1,720,973 research outputs found
Preclosure of Femoral Vein Access Site With the Suture-Mediated Proglide Device During MitraClip Implantation
No full textThis study was designed to show the feasibility, safety, and efficacy of venous access-site closure with a single 6 Fr suture-mediated Proglide (Abbott Vascular) during MitraClip procedures. Methods. Preclosure of the right femoral vein with Proglide used for access with the 24 Fr guiding catheter was performed. A total of 72 patients undergoing MitraClip were enrolled in this study (28 patients retrospectively and 44 patients prospectively), of whom 42 patients underwent a groin examination with ultrasound 2 days after the procedure. Results. Only 1 patient (1.4%) needed transfusion of packed cells because of bleeding and hematoma in the groin due to Proglide failure. None of the patients that were examined with ultrasound revealed an arteriovenous fistula or a spurious aneurysm, a local thrombosis, or a local stenosis related to the Proglide device. Conclusion. This study demonstrates that vascular closure with the suture-mediated Proglide system is feasible, safe, and efficacious in large venous sites of 24 Fr as needed in patients undergoing MitraClip implantation despite the necessity of anticoagulation or platelet inhibition.Heart Centre Gottingen working group on interventional cardiolog
Patients with paradoxical low-flow, low-gradient aortic stenosis gain the least benefit from TAVI among all hemodynamic subtypes
No full textAbstract Background 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. Methods 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. Results 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). Conclusions 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. Graphical abstractDeutsche Forschungsgemeinschaft http://dx.doi.org/10.13039/501100001659Herzzentrum Göttinge
Cardiovascular MRI–derived Right Atrial Strain for Improved Risk Stratification in Patients with Severe Aortic Stenosis
No full textCardiac MRI–derived imaging markers demonstrated significant prognostic value in individuals with severe aortic stenosis, with right atrial strain independently predicting cardiovascular mortality and enabling identification of additional high-risk subgroups.Purpose To assess the prognostic implications of cardiac MRI–derived imaging markers in individuals with severe aortic stenosis (AS). Materials and Methods This prospective study (German Clinical Trials Register, DRKS00024479) enrolled individuals with severe AS who underwent cardiac MRI before transcatheter aortic valve replacement (TAVR) from January 2017 to March 2022. Image analyses included myocardial volumes, cardiac MRI feature tracking–derived left atrial (LA) and right atrial (RA) as well as left ventricular (LV) and right ventricular (RV) strain, myocardial T1 mapping, and late gadolinium enhancement analyses. Cardiovascular (CV) mortality was defined as primary clinical end point. Cox proportional hazards models were used to determine the association between cardiac MRI–derived parameters and CV mortality. Results The final analysis included 145 participants (median age, 80 years [IQR, 75–83 years]; 91 male). Participants who experienced CV death during follow-up had significantly enlarged RV end-diastolic volumes (median, 82.9 [IQR, 70.8–96.0] mL/m 2 vs 62.8 [54.7–76.0] mL/m 2 ; P < .001) and impaired strain values of all cardiac chambers compared with those who survived (LV global longitudinal strain [GLS], −18.1% [−13.1% to −20.4%] vs −22.5% [−16.1% to −27.3%], P = .02; RV GLS, −22.9% [−18.6% to −25.4%] vs −27.9% [−22.9% to −32.0%], P = .002; LA atrial reservoir strain [Es], 9.5% [7.2%–15.4%] vs 14.3% [9.0%–18.1%], P = .04; RA Es, 12.4% [6.8%–14.4%] vs 16.2% [11.2%–22.1%], P < .001). RA reservoir strain independently helped predict CV mortality after adjustment for other cardiac MRI markers and clinical parameters of heart failure (hazard ratio, 0.82 [95% CI: 0.71, 0.95]; P = .008). Within the subgroup of participants with high extracellular volume values, RA strain further identified participants with AS at high risk for CV mortality ( P = .001 on log-rank testing). Conclusion In individuals with AS undergoing TAVR, several cardiac MRI parameters were significantly associated with CV mortality. RA strain was an independent predictor of CV mortality and may provide more optimized patient management. Keywords: Cardiac MRI, Aortic Stenosis, TAVR, Risk Assessment, Strain Analyses German Clinical Trials Register no. DRKS00024479 Supplemental material is available for this article. © RSNA, 2025Cardiac MRI–derived imaging markers demonstrated significant prognostic value in individuals with severe aortic stenosis, with right atrial strain independently predicting cardiovascular mortality and enabling identification of additional high-risk subgroups.Purpose To assess the prognostic implications of cardiac MRI–derived imaging markers in individuals with severe aortic stenosis (AS). Materials and Methods This prospective study (German Clinical Trials Register, DRKS00024479) enrolled individuals with severe AS who underwent cardiac MRI before transcatheter aortic valve replacement (TAVR) from January 2017 to March 2022. Image analyses included myocardial volumes, cardiac MRI feature tracking–derived left atrial (LA) and right atrial (RA) as well as left ventricular (LV) and right ventricular (RV) strain, myocardial T1 mapping, and late gadolinium enhancement analyses. Cardiovascular (CV) mortality was defined as primary clinical end point. Cox proportional hazards models were used to determine the association between cardiac MRI–derived parameters and CV mortality. Results The final analysis included 145 participants (median age, 80 years [IQR, 75–83 years]; 91 male). Participants who experienced CV death during follow-up had significantly enlarged RV end-diastolic volumes (median, 82.9 [IQR, 70.8–96.0] mL/m 2 vs 62.8 [54.7–76.0] mL/m 2 ; P < .001) and impaired strain values of all cardiac chambers compared with those who survived (LV global longitudinal strain [GLS], −18.1% [−13.1% to −20.4%] vs −22.5% [−16.1% to −27.3%], P = .02; RV GLS, −22.9% [−18.6% to −25.4%] vs −27.9% [−22.9% to −32.0%], P = .002; LA atrial reservoir strain [Es], 9.5% [7.2%–15.4%] vs 14.3% [9.0%–18.1%], P = .04; RA Es, 12.4% [6.8%–14.4%] vs 16.2% [11.2%–22.1%], P < .001). RA reservoir strain independently helped predict CV mortality after adjustment for other cardiac MRI markers and clinical parameters of heart failure (hazard ratio, 0.82 [95% CI: 0.71, 0.95]; P = .008). Within the subgroup of participants with high extracellular volume values, RA strain further identified participants with AS at high risk for CV mortality ( P = .001 on log-rank testing). Conclusion In individuals with AS undergoing TAVR, several cardiac MRI parameters were significantly associated with CV mortality. RA strain was an independent predictor of CV mortality and may provide more optimized patient management. Keywords: Cardiac MRI, Aortic Stenosis, TAVR, Risk Assessment, Strain Analyses German Clinical Trials Register no. DRKS00024479 Supplemental material is available for this article. © RSNA, 202
Failure of acute procedural success predicts adverse outcome after percutaneous edge-to-edge mitral valve repair with MitraClip
No full textAims: MitraClip implantation is evolving as a potential alternative treatment to conventional surgery in high-risk patients with significant mitral regurgitation (MR). However, outcome predictors are under-investigated. The aim of this study was to identify predictors of midterm mortality and heart failure rehospitalisation after percutaneous mitral valve repair with MitraClip. Methods and results: A total of 150 consecutive patients were followed for a median of 463 days. Survival analyses were performed for baseline characteristics, risk scores and failure of acute procedural success (APS) defined as persisting MR grade 3+ or 4+. Univariate significant risk stratifiers were tested in multivariate analyses using a Cox proportional hazards model. Overall survival was 96% at 30 days, 79.5% at 12 months, and 62% at two years. Multivariate analysis identified APS failure (HR 2.13, p=0.02), NYHA Class IV at baseline (HR 2.11, p=0.01) and STS score >= 12 (HR 2.20, p<0.0001) as significant independent predictors of all-cause mortality, and APS failure (HR 2.31, p=0.01) and NYHA Class IV at baseline (HR 1.89, p=0.03) as significant independent predictors of heart failure rehospitalisation. Furthermore, a post-procedural significant decrease in hospitalisation rate could only be observed after successful interventions (0.89 +/- 1.07 per year before vs. 0.54 +/- 0.96 after implantation, p=0.01). Patients with severely dilated and overloaded ventricles who did not meet EVEREST II eligibility criteria were at higher risk of APS failure. Conclusions: The failure of acute procedural success proved to have the most important impact on outcome after MitraClip implantation
Transient acute right coronary artery deformation during transcatheter interventional tricuspid repair with the Cardioband tricuspid system
No full textLow-flow in aortic valve stenosis patients with reduced ejection fraction does not depend on left ventricular function
No full textAbstract
Background
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.
Methods
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.
Results
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.
Conclusion
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.
Graphical Abstract
Comparison of patients with high-gradient (HG) and low-gradient (LG) aortic stenosis (AS) and reduced ejection fraction. Comprehensive analyses including clinical data, gene expression analyses, cardiovascular magnetic resonance (CMR) imaging as well as echocardiography were performed. AF: Atrial fibrillation, MR: mitral regurgitation, RVEF: right ventricular ejection fraction, ECV%: extracellular volume.Deutsche Forschungsgemeinschaft http://dx.doi.org/10.13039/501100001659Herzzentrum Göttinge
Histological assessment of cardiac amyloidosis in patients undergoing transcatheter aortic valve replacement
No full textAbstract
Aims
Studies have reported a strongly varying co‐prevalence of aortic stenosis (AS) and cardiac amyloidosis (CA). We sought to histologically determine the co‐prevalence of AS and CA in patients undergoing transcatheter aortic valve replacement (TAVR). Consequently, we aimed to derive an algorithm to identify cases in which to suspect the co‐prevalence of AS and CA.
Methods and results
In this prospective, monocentric study, endomyocardial biopsies of 162 patients undergoing TAVR between January 2017 and March 2021 at the University Medical Centre Göttingen were analysed by one pathologist blinded to clinical data using haematoxylin–eosin staining, Elastica van Gieson staining, and Congo red staining of endomyocardial biopsies. CA was identified in only eight patients (4.9%). CA patients had significantly higher N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) levels (4356.20 vs. 1938.00 ng/L,
P
= 0.034), a lower voltage‐to‐mass ratio (0.73 vs. 1.46 × 10
−2
mVm
2
/g,
P
= 0.022), and lower transaortic gradients (Pmean 17.5 vs. 38.0 mmHg,
P
= 0.004) than AS patients. Concomitant CA was associated with a higher prevalence of post‐procedural acute kidney injury (50.0% vs. 13.1%,
P
= 0.018) and sudden cardiac death [SCD;
P
(log‐rank test) = 0.017]. Following propensity score matching, 184 proteins were analysed to identify serum biomarkers of concomitant CA. CA patients expressed lower levels of chymotrypsin (
P
= 0.018) and carboxypeptidase 1 (
P
= 0.027). We propose an algorithm using commonly documented parameters—stroke volume index, ejection fraction, NT‐proBNP levels, posterior wall thickness, and QRS voltage‐to‐mass ratio—to screen for CA in AS patients, reaching a sensitivity of 66.6% with a specificity of 98.1%.
Conclusions
The co‐prevalence of AS and CA was lower than expected, at 4.9%. Despite excellent 1 year mortality, AS + CA patients died significantly more often from SCD. We propose a multimodal algorithm to facilitate more effective screening for CA containing parameters commonly documented during clinical routine. Proteomic biomarkers may yield additional information in the future.Deutsche Forschungsgemeinschaft https://doi.org/10.13039/501100001659Open-Access-Publikationsfonds 202
ARTIFICIAL INTELLIGENCE ENABLED FULLY AUTOMATED CMR FUNCTION QUANTIFICATION FOR OPTIMIZED RISK STRATIFICATION IN PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT
No full textLoss of CASK Accelerates Heart Failure Development
No full textRationale: Increased myocardial activity of CaMKII (Ca/calmodulin-dependent kinase II) leads to heart failure and arrhythmias. In Drosophila neurons, interaction of CaMKII with CASK (Ca/CaM-dependent serine protein kinase) has been shown to inhibit CaMKII activity, but the consequences of this regulation for heart failure and ventricular arrhythmias are unknown. Objective: We hypothesize that CASK associates with CaMKII in human and mouse hearts thereby limiting CaMKII activity and that altering CASK expression in mice changes CaMKII activity accordingly, with functional consequences for contractile function and arrhythmias. Methods and Results: Immunoprecipitation revealed that CASK associates with CaMKII in human hearts. CASK expression is unaltered in heart failure but increased in patients with aortic stenosis. In mice, cardiomyocyte-specific knockout of CASK increased CaMKII-autophosphorylation at the stimulatory T287 site, but reduced phosphorylation at the inhibitory T305/306 site. Knockout of CASK mice showed increased CaMKII-dependent sarcoplasmic reticulum Ca leak, reduced sarcoplasmic reticulum Ca content, increased susceptibility to ventricular arrhythmias, greater loss of ejection fraction, and increased mortality after transverse aortic constriction. Intriguingly, stimulation of the cardiac glucagon-like peptide 1 receptor with exenatide increased CASK expression resulting in increased inhibitory CaMKII T305 phosphorylation, reduced CaMKII activity, and reduced sarcoplasmic reticulum Ca leak in wild type but not CASK-KO. Conclusions: CASK associates with CaMKII in the human heart. Knockout of CASK in mice increases CaMKII activity, leading to contractile dysfunction and arrhythmias. Increasing CASK expression reduces CaMKII activity, improves Ca handling and contractile function
Impact of MitraClip Implantation on Right Heart Function
No full textBackground: The MitraClip procedure is a catheter-based method for percutaneous repair of mitral regurgitation in patients with high operative risk. Right heart failure and pulmonary hypertension are known predictors of increased mortality after mitral valve repair. Our aim was to identify the impact of MitraClip implantation on the right heart. Furthermore, we sought to analyze how changes in the right heart impacted the survival of patients.
Methods: We conducted a prospective multi-center observatory trial between 2009 and 2011. 70 patients were enrolled. Inclusion criteria were clinical signs of right heart failure as well as echocardiographic signs of pulmonary hypertension (PAP syst>50mmHg) and tricuspid regurgitation >II°. Echocardiography was carried out before intervention, at the point of discharge and 12±2 months after intervention. A six-minute-walk-test and a Minnesota Living with Heart Failure Questionnaire werde carried out before intervention and 6±2 months after. In the fall of 2013 all patients were contacted to identify events of death. Continuous variables were analyzed using Wilcoxon matched pairs test. Kapan-Meier-curves and logrank tests were used for survival analysis.
Results: Mean age of our patient cohort was 73±9 years, 66% of patients were male. Secondary mitral regurgitation was dominant (71%). Patients suffered from severe congestive heart failure (NYHA III or higher: 94%) and had a very high operative risk (mean log. EuroScore I 30±12%).
We were able to observe a significant reduction of systolic pulmonary arterial pressure (60,85 vs. 54,0 mmHg; p=0,04) at discharge. TAPSE increased significantly at discharge (16,0 vs. 20,0 mm, p=0,002). The maximum velocity of tricuspid regurgitation also decreased significantly at discharge (3,51 vs. 3,16 m/s, p=0,001). All results remained stable 12 months after intervention without reaching new statistical significance compared to the results at discharge.
Vena contracta and RVOT showed a significant reduction 12 months after intervention (0,74 vs. 0,77mm, p=0,01 respectively 3,30 vs. 3,52cm, p=0,01).
17 patients showed a normalization of TAPSE 12 months after intervention. These patients had a significant better survival than patients whose TAPSE decreased or remained unchanged 12 months after MitraClip implantation (p=0,03).
Conclusion: MitraClip implantation leads to acute hemodynamic improvements in patients with pulmonary hypertension and tricuspid regurgitation. Patients whose TAPSE normalizes within one year after percutaneous mitral valve repair show a significant better survival. Therefore, right heart failure should not be used as a criterion against MitraClip implantation as long as a comparable survival benefit has not been shown for medical treatment. Further sudies are needed to identify factors that predict right heart recovery after MitraClip implantation.2018-03-2
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