Iria Silva, Alberto Alperi, Antonio Muñoz, Asim Cheema, Luis Nombela, Gabriela Veiga-Fernandez, Edgar Tay, Marina Urena, Lluis Asmarats, María Del Trigo, Yinghao Lim, Lola Gutierrez Alonso, Ander Regueiro, Francisco Campelo-Parada, Vicenç Serra, David Del Val, Henrique Barbosa Ribeiro, Julien Ternacle, Victoria Vilalta, Pablo Vidal, Yassin Belahnech, Fernando Alfonso, Jorge Nuche, Josep Rodes-Cabau, Philippe Pibarot
Aims: Valve durability becomes a major issue as transcatheter aortic valve implantation (TAVI) is expanding to populations with longer life expectancy. We sought to i) determine the incidence of structural valve deterioration (SVD), ii) compare the incidence of SVD between balloon-expandable (BE) and self-expandable (SE) valves, and iii) analyze the impact of SVD.
Methods and results: 2040 patients who underwent TAVI (2007-2020) from 9 centers were included. After inverse probability treatment weighting (IPTW), 1848 patients were selected (973 BE and 875 SE). SVD was defined using recent echocardiographic definitions according to VARC-3 criteria: Median follow-up was 4.2 (IQR: 2.5-5.7) years. The estimated incidence of SVD and bioprosthetic valve failure (BVF) at 8-years follow-up for the overall cohort were 13.3% (95%CI 9.8-18%) and 11.5% (95%CI 8.9-14.8%), respectively. After IPTW and a median follow-up of 4 years, the risk of SVD (5.25 % vs. 1.19%; HR 10.25, 95%CI 3.79-27.71, p <0.001), and all-cause BVF (6.41% vs. 3.2%; HR 2.1, 95%CI 1.27-3.47 p=0.004), was significantly higher for BE compared to SE recipients. Patients developing SVD had a trend towards a higher incidence of cardiovascular death (p=0.06), as well as a significantly higher risk of heart failure rehospitalization (p=0.048). After IPTW, there were no differences between BE and SE recipients in the combined endpoint of cardiovascular death, heart failure rehospitalization and valve reintervention (p=0.46).
Conclusions: In this real-world registry, the incidence of SVD at 8-years after TAVI was relatively low. The risk of SVD was higher among BE compared to SE valve recipients. SVD was associated with increased risk of heart failure rehospitalization and a trend towards a higher risk of cardiovascular death.
{"title":"Incidence and Impact of Structural Valve Deterioration Following TAVI: a Multicenter Real-World Study.","authors":"Iria Silva, Alberto Alperi, Antonio Muñoz, Asim Cheema, Luis Nombela, Gabriela Veiga-Fernandez, Edgar Tay, Marina Urena, Lluis Asmarats, María Del Trigo, Yinghao Lim, Lola Gutierrez Alonso, Ander Regueiro, Francisco Campelo-Parada, Vicenç Serra, David Del Val, Henrique Barbosa Ribeiro, Julien Ternacle, Victoria Vilalta, Pablo Vidal, Yassin Belahnech, Fernando Alfonso, Jorge Nuche, Josep Rodes-Cabau, Philippe Pibarot","doi":"10.1093/ehjci/jeaf083","DOIUrl":"https://doi.org/10.1093/ehjci/jeaf083","url":null,"abstract":"<p><strong>Aims: </strong>Valve durability becomes a major issue as transcatheter aortic valve implantation (TAVI) is expanding to populations with longer life expectancy. We sought to i) determine the incidence of structural valve deterioration (SVD), ii) compare the incidence of SVD between balloon-expandable (BE) and self-expandable (SE) valves, and iii) analyze the impact of SVD.</p><p><strong>Methods and results: </strong>2040 patients who underwent TAVI (2007-2020) from 9 centers were included. After inverse probability treatment weighting (IPTW), 1848 patients were selected (973 BE and 875 SE). SVD was defined using recent echocardiographic definitions according to VARC-3 criteria: Median follow-up was 4.2 (IQR: 2.5-5.7) years. The estimated incidence of SVD and bioprosthetic valve failure (BVF) at 8-years follow-up for the overall cohort were 13.3% (95%CI 9.8-18%) and 11.5% (95%CI 8.9-14.8%), respectively. After IPTW and a median follow-up of 4 years, the risk of SVD (5.25 % vs. 1.19%; HR 10.25, 95%CI 3.79-27.71, p <0.001), and all-cause BVF (6.41% vs. 3.2%; HR 2.1, 95%CI 1.27-3.47 p=0.004), was significantly higher for BE compared to SE recipients. Patients developing SVD had a trend towards a higher incidence of cardiovascular death (p=0.06), as well as a significantly higher risk of heart failure rehospitalization (p=0.048). After IPTW, there were no differences between BE and SE recipients in the combined endpoint of cardiovascular death, heart failure rehospitalization and valve reintervention (p=0.46).</p><p><strong>Conclusions: </strong>In this real-world registry, the incidence of SVD at 8-years after TAVI was relatively low. The risk of SVD was higher among BE compared to SE valve recipients. SVD was associated with increased risk of heart failure rehospitalization and a trend towards a higher risk of cardiovascular death.</p>","PeriodicalId":12026,"journal":{"name":"European Heart Journal - Cardiovascular Imaging","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Louisa Fay, Tobias Hepp, Moritz T Winkelmann, Annette Peters, Margit Heier, Thoralf Niendorf, Tobias Pischon, Beate Endemann, Jeanette Schulz-Menger, Lilian Krist, Matthias B Schulze, Rafael Mikolajczyk, Andreas Wienke, Nadia Obi, Bernard C Silenou, Berit Lange, Hans-Ulrich Kauczor, Wolfgang Lieb, Hansjörg Baurecht, Michael Leitzmann, Kira Trares, Hermann Brenner, Karin B Michels, Stefanie Jaskulski, Henry Völzke, Konstantin Nikolaou, Christopher L Schlett, Fabian Bamberg, Mario Lescan, Bin Yang, Thomas Küstner, Sergios Gatidis
Aims: Understanding determinants of thoracic aortic morphology is crucial for precise diagnostics and therapeutic approaches. This study aimed to automatically characterize ascending aortic morphology based on 3D non-contrast-enhanced magnetic resonance angiography (NC-MRA) data from the epidemiological cross-sectional German National Cohort (NAKO) and to investigate possible determinants of mid-ascending aortic diameter (mid-AAoD).
Methods and results: Deep learning (DL) automatically segmented the thoracic aorta and ascending aortic length, volume, and diameter was extracted from 25,073 NC-MRAs. Statistical analyses investigated relationships between mid-AAoD and demographic factors, hypertension, diabetes, alcohol, and tobacco consumption. Males exhibited significantly larger mid-AAoD than females (M:35.5±4.8mm, F:33.3±4.5mm). Age and body surface area (BSA) were positively correlated with mid-AAoD (age: male: r²=0.20, p<0.001, female: r²=0.16, p<0.001; BSA: male: r²=0.08, p<0.001, female: r²=0.05, p<0.001). Hypertensive and diabetic subjects showed higher mid-AAoD (ΔHypertension = 2.9 ± 0.5mm; ΔDiabetes = 1.5 ± 0.6mm). Hypertension was linked to higher mid-AAoD regardless of age and BSA, while diabetes and mid-AAoD were uncorrelated across age-stratified subgroups. Daily alcohol consumption (male: 37.4±5.1mm, female: 35.0±4.8mm) and smoking history exceeding 16.5 pack-years (male: 36.6±5.0mm, female: 33.9±4.3mm) exhibited highest mid-AAoD. Causal analysis (Peter-Clark algorithm) suggested that age, BSA, hypertension, and alcohol consumption are possibly causally related to mid-AAoD, while diabetes and smoking are likely spuriously correlated.
Conclusions: This study demonstrates the potential of DL and causal analysis for understanding ascending aortic morphology. By disentangling observed correlations using causal analysis, this approach identifies possible causal determinants, such as age, BSA, hypertension, and alcohol consumption. These findings can inform targeted diagnostics and preventive strategies, supporting clinical decision-making for cardiovascular health.
{"title":"Determinants of ascending aortic morphology: Cross-sectional deep learning-based analysis on 25,073 non-contrast-enhanced NAKO MRI studies.","authors":"Louisa Fay, Tobias Hepp, Moritz T Winkelmann, Annette Peters, Margit Heier, Thoralf Niendorf, Tobias Pischon, Beate Endemann, Jeanette Schulz-Menger, Lilian Krist, Matthias B Schulze, Rafael Mikolajczyk, Andreas Wienke, Nadia Obi, Bernard C Silenou, Berit Lange, Hans-Ulrich Kauczor, Wolfgang Lieb, Hansjörg Baurecht, Michael Leitzmann, Kira Trares, Hermann Brenner, Karin B Michels, Stefanie Jaskulski, Henry Völzke, Konstantin Nikolaou, Christopher L Schlett, Fabian Bamberg, Mario Lescan, Bin Yang, Thomas Küstner, Sergios Gatidis","doi":"10.1093/ehjci/jeaf081","DOIUrl":"https://doi.org/10.1093/ehjci/jeaf081","url":null,"abstract":"<p><strong>Aims: </strong>Understanding determinants of thoracic aortic morphology is crucial for precise diagnostics and therapeutic approaches. This study aimed to automatically characterize ascending aortic morphology based on 3D non-contrast-enhanced magnetic resonance angiography (NC-MRA) data from the epidemiological cross-sectional German National Cohort (NAKO) and to investigate possible determinants of mid-ascending aortic diameter (mid-AAoD).</p><p><strong>Methods and results: </strong>Deep learning (DL) automatically segmented the thoracic aorta and ascending aortic length, volume, and diameter was extracted from 25,073 NC-MRAs. Statistical analyses investigated relationships between mid-AAoD and demographic factors, hypertension, diabetes, alcohol, and tobacco consumption. Males exhibited significantly larger mid-AAoD than females (M:35.5±4.8mm, F:33.3±4.5mm). Age and body surface area (BSA) were positively correlated with mid-AAoD (age: male: r²=0.20, p<0.001, female: r²=0.16, p<0.001; BSA: male: r²=0.08, p<0.001, female: r²=0.05, p<0.001). Hypertensive and diabetic subjects showed higher mid-AAoD (ΔHypertension = 2.9 ± 0.5mm; ΔDiabetes = 1.5 ± 0.6mm). Hypertension was linked to higher mid-AAoD regardless of age and BSA, while diabetes and mid-AAoD were uncorrelated across age-stratified subgroups. Daily alcohol consumption (male: 37.4±5.1mm, female: 35.0±4.8mm) and smoking history exceeding 16.5 pack-years (male: 36.6±5.0mm, female: 33.9±4.3mm) exhibited highest mid-AAoD. Causal analysis (Peter-Clark algorithm) suggested that age, BSA, hypertension, and alcohol consumption are possibly causally related to mid-AAoD, while diabetes and smoking are likely spuriously correlated.</p><p><strong>Conclusions: </strong>This study demonstrates the potential of DL and causal analysis for understanding ascending aortic morphology. By disentangling observed correlations using causal analysis, this approach identifies possible causal determinants, such as age, BSA, hypertension, and alcohol consumption. These findings can inform targeted diagnostics and preventive strategies, supporting clinical decision-making for cardiovascular health.</p>","PeriodicalId":12026,"journal":{"name":"European Heart Journal - Cardiovascular Imaging","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pedro Cepas-Guillén, David R Holmes, Joao Cavalcante, Xavier Freixa, Gilles O Hara, Jonathan Beaudoin, Julio Farjat-Pasos, Benoit Labbé, Josep Rodés-Cabau, Erwan Salaun
Growing evidence has demonstrated the clinical benefit of percutaneous left atrial appendage closure (LAAC) in patients with atrial fibrillation. Although procedural complication rates have declined with increasing experience, post-procedural device-related complications persist, impacting prognosis and reducing the long-term benefits of the procedure. Given the potential impact of these complications, surveillance imaging after LAAC is mandatory. Currently, different imaging modalities offer unique advantages to manage these complications which warrants a combined approach to optimize both short- and long-term follow-up. The aims of this review are to explore the distinct characteristics of each imaging modality, highlighting the primary findings to be assessed during each imaging follow-up. Additionally, we propose an optimized clinical imaging surveillance roadmap from discharge to long-term follow-up.
{"title":"Imaging Assessment After Percutaneous Left Atrial Appendage Closure: From Immediate to Long-Term Follow-Up.","authors":"Pedro Cepas-Guillén, David R Holmes, Joao Cavalcante, Xavier Freixa, Gilles O Hara, Jonathan Beaudoin, Julio Farjat-Pasos, Benoit Labbé, Josep Rodés-Cabau, Erwan Salaun","doi":"10.1093/ehjci/jeaf078","DOIUrl":"https://doi.org/10.1093/ehjci/jeaf078","url":null,"abstract":"<p><p>Growing evidence has demonstrated the clinical benefit of percutaneous left atrial appendage closure (LAAC) in patients with atrial fibrillation. Although procedural complication rates have declined with increasing experience, post-procedural device-related complications persist, impacting prognosis and reducing the long-term benefits of the procedure. Given the potential impact of these complications, surveillance imaging after LAAC is mandatory. Currently, different imaging modalities offer unique advantages to manage these complications which warrants a combined approach to optimize both short- and long-term follow-up. The aims of this review are to explore the distinct characteristics of each imaging modality, highlighting the primary findings to be assessed during each imaging follow-up. Additionally, we propose an optimized clinical imaging surveillance roadmap from discharge to long-term follow-up.</p>","PeriodicalId":12026,"journal":{"name":"European Heart Journal - Cardiovascular Imaging","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Correction to: The role of multi-modality imaging in multiple valvular heart diseases: a clinical consensus statement of the European Association of Cardiovascular Imaging of the European Society of Cardiology.","authors":"","doi":"10.1093/ehjci/jeaf075","DOIUrl":"https://doi.org/10.1093/ehjci/jeaf075","url":null,"abstract":"","PeriodicalId":12026,"journal":{"name":"European Heart Journal - Cardiovascular Imaging","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Coronary-pulmonary collateral as major pulmonary blood sources in tetralogy of Fallot with absent left pulmonary artery.","authors":"Leizhi Ku, Yuhang Wang, Zheng Liu, Xiaojing Ma","doi":"10.1093/ehjci/jeae303","DOIUrl":"10.1093/ehjci/jeae303","url":null,"abstract":"","PeriodicalId":12026,"journal":{"name":"European Heart Journal - Cardiovascular Imaging","volume":" ","pages":"585"},"PeriodicalIF":6.7,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Aneurysm of the sinus of Valasalva dissecting into the interventricular septum and non-compaction of the left ventricle.","authors":"Humberto Morais, Mauer A A Gonçalves","doi":"10.1093/ehjci/jeaf079","DOIUrl":"https://doi.org/10.1093/ehjci/jeaf079","url":null,"abstract":"","PeriodicalId":12026,"journal":{"name":"European Heart Journal - Cardiovascular Imaging","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}