</h3><p>Despite the growing use of temporary mechanical circulatory support (tMCS), little data exists to inform management and weaning of these devices.</p></div><div><h3>Methods</h3><p>We performed an online survey among cardiac intensive care unit directors in North America to examine current practices in the management of patients treated with intraaortic balloon pump and Impella.</p></div><div><h3>Results</h3><p>We received responses from 84% of surveyed centers (n=37). Our survey focused on three key aspects of daily management: 1. Hemodynamic monitoring; 2. Hemocompatibility; and 3. Weaning and removal. We found substantial variability surrounding all three areas of care.</p></div><div><h3>Conclusion</h3><p>Our findings highlight the need for consensus around practices associated with improved outcomes in patients treated with tMCS.</p></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"276 ","pages":"Pages 115-119"},"PeriodicalIF":3.7,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049168","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":"The impact of mavacamten dosing on wall thickness regression: an insight from longer term follow-up based on genetic profile","authors":"Said Alsidawi MD ,&nbsp;Kaitlin M. Roehl PA ,&nbsp;Juan Maria Farina MD ,&nbsp;Reza Arsanjani MD ,&nbsp;John R. Giudicessi MD, PhD ,&nbsp;Jeffrey B. Geske MD ,&nbsp;Darrell B. Newman MD ,&nbsp;Michael J. Ackerman MD, PhD ,&nbsp;Steve R. Ommen MD","doi":"10.1016/j.ahj.2024.07.001","DOIUrl":"10.1016/j.ahj.2024.07.001","url":null,"abstract":"<div><h3>Introduction</h3><p>We have previously reported that genetically positive patients have a more profound early decrease in provocable left ventricular outflow tract gradient compared to genetically negative patients utilizing mavacamten in the first 12 weeks of therapy.</p></div><div><h3>Methods and results</h3><p>In this current analysis, we found that genetically positive patients have less favorable remodeling as measured by left ventricular wall thickness regression when evaluated long-term as compared to genetically negative patients, despite an overall better early response to mavacamten. The majority of genetically positive patients were maintained on only 2.5 mg of mavacamten due to early robust response.</p></div><div><h3>Conclusion</h3><p>We hypothesize that this lower dosing attenuated the long-term benefit of mavacamten in genetically positive patients. We believe that the long-term benefit of mavacamten on positive cardiac remodeling is dose-dependent and not solely related to the magnitude of left ventricular outflow gradient decrease.</p></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"277 ","pages":"Pages 138-141"},"PeriodicalIF":3.7,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142136319","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":"Investigating racial and gender disparities in virtual randomized clinical trial enrollment: Insights from the BE ACTIVE study","authors":"Michael P. Fortunato MD ,&nbsp;Anthony Girard ScM ,&nbsp;Samantha Coratti BA ,&nbsp;David Farraday BA ,&nbsp;Laurie Norton MA, MBE ,&nbsp;Charles Rareshide MA ,&nbsp;Jingsan Zhu MS, MBA ,&nbsp;Neel Chokshi MD, MBA ,&nbsp;Julia E. Szymczak PhD ,&nbsp;Tamar Klaiman PhD ,&nbsp;Louise B. Russell PhD ,&nbsp;Dylan S. Small PhD ,&nbsp;Mitesh S. Patel MD, MBA ,&nbsp;Kevin G.M. Volpp MD, PhD ,&nbsp;Alexander C. Fanaroff MD, MHS","doi":"10.1016/j.ahj.2024.06.003","DOIUrl":"10.1016/j.ahj.2024.06.003","url":null,"abstract":"<div><p>Randomized clinical trials (RCTs) often suffer from a lack of representation from historically marginalized populations, and it is uncertain whether virtual RCTs (vRCTs) enhance representativeness or if elements of their consent and enrollment processes may instead contribute to underrepresentation of these groups. In this study, we aimed to identify disparities in enrollment demographics in a vRCT, the BE ACTIVE study, which recruited patients within a single health system. We discovered that the proportions of eligible patients who were randomized differed significantly by gender and race/ethnicity (men 1.2%, women 2.0%, <em>P</em> &lt; .001; White 1.8%, Black 1.3%, Hispanic 0.7%, Asian 0.9%; <em>P</em> &lt; .001), and compared with White patients, non-White patients were less likely to have a valid email address on file and were less likely to click on the email link to the study webpage and begin enrollment.</p></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"276 ","pages":"Pages 120-124"},"PeriodicalIF":3.7,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142049169","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":"Burden of hospitalization during the first year following transcatheter and surgical aortic valve replacement","authors":"Jawad H. Butt MD ,&nbsp;Adelina Yafasova MD ,&nbsp;David Thein MD ,&nbsp;Xenia Begun MD ,&nbsp;Eva Havers-Borgersen MD ,&nbsp;Pernille S. Bække MD ,&nbsp;Morten H. Smerup MD, PhD ,&nbsp;Ole De Backer MD, PhD ,&nbsp;Lars Køber MD, DMSc ,&nbsp;Emil L. Fosbøl MD, PhD","doi":"10.1016/j.ahj.2024.07.014","DOIUrl":"10.1016/j.ahj.2024.07.014","url":null,"abstract":"<div><h3>Background</h3><p>Hospitalizations are a major burden for both patients and society but are potentially preventable. We examined the one-year hospitalization burden in patients undergoing transcatheter aortic valve replacement (TAVR) and compared hospitalization rates and patterns with those undergoing isolated surgical aortic valve replacement (SAVR).</p></div><div><h3>Methods</h3><p>Using Danish nationwide registries, we identified patients who underwent first-time TAVR and isolated SAVR (2008-2019), respectively. Subsequent hospitalizations were classified as cardiovascular or noncardiovascular according to discharge diagnosis codes.</p></div><div><h3>Results</h3><p>Patients undergoing TAVR (N = 4,921) were older and had more comorbidities than those undergoing SAVR (N = 5,220). There were 5,725 and 4,426 hospitalizations within the first year after discharge in the TAVR and SAVR group, respectively. During the one-year follow-up period post-TAVR, 46.6% were not admitted, 25.4% were admitted once, 12.6% twice, and 15.4% 3 times or more. The corresponding proportions in patients undergoing SAVR were 55.3%, 25.1%, 10.0%, and 9.5%, respectively. Among patients with ≥1 hospitalization following TAVR, 50.3% had a total length of all hospital stays between 1 and 7days, 19.0% 8-14days, 18.0% 15-30days, 9.9% 31-60days, and 2.8% ≥61days. The corresponding proportions for patients undergoing SAVR were 58.6%, 17.2%, 13.1%, 7.4%, and 3.7%, respectively. Compared with patients undergoing SAVR, those undergoing TAVR had a lower early (day0-30: HR 0.89 [95% CI, 0.80-0.98]), but a higher late hospitalization rate (day 31-365: 1.46 [1.32-1.60]).</p></div><div><h3>Conclusions</h3><p>The 1-year hospitalization burden following TAVR is substantial. Compared with patients undergoing isolated SAVR, those undergoing TAVR had a lower early, but a higher late hospitalization rate – a difference that likely reflects unmeasured differences in the patient cohorts.</p></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"276 ","pages":"Pages 12-21"},"PeriodicalIF":3.7,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0002870324001807/pdfft?md5=90db2ab5a96d833658bb3c82c377f966&pid=1-s2.0-S0002870324001807-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141858848","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":"Malignant left ventricular hypertrophy and risk of cognitive impairment in SPRINT MIND trial","authors":"Richard Kazibwe MD, MS ,&nbsp;Muhammad Imtiaz Ahmad MD, MS ,&nbsp;Timothy M. Hughes PhD ,&nbsp;Lin Y. Chen MD, MS ,&nbsp;Elsayed Z. Soliman MD, MSc, MS","doi":"10.1016/j.ahj.2024.07.012","DOIUrl":"10.1016/j.ahj.2024.07.012","url":null,"abstract":"<div><h3>Background</h3><p>The association of malignant left ventricular hypertrophy (LVH), a specific subphenotype of LVH characterized by elevated levels of high-sensitivity cardiac troponin (hs-cTnT) or N-terminal pro–B-type natriuretic peptide (NT-proBNP), with cognitive decline remains understudied.</p></div><div><h3>Methods</h3><p>This post-hoc analysis included a total of 8,027 (67.9 ± 9.3 years) SPRINT MIND trial participants who had with at least 1 follow-up cognitive assessment. Participants were classified into 6 groups on the basis of LVH status on electrocardiogram (ECG), and elevations in levels of hs-cTnT ≥14 ng/L or NT-proBNP ≥125 pg/mL at baseline visit. Multivariate Cox proportional hazard models were used to examine the association of LVH/biomarker groups with incident probable dementia, mild cognitive impairment (MCI) and a composite of MCI/probable dementia.</p></div><div><h3>Results</h3><p>Over a median follow-up period of 5 years, there were 306, 597, and 818 incidents of MCI, probable dementia and a composite of MCI/probable dementia, respectively. Compared with participants without LVH and normal biomarker levels, those with concomitant LVH and elevated levels of both biomarkers were associated with a higher risk of probable dementia (HR, 2.50; 95% CI (1.26-4.95), MCI (HR, 1.78; 95% CI (0.99-3.23) and the composite of MCI/ probable dementia (HR, 1.89; 95% CI, 1.16-3.10).</p></div><div><h3>Conclusions</h3><p>Among SPRINT participants, malignant LVH is associated with incident probable dementia and mild cognitive impairment. These findings underscore the potential utility of measuring hs-cTnT and NT-proBNP levels when LVH is detected on ECG, aiding in the differentiation of individuals with a favorable risk for cognitive impairment from those with a higher risk.</p></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"276 ","pages":"Pages 31-38"},"PeriodicalIF":3.7,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141787084","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":"Corrigendum to “Right atrial dysfunction is associated with atrial arrhythmias in adults with repaired tetralogy of Fallot” [American Heart Journal Volume 263 (2023)141-150]","authors":"Alexander C. Egbe MD, MS, MPH,&nbsp;William R. Miranda MD,&nbsp;Malini Madhavan MBBS,&nbsp;Omar Abozied MBBS,&nbsp;Ahmed Younis MBBS,&nbsp;Marwan H. Ahmed MBBS,&nbsp;Heidi M. Connolly MD,&nbsp;Abhishek J. Deshmukh MBBS","doi":"10.1016/j.ahj.2024.07.010","DOIUrl":"10.1016/j.ahj.2024.07.010","url":null,"abstract":"","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"275 ","pages":"Page 191"},"PeriodicalIF":3.7,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0002870324001765/pdfft?md5=277faa4c3d00297b2ba69e4488a87043&pid=1-s2.0-S0002870324001765-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141756687","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 impact of quantitative flow ratio (QFR)-consistent complete revascularization in patients with myocardial infarction and multivessel coronary artery disease","authors":"Aslihan Erbay MD ,&nbsp;Lisa Penzel MD ,&nbsp;Youssef S. Abdelwahed MD ,&nbsp;Andrea Heuberger MD ,&nbsp;Anne-Sophie Schatz MD ,&nbsp;Claudio Seppelt MD ,&nbsp;Lara S. Schlender MD ,&nbsp;Julia Steiner MD ,&nbsp;Arash Haghikia MD ,&nbsp;Sebastian Steven MD ,&nbsp;Ulf Landmesser MD ,&nbsp;Barbara E. Stähli MD ,&nbsp;David M. Leistner MD","doi":"10.1016/j.ahj.2024.07.011","DOIUrl":"10.1016/j.ahj.2024.07.011","url":null,"abstract":"<div><h3>Background</h3><p>Complete revascularization is associated with improved outcomes in patients with myocardial infarction and multivessel coronary artery disease. Quantitative flow ratio (QFR) represents an emerging angiography-based tool for functional lesion assessment. The present study investigated the prognostic impact of QFR-consistent complete revascularization in patients with myocardial infarction and multivessel disease.</p></div><div><h3>Methods</h3><p>A total of 792 patients with myocardial infarction and multivessel disease were enrolled in the analysis. Post-hoc QFR analyses of 1,320 nonculprit vessels were performed by investigators blinded to clinical outcomes. The primary endpoint was a composite of all-cause death, nonculprit vessel related nonfatal myocardial infarction, and ischemia-driven revascularization at 2 years after index myocardial infarction. Patients were stratified into a QFR-consistent PCI group (n = 646) and a QFR-inconsistent PCI group (n = 146), based on whether the intervention was congruent with the QFR-determined functional significance of the nonculprit lesions.</p></div><div><h3>Results</h3><p>The primary endpoint occurred in a total of 22 patients (3.4%) in the QFR-consistent PCI group and in 27 patients (18.5%) in the QFR-inconsistent group (HR 0.17, 95% CI 0.10-0.30, <em>P</em> &lt; .001).The difference in the primary endpoint was driven by reduced rates of nonfatal myocardial infarction (2.0% vs. 15.1%; HR 0.13, 95% CI 0.06-0.25; <em>P</em> &lt; .001) and ischemia-driven revascularization (1.2% vs. 5.5%; HR 0.21, 95% CI 0.08-0.57; <em>P</em> = .001) in the QFR-consistent PCI group.</p></div><div><h3>Conclusions</h3><p>Among patients with myocardial infarction and multivessel disease, a QFR-consistent complete revascularization was associated with a reduced risk of all-cause mortality, nonfatal myocardial infarction, and ischemia-driven revascularization. These findings underline the value of angiography-based functional lesion assessment for personalized revascularization strategies.</p></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"276 ","pages":"Pages 22-30"},"PeriodicalIF":3.7,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0002870324001777/pdfft?md5=519de7d165db2aac4cfb3489ded1e1ef&pid=1-s2.0-S0002870324001777-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733397","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":"Rationale, Design and Baseline Characteristics of a Randomized Controlled Trial of a Cardiovascular Quality Improvement Strategy in India: The C-QIP Trial","authors":"Kavita Singh PhD ,&nbsp;Kalyani Nikhare BDS, MPH ,&nbsp;Mareesha Gandral BDS, MPH ,&nbsp;Kiran Aithal MD ,&nbsp;Satish G. Patil PhD ,&nbsp;Girish MP MD, DM ,&nbsp;Mohit Gupta MD, DM ,&nbsp;Kushal Madan PhD ,&nbsp;J.P.S. Sawhney DM ,&nbsp;Kamar Ali BTech ,&nbsp;Dimple Kondal PhD ,&nbsp;Devraj Jindal BDS, MPH ,&nbsp;Emily Mendenhall PhD ,&nbsp;Shivani A. Patel PhD ,&nbsp;K.M. Venkat Narayan MD, MSC, MBA ,&nbsp;Nikhil Tandon MD, PhD ,&nbsp;Ambuj Roy MD, DM ,&nbsp;Mark D. Huffman MD, MPH ,&nbsp;Dorairaj Prabhakaran MD, DM","doi":"10.1016/j.ahj.2024.07.008","DOIUrl":"10.1016/j.ahj.2024.07.008","url":null,"abstract":"<div><h3>Background</h3><p>Quality of chronic care for cardiovascular disease (CVD) remains suboptimal worldwide. The Collaborative Quality ImProvement (C-QIP) trial aims to develop and test the feasibility and clinical effect of a multicomponent strategy among patients with prevalent CVD in India.</p></div><div><h3>Methods</h3><p>The C-QIP is a clinic-based, open randomized trial of a multicomponent intervention vs usual care that was locally developed and adapted for use in Indian settings through rigorous formative research guided by Consolidated Framework for Implementation Research (CFIR). The C-QIP intervention consisted of 5 components: 1) electronic health records and decision support system for clinicians, 2) trained nonphysician health workers (NPHW), 3) text-message based lifestyle reminders, 4) patient education materials, 5) quarterly audit and feedback reports. Patients with CVD (ischemic heart disease, ischemic stroke, or heart failure) attending outpatient CVD clinics were recruited from September 2022 to September 2023 and were randomized to the intervention or usual care arm for at least 12 months follow-up. The co-primary outcomes are implementation feasibility, fidelity (ie, dose delivered and dose received), acceptability, adoption and appropriateness, measured at multiple levels: patient, provider and clinic site-level, The secondary outcomes include prescription of guideline directed medical therapy (GDMT) (provider-level), and adherence to prescribed therapy, change in mean blood pressure (BP) and LDL-cholesterol between the intervention and control groups (patient-level). In addition, a trial-based process and economic evaluations will be performed using standard guidelines.</p></div><div><h3>Results</h3><p>We recruited 410 socio-demographically diverse patients with CVD from 4 hospitals in India. Mean (SD) age was 57.5 (11.7) years, and 73.0% were males. Self-reported history of hypertension (48.5%) and diabetes (41.5%) was common. At baseline, mean (SD) BP was 127.9 (18.2) /76.2 (11.6) mm Hg, mean (SD) LDLc: 80.3 (37.3) mg/dl and mean (SD) HbA1c: 6.8% (1.6%). At baseline, the GDMT varied from 62.4% for patients with ischemic heart disease, 48.6% for ischemic stroke and 36.1% for heart failure.</p></div><div><h3>Conclusion</h3><p>This study will establish the feasibility of delivering contextually relevant, and evidence-based C-QIP strategy and assess whether it is acceptable to the target populations. The study results will inform a larger scale confirmatory trial of a comprehensive CVD care model in low-resource settings.</p></div><div><h3>Trial registration</h3><p>Clinical Trials Registry India: CTRI/2022/04/041847; Clinicaltrials.gov number: NCT05196659.</p></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"276 ","pages":"Pages 83-98"},"PeriodicalIF":3.7,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733398","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":"Predicted prosthesis–patient mismatch and long-term clinical outcomes after transcatheter aortic valve replacement: A SWEDEHEART study","authors":"Emma Ellfors MD ,&nbsp;Michael Dismorr MD, PhD ,&nbsp;Andreas Rück MD, PhD ,&nbsp;Magnus Settergren MD, PhD ,&nbsp;Ulrik Sartipy MD, PhD ,&nbsp;Natalie Glaser MD, PhD","doi":"10.1016/j.ahj.2024.07.009","DOIUrl":"10.1016/j.ahj.2024.07.009","url":null,"abstract":"<div><h3>Background</h3><p>The impact of prosthesis–patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) is uncertain. This study was performed to investigate the risk of all-cause mortality, heart failure hospitalization, and aortic valve reintervention in patients with and without predicted PPM after TAVR.</p></div><div><h3>Methods</h3><p>This nationwide, population-based cohort study included all patients who underwent transfemoral primary TAVR in Sweden from 2008 to 2022 in the SWEDEHEART register. PPM was defined according to published effective orifice areas for each valve model and size. The patients were divided into those with and without PPM. Additional baseline characteristics and outcome data were obtained from other national health data registers. Regression standardization was used to adjust for intergroup differences.</p></div><div><h3>Results</h3><p>Of 8485 patients, 7879 (93%) had no PPM and 606 (7%) had PPM. The crude cumulative incidence of all-cause mortality at 1, 5, and 10 years in patients with versus without PPM was 7% versus 9%, 40% versus 44%, and 80% versus 85%, respectively. After regression standardization, there was no between-group difference in long-term mortality, and the absolute difference at 10 years was 1.5% (95% confidence interval, −2.9%-6.0%). The mean follow-up was 3.0 years (maximum, 14 years). There was no difference in the risk of heart failure hospitalization or aortic valve reintervention.</p></div><div><h3>Conclusions</h3><p>The risk of all-cause mortality, heart failure hospitalization, or aortic valve reintervention was not higher in patients with than without predicted PPM following TAVR. Furthermore, PPM was present in only 7% of patients, and severe PPM was almost nonexistent.</p></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"276 ","pages":"Pages 70-82"},"PeriodicalIF":3.7,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0002870324001753/pdfft?md5=bb2ac12291f41d65005fc92a68449454&pid=1-s2.0-S0002870324001753-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733368","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":"Sarcopenia and frailty in patients undergoing transcatheter aortic valve replacement","authors":"Ian Persits DO ,&nbsp;Saeid Mirzai DO ,&nbsp;Kunaal S. Sarnaik BS ,&nbsp;Maximilian C. Volk DO ,&nbsp;James Yun MDPhD ,&nbsp;Serge Harb MD ,&nbsp;Rishi Puri MDPhD ,&nbsp;Samir Kapadia MD ,&nbsp;Amar Krishnaswamy MD ,&nbsp;Po-Hao Chen MDMBA ,&nbsp;Grant Reed MD ,&nbsp;W. H. Wilson Tang MD FACC FAHA FHFSA FHFA","doi":"10.1016/j.ahj.2024.07.007","DOIUrl":"10.1016/j.ahj.2024.07.007","url":null,"abstract":"<div><h3>Background</h3><p>Skeletal muscle mass (SMM) plays a crucial role in risk assessment in transcatheter aortic valve replacement (TAVR) candidates, yet it remains underutilized. Traditional methods focus on weakness or performance but omit SMM. This study compared traditional and novel markers of sarcopenia and frailty in terms of their ability to predict adverse outcomes post-TAVR.</p></div><div><h3>Methods</h3><p>Three risk models were evaluated for the composite outcome of perioperative complications, 1-year rehospitalization, or 1-year mortality: (1) sarcopenia by combining low muscle mass (LMM) and weakness/performance assessed by hand grip strength or gait speed; (2) frailty by an Adapted Green score; and (3) frailty by the Green-SMI score incorporating LMM by multilevel opportunistic pre-TAVR thoracic CT segmentation.</p></div><div><h3>Results</h3><p>In this study we included 184 eligible patients from January to December of 2018, (96.7%) of which were balloon expandable valves. The three risk models identified 22.8% patients as sarcopenic, 63.6% as frail by the Adapted Green score, and 53.8% as frail by the Green-SMI score. There were higher rates of the composite outcome in patients with sarcopenia (54.8%) and frailty (41.9% with the Adapted Green and 50.5% with the Green-SMI score) compared to their nonsarcopenic (30.3%) and nonfrail counterparts (25.4% with the Adapted Green and 18.8% with the Green-SMI score). Sarcopenia and frailty by Green-SMI, but not by the Adapted Green, were associated with higher risks of the composite outcome on multivariable adjustment (HR 2.2 [95% CI: 1.25-4.02], <em>P</em> = .007 and HR 3.4 [95% CI: 1.75-6.65], <em>P</em> &lt; .001, respectively).</p></div><div><h3>Conclusions</h3><p>The integration of preoperative CT-based SMM to a frailty score significantly improves the prediction of adverse outcomes in patients undergoing TAVR.</p></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"276 ","pages":"Pages 49-59"},"PeriodicalIF":3.7,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S000287032400173X/pdfft?md5=dee53a9c4826b92adec451bfda59638a&pid=1-s2.0-S000287032400173X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733399","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}