S. Ann, Hyeji Lee, Kyung Sun Park, Young-jee Jeon, Eun Ji Park, Sangwoo Park, Yong-Giun Kim, Yongjik Lee, Seong Hoon Choi, W. Kwon, Gyung-Min Park
Background Data are limited on the association between marital status and subclinical coronary atherosclerosis. This study investigated the influence of marital status on subclinical coronary atherosclerosis detected by coronary computed tomographic angiography in an asymptomatic population. Methods and Results This retrospective study analyzed 9288 asymptomatic individuals (mean age, 53.7±8.0 years; 6041 [65%] men) with no history of coronary artery disease who voluntarily underwent coronary computed tomographic angiography during a general health examination. Marital categories were married (n=8481) versus unmarried (n=807), comprising never married (n=195), divorced (n=183), separated (n=119), and widowed (n=310) individuals. The degree and extent of subclinical coronary atherosclerosis were evaluated by coronary computed tomographic angiography; ≥50% diameter stenosis was defined as significant. Logistic regression and propensity score matching analyses were used to determine the association between marital status and subclinical coronary atherosclerosis. After adjustment for cardiovascular risk factors, no significant differences were observed in the adjusted odds ratio (OR) of unmarried status for any coronary plaque (OR, 1.077; 95% CI, 0.899–1.291), calcified plaque (OR, 1.058; 95% CI, 0.881–1.271), noncalcified plaque (OR, 0.966; 95% CI, 0.691–1.351), mixed plaque (OR, 1.301; 95% CI, 0.884–1.917), and significant coronary artery stenosis (OR, 1.066; 95% CI, 0.771–1.474). Similarly, in the 2:1 propensity‐score matched population (n=2398), no statistically significant differences were observed for the OR of marital status for any subclinical coronary atherosclerosis (P>0.05 for all). Conclusions In this large cross‐sectional study, marital status was not associated with an increased risk of subclinical coronary atherosclerosis.
{"title":"Marital Status and Subclinical Coronary Atherosclerosis in Asymptomatic Individuals","authors":"S. Ann, Hyeji Lee, Kyung Sun Park, Young-jee Jeon, Eun Ji Park, Sangwoo Park, Yong-Giun Kim, Yongjik Lee, Seong Hoon Choi, W. Kwon, Gyung-Min Park","doi":"10.1161/JAHA.121.024942","DOIUrl":"https://doi.org/10.1161/JAHA.121.024942","url":null,"abstract":"Background Data are limited on the association between marital status and subclinical coronary atherosclerosis. This study investigated the influence of marital status on subclinical coronary atherosclerosis detected by coronary computed tomographic angiography in an asymptomatic population. Methods and Results This retrospective study analyzed 9288 asymptomatic individuals (mean age, 53.7±8.0 years; 6041 [65%] men) with no history of coronary artery disease who voluntarily underwent coronary computed tomographic angiography during a general health examination. Marital categories were married (n=8481) versus unmarried (n=807), comprising never married (n=195), divorced (n=183), separated (n=119), and widowed (n=310) individuals. The degree and extent of subclinical coronary atherosclerosis were evaluated by coronary computed tomographic angiography; ≥50% diameter stenosis was defined as significant. Logistic regression and propensity score matching analyses were used to determine the association between marital status and subclinical coronary atherosclerosis. After adjustment for cardiovascular risk factors, no significant differences were observed in the adjusted odds ratio (OR) of unmarried status for any coronary plaque (OR, 1.077; 95% CI, 0.899–1.291), calcified plaque (OR, 1.058; 95% CI, 0.881–1.271), noncalcified plaque (OR, 0.966; 95% CI, 0.691–1.351), mixed plaque (OR, 1.301; 95% CI, 0.884–1.917), and significant coronary artery stenosis (OR, 1.066; 95% CI, 0.771–1.474). Similarly, in the 2:1 propensity‐score matched population (n=2398), no statistically significant differences were observed for the OR of marital status for any subclinical coronary atherosclerosis (P>0.05 for all). Conclusions In this large cross‐sectional study, marital status was not associated with an increased risk of subclinical coronary atherosclerosis.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88740363","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}
M. Daley, E. Buratto, Gregory King, L. Grigg, A. Iyengar, N. Alphonso, A. Bullock, D. Celermajer, J. Ayer, Terry Robertson, Y. D'udekem, I. Konstantinov
Background The long‐term impact of fenestration at the time of Fontan operation remains unclear. We aimed to review the early and long‐term impact of Fontan fenestration in the Australia and New Zealand cohort. Methods and Results We reviewed 1443 patients (621 fenestrated, 822 nonfenestrated) from the Australia and New Zealand Fontan registry. Data were collected on preoperative demographics, operative details, and follow‐up. Propensity‐score matching was performed to account for the various preoperative and operative differences and risk factors. Primary outcomes were survival and freedom from failure. Median follow‐up was 10.6 years. After propensity‐score matching (407 matched pairs), there was no difference in survival (87% versus 90% at 20 years; P=0.16) or freedom from failure (73% versus 80% at 20 years; P=0.10) between patients with and without fenestration, respectively. Although patients with fenestration had longer bypass and cross‐clamp times (P<0.001), there was no difference in hospital length of stay or prolonged pleural effusions (P=0.80 and P=0.46, respectively). Freedom from systemic and Fontan circuit thromboembolism was higher in the nonfenestrated group (89%; 95% CI, 88%–95%) than the fenestrated group (84%; 95% CI, 77%–89%; P=0.03). There was no difference in incidence of plastic bronchitis, protein‐losing enteropathy, New York Heart Association Class III/IV symptoms, or Fontan takedown. Conclusions In the propensity score–matched analysis we have demonstrated no difference in long‐term survival or freedom from Fontan failure in patients with and without fenestration. There was a higher incidence of long‐term thromboembolic events in patients with fenestration. Overall, it appears that fenestration in Fontan circulation does not bring long‐term benefits.
背景Fontan手术时开窗的长期影响尚不清楚。我们的目的是回顾Fontan开窗对澳大利亚和新西兰队列的早期和长期影响。方法和结果我们回顾了来自澳大利亚和新西兰Fontan注册中心的1443例患者(621例开窗，822例非开窗)。收集术前人口统计学、手术细节和随访资料。进行倾向评分匹配，以解释各种术前和手术差异和危险因素。主要结局是生存和免于失败。中位随访时间为10.6年。倾向评分匹配(407对配对)后，20年生存率无差异(87% vs 90%;P=0.16)或免于失败(73%对80%;P=0.10)。虽然开窗患者的搭桥和交叉钳夹时间较长(P<0.001)，但住院时间和延长的胸腔积液没有差异(P分别=0.80和P=0.46)。未开窗组的全身性和丰坦回路血栓栓塞发生率更高(89%;95% CI, 88%-95%)高于开窗组(84%;95% ci, 77%-89%;P = 0.03)。可塑性支气管炎、蛋白质丢失性肠病、纽约心脏协会III/IV级症状或丰坦停用的发生率无差异。结论:在倾向评分匹配分析中，我们已经证明，在开窗和不开窗的患者中，长期生存率和Fontan失效的自由度没有差异。开窗患者的长期血栓栓塞事件发生率较高。总的来说，在方潭循环中开窗似乎没有带来长期的好处。
{"title":"Impact of Fontan Fenestration on Long‐Term Outcomes: A Propensity Score–Matched Analysis","authors":"M. Daley, E. Buratto, Gregory King, L. Grigg, A. Iyengar, N. Alphonso, A. Bullock, D. Celermajer, J. Ayer, Terry Robertson, Y. D'udekem, I. Konstantinov","doi":"10.1161/JAHA.122.026087","DOIUrl":"https://doi.org/10.1161/JAHA.122.026087","url":null,"abstract":"Background The long‐term impact of fenestration at the time of Fontan operation remains unclear. We aimed to review the early and long‐term impact of Fontan fenestration in the Australia and New Zealand cohort. Methods and Results We reviewed 1443 patients (621 fenestrated, 822 nonfenestrated) from the Australia and New Zealand Fontan registry. Data were collected on preoperative demographics, operative details, and follow‐up. Propensity‐score matching was performed to account for the various preoperative and operative differences and risk factors. Primary outcomes were survival and freedom from failure. Median follow‐up was 10.6 years. After propensity‐score matching (407 matched pairs), there was no difference in survival (87% versus 90% at 20 years; P=0.16) or freedom from failure (73% versus 80% at 20 years; P=0.10) between patients with and without fenestration, respectively. Although patients with fenestration had longer bypass and cross‐clamp times (P<0.001), there was no difference in hospital length of stay or prolonged pleural effusions (P=0.80 and P=0.46, respectively). Freedom from systemic and Fontan circuit thromboembolism was higher in the nonfenestrated group (89%; 95% CI, 88%–95%) than the fenestrated group (84%; 95% CI, 77%–89%; P=0.03). There was no difference in incidence of plastic bronchitis, protein‐losing enteropathy, New York Heart Association Class III/IV symptoms, or Fontan takedown. Conclusions In the propensity score–matched analysis we have demonstrated no difference in long‐term survival or freedom from Fontan failure in patients with and without fenestration. There was a higher incidence of long‐term thromboembolic events in patients with fenestration. Overall, it appears that fenestration in Fontan circulation does not bring long‐term benefits.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89271159","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}
Benjamin Lidgard, L. Zelnick, A. Go, K. O’Brien, N. Bansal
Background Contemporary guidelines recommend using atherosclerotic cardiovascular disease screening tools to guide primary prevention. The performance of these scores is not well known in patients with moderate to advanced chronic kidney disease, particularly in combination with clinically available cardiac biomarkers including N‐terminal pro–brain‐type natriuretic peptide and high‐sensitivity troponin T (hsTnT). Methods and Results We studied 1027 participants from the Chronic Renal Insufficiency Cohort without self‐reported atherosclerotic cardiovascular disease who were not taking aspirin or statins at enrollment. Framingham Risk Score, Pooled Cohort Equation, N‐terminal pro–brain‐type natriuretic peptide, and hsTnT were measured at baseline. Outcomes included fatal and nonfatal myocardial infarction, stroke, and cardiac death. We calculated 10‐fold cross‐validated Harrell’s C‐indices for each risk score and cardiac biomarker alone and in combination. The C‐index (95% CI) for discrimination of atherosclerotic cardiovascular disease was 0.72 (0.67, 0.77) for the Framingham Risk Score, and 0.72 (0.67, 0.76) for the Pooled Cohort Equation. HsTnT had comparable discrimination to each risk score, and improved the discrimination of each (change in Framingham 0.029, 95% CI 0.003, 0.055; change in Pooled Cohort Equation 0.027, 95% CI 0.002, 0.052). N‐terminal pro–brain‐type natriuretic peptide had poorer discrimination than the risk scores and did not significantly improve their discrimination (change in Framingham 0.009, 95% CI −0.001, 0.018; change in Pooled Cohort Equation 0.011, 95% CI −0.001, 0.024). Conclusions The Framingham Risk Score and Pooled Cohort Equation demonstrated moderate discrimination for atherosclerotic cardiovascular disease in patients with chronic kidney disease. HsTnT, but not N‐terminal pro–brain‐type natriuretic peptide, improved their discrimination overall. Until chronic kidney disease–specific atherosclerotic cardiovascular disease risk scores can be developed, it may be worth considering how to incorporate hsTnT into existing clinical risk scores.
背景当代指南推荐使用动脉粥样硬化性心血管疾病筛查工具指导初级预防。这些评分在中晚期慢性肾病患者中的表现尚不清楚，特别是在与临床可用的心脏生物标志物(包括N端前脑型利钠肽和高敏感性肌钙蛋白T (hsTnT))联合使用时。方法和结果我们研究了1027名来自慢性肾功能不全队列的参与者，他们没有自我报告的动脉粥样硬化性心血管疾病，在入组时没有服用阿司匹林或他汀类药物。在基线时测量Framingham风险评分、合并队列方程、N端脑前型利钠肽和hsTnT。结果包括致死性和非致死性心肌梗死、中风和心源性死亡。我们计算了10倍交叉验证的Harrell’s C指数，用于每个风险评分和单独或联合的心脏生物标志物。鉴别动脉粥样硬化性心血管疾病的C‐指数(95% CI)， Framingham风险评分为0.72(0.67,0.77)，合并队列方程为0.72(0.67,0.76)。HsTnT与各风险评分的鉴别性相当，并改善了各风险评分的鉴别性(Framingham 0.029, 95% CI 0.003, 0.055;合并队列方程变化0.027,95% CI 0.002, 0.052)。N端脑前型利钠肽的辨别能力低于风险评分，并且没有显著改善其辨别能力(Framingham变化0.009,95% CI - 0.001, 0.018;合并队列方程变化0.011,95% CI−0.001,0.024)。结论:Framingham风险评分和合并队列方程显示慢性肾脏疾病患者对动脉粥样硬化性心血管疾病有中度区分。HsTnT，而不是N端脑前型利钠肽，总体上提高了他们的识别能力。在慢性肾脏疾病特异性动脉粥样硬化性心血管疾病风险评分得以开发之前，如何将hsTnT纳入现有的临床风险评分可能值得考虑。
{"title":"Framingham and American College of Cardiology/American Heart Association Pooled Cohort Equations, High‐Sensitivity Troponin T, and N‐Terminal Pro–Brain‐Type Natriuretic Peptide for Predicting Atherosclerotic Cardiovascular Events Across the Spectrum of Kidney Dysfunction","authors":"Benjamin Lidgard, L. Zelnick, A. Go, K. O’Brien, N. Bansal","doi":"10.1161/JAHA.121.024913","DOIUrl":"https://doi.org/10.1161/JAHA.121.024913","url":null,"abstract":"Background Contemporary guidelines recommend using atherosclerotic cardiovascular disease screening tools to guide primary prevention. The performance of these scores is not well known in patients with moderate to advanced chronic kidney disease, particularly in combination with clinically available cardiac biomarkers including N‐terminal pro–brain‐type natriuretic peptide and high‐sensitivity troponin T (hsTnT). Methods and Results We studied 1027 participants from the Chronic Renal Insufficiency Cohort without self‐reported atherosclerotic cardiovascular disease who were not taking aspirin or statins at enrollment. Framingham Risk Score, Pooled Cohort Equation, N‐terminal pro–brain‐type natriuretic peptide, and hsTnT were measured at baseline. Outcomes included fatal and nonfatal myocardial infarction, stroke, and cardiac death. We calculated 10‐fold cross‐validated Harrell’s C‐indices for each risk score and cardiac biomarker alone and in combination. The C‐index (95% CI) for discrimination of atherosclerotic cardiovascular disease was 0.72 (0.67, 0.77) for the Framingham Risk Score, and 0.72 (0.67, 0.76) for the Pooled Cohort Equation. HsTnT had comparable discrimination to each risk score, and improved the discrimination of each (change in Framingham 0.029, 95% CI 0.003, 0.055; change in Pooled Cohort Equation 0.027, 95% CI 0.002, 0.052). N‐terminal pro–brain‐type natriuretic peptide had poorer discrimination than the risk scores and did not significantly improve their discrimination (change in Framingham 0.009, 95% CI −0.001, 0.018; change in Pooled Cohort Equation 0.011, 95% CI −0.001, 0.024). Conclusions The Framingham Risk Score and Pooled Cohort Equation demonstrated moderate discrimination for atherosclerotic cardiovascular disease in patients with chronic kidney disease. HsTnT, but not N‐terminal pro–brain‐type natriuretic peptide, improved their discrimination overall. Until chronic kidney disease–specific atherosclerotic cardiovascular disease risk scores can be developed, it may be worth considering how to incorporate hsTnT into existing clinical risk scores.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72882571","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}
P. S. Rønningen, T. Berge, M. Solberg, S. Enger, M. O. Pervez, E. B. Orstad, B. Kvisvik, E. N. Aagaard, M. Lyngbakken, I. Ariansen, H. Røsjø, K. Steine, A. Tveit
Background Echocardiographic measures of left atrial volumes are powerful predictors of cardiovascular events and important for assessing diastolic dysfunction. Despite this, there is limited knowledge of factors influencing left atrial remodeling. In particular, the impact of blood pressure in those in their early 40s on left atrial volumes later in life has not been sufficiently elucidated. Methods and Results We linked data from individuals born in 1950 who participated in the Age 40 Program, and the ACE (Akershus Cardiac Examination) 1950 Study. We divided the study population into quartiles of systolic blood pressure in their early 40s and assessed the proportion of individuals with an enlarged left atrium in their mid‐60s. The associations between blood pressure and left atrial volumes were assessed in linear regression analyses. Of the 2591 individuals included in this study, 1302 (50.3%) were women, and the mean age in the Age 40 Program was 40.1±0.3 years. Systolic blood pressure was 128.1±13.6 mm Hg and diastolic blood pressure was 78.3±9.5 mm Hg. Mean age in the ACE 1950 Study was 64.0±0.6 years. The proportion of individuals with an enlarged left atrium increased across the quartiles of systolic blood pressure (P=0.001). Systolic blood pressure was independently associated with left atrial volumes; the end‐systolic volume was 0.09 mL (95% CI, 0.04–0.14 mL) larger per 1‐mm Hg higher systolic blood pressure. Conclusions Our findings suggest that increased blood pressure in those in their early 40s is relevant for left atrial remodeling later in life. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01555411.
超声心动图测量左心房容积是心血管事件的有力预测指标，对评估舒张功能障碍很重要。尽管如此，对影响左心房重构的因素了解有限。特别是，40岁出头的人的血压对以后的左心房容量的影响还没有得到充分的阐明。方法和结果我们将1950年出生的40岁人群的数据与ACE(阿克斯舒斯心脏检查)1950年研究相关联。我们将研究人群按40岁出头的收缩压分成四分位数，并评估60岁中期左心房扩大的个体比例。用线性回归分析评估血压和左心房容积之间的关系。在本研究纳入的2591名个体中，1302名(50.3%)为女性，40岁计划的平均年龄为40.1±0.3岁。收缩压为128.1±13.6 mm Hg，舒张压为78.3±9.5 mm Hg, ACE 1950研究的平均年龄为64.0±0.6岁。在收缩压的四分位数中，左心房增大的个体比例增加(P=0.001)。收缩压与左房容积独立相关;收缩压每升高1毫米汞柱，收缩压末容积增加0.09 mL (95% CI, 0.04-0.14 mL)。结论:我们的研究结果表明，40岁出头的人血压升高与以后的左房重构有关。注册网址:https://www.clinicaltrials.gov;唯一标识符:NCT01555411。
{"title":"Impact of Blood Pressure in the Early 40s on Left Atrial Volumes in the Mid‐60s: Data From the ACE 1950 Study","authors":"P. S. Rønningen, T. Berge, M. Solberg, S. Enger, M. O. Pervez, E. B. Orstad, B. Kvisvik, E. N. Aagaard, M. Lyngbakken, I. Ariansen, H. Røsjø, K. Steine, A. Tveit","doi":"10.1161/JAHA.121.023738","DOIUrl":"https://doi.org/10.1161/JAHA.121.023738","url":null,"abstract":"Background Echocardiographic measures of left atrial volumes are powerful predictors of cardiovascular events and important for assessing diastolic dysfunction. Despite this, there is limited knowledge of factors influencing left atrial remodeling. In particular, the impact of blood pressure in those in their early 40s on left atrial volumes later in life has not been sufficiently elucidated. Methods and Results We linked data from individuals born in 1950 who participated in the Age 40 Program, and the ACE (Akershus Cardiac Examination) 1950 Study. We divided the study population into quartiles of systolic blood pressure in their early 40s and assessed the proportion of individuals with an enlarged left atrium in their mid‐60s. The associations between blood pressure and left atrial volumes were assessed in linear regression analyses. Of the 2591 individuals included in this study, 1302 (50.3%) were women, and the mean age in the Age 40 Program was 40.1±0.3 years. Systolic blood pressure was 128.1±13.6 mm Hg and diastolic blood pressure was 78.3±9.5 mm Hg. Mean age in the ACE 1950 Study was 64.0±0.6 years. The proportion of individuals with an enlarged left atrium increased across the quartiles of systolic blood pressure (P=0.001). Systolic blood pressure was independently associated with left atrial volumes; the end‐systolic volume was 0.09 mL (95% CI, 0.04–0.14 mL) larger per 1‐mm Hg higher systolic blood pressure. Conclusions Our findings suggest that increased blood pressure in those in their early 40s is relevant for left atrial remodeling later in life. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01555411.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79413050","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}
Kaitlyn D Ibrahim, Lauren A Tragesser, Rohit S. Soans, A. Haddad, Vikram J. Eddy, Joseph McComb, M. Keane, Isaac R. Whitman
Background We investigated preoperative referral patterns, rates of cardiovascular testing, surgical wait times, and postoperative outcomes in White versus Black, Hispanic, or other racial or ethnic groups of patients undergoing metabolic and bariatric surgery. Methods and Results This was a single center retrospective cohort analysis of 797 consecutive patients undergoing metabolic and bariatric surgery from January 2014 to December 2018; 86% (n=682) were Black, Hispanic, or other racial or ethnic groups. White versus Black, Hispanic, or other racial or ethnic groups had similar baseline comorbidities and were referred for preoperative cardiovascular evaluation in similar proportion (65% versus 68%, P=0.529). Black, Hispanic, or other racial or ethnic groups of patients were less likely to undergo preoperative cardiovascular testing (unadjusted odds ratio [OR], 0.56; 95% CI, 0.33–0.95; P=0.031; adjusted for Revised Cardiac Risk Index OR, 0.59; 95% CI, 0.35–0.996; P=0.049). White patients had a shorter wait time for surgery (unadjusted hazard ratio [HR], 0.7; 95% CI, 0.58–0.87; P=0.001; adjusted HR, 0.7; 95% CI, 0.56–0.95; P=0.018). Reduction in body mass index at 6 months was greater in White patients (12.9 kg/m2 versus 12.0 kg/m2, P=0.0289), but equivalent at 1 year (14.9 kg/m2 versus 14.3 kg/m2, P=0.330). Conclusions White versus Black, Hispanic, or other racial or ethnic groups of patients were referred for preoperative cardiovascular evaluation in similar proportion. White patients underwent more preoperative cardiac testing yet had a shorter wait time for surgery. Early weight loss was greater in White patients, but equivalent between groups at 12 months.
{"title":"Impact of Racial Disparities in Preoperative Cardiovascular Evaluation and Surgical Outcomes in Patients Undergoing Metabolic and Bariatric Surgery: A Retrospective Cohort Analysis","authors":"Kaitlyn D Ibrahim, Lauren A Tragesser, Rohit S. Soans, A. Haddad, Vikram J. Eddy, Joseph McComb, M. Keane, Isaac R. Whitman","doi":"10.1161/JAHA.121.024499","DOIUrl":"https://doi.org/10.1161/JAHA.121.024499","url":null,"abstract":"Background We investigated preoperative referral patterns, rates of cardiovascular testing, surgical wait times, and postoperative outcomes in White versus Black, Hispanic, or other racial or ethnic groups of patients undergoing metabolic and bariatric surgery. Methods and Results This was a single center retrospective cohort analysis of 797 consecutive patients undergoing metabolic and bariatric surgery from January 2014 to December 2018; 86% (n=682) were Black, Hispanic, or other racial or ethnic groups. White versus Black, Hispanic, or other racial or ethnic groups had similar baseline comorbidities and were referred for preoperative cardiovascular evaluation in similar proportion (65% versus 68%, P=0.529). Black, Hispanic, or other racial or ethnic groups of patients were less likely to undergo preoperative cardiovascular testing (unadjusted odds ratio [OR], 0.56; 95% CI, 0.33–0.95; P=0.031; adjusted for Revised Cardiac Risk Index OR, 0.59; 95% CI, 0.35–0.996; P=0.049). White patients had a shorter wait time for surgery (unadjusted hazard ratio [HR], 0.7; 95% CI, 0.58–0.87; P=0.001; adjusted HR, 0.7; 95% CI, 0.56–0.95; P=0.018). Reduction in body mass index at 6 months was greater in White patients (12.9 kg/m2 versus 12.0 kg/m2, P=0.0289), but equivalent at 1 year (14.9 kg/m2 versus 14.3 kg/m2, P=0.330). Conclusions White versus Black, Hispanic, or other racial or ethnic groups of patients were referred for preoperative cardiovascular evaluation in similar proportion. White patients underwent more preoperative cardiac testing yet had a shorter wait time for surgery. Early weight loss was greater in White patients, but equivalent between groups at 12 months.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75944587","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}
S. Zahid, D. Rai, Mian Tanveer ud Din, M. Khan, W. Ullah, Muhammad Usman khan, Samarthkumar Thakkar, A. Hussein, Bipul Baibhav, M. Rao, Farhad Abtahian, Deepak L. Bhatt, Jeremiah P. Depta
Background There is a paucity of data on the feasibility of same‐day discharge (SDD) following transcatheter aortic valve implantation (TAVI) at a national level. Methods and Results This study used data from the Nationwide Readmission Database from the fourth quarter of 2015 through 2019 and identified patients undergoing TAVI using the claim code 02RF3. A total of 158 591 weighted hospitalizations for TAVI were included in the analysis. Of the patients undergoing TAVI, 961 (0.6%) experienced SDD. Non‐SDDs included 65 814 (41.5%) patients who underwent TAVI who were discharged the next day, and 91 816 (57.9%) discharged on the second or third day. The 30‐day readmission rate for SDD after TAVI was similar to non‐SDD TAVI (9.8% versus 8.9%, P=0.31). The cumulative incidence of 30‐day readmissions for SDD was higher compared with next‐day discharge (log‐rank P=0.01) but comparable to second‐ or third‐day discharge (log‐rank P=0.66). At 30 days, no differences were observed in major or minor vascular complications, heart failure, or ischemic stroke for SDD compared with non‐SDD. Acute kidney injury, pacemaker implantation, and bleeding complications were lower with SDD. Predictors associated with SDD included age <85 years, male sex, and prior pacemaker placement, whereas left bundle‐branch block, right bundle‐branch block, second‐degree heart block, heart failure, prior percutaneous coronary intervention, and atrial fibrillation were negatively associated with SDD. Conclusions SDD following TAVI is associated with similar 30‐day readmission and complication rates compared with non‐SDD. Further prospective studies are needed to assess the safety and feasibility of SDD after TAVI.
在全国范围内，关于经导管主动脉瓣植入术(TAVI)后当日出院(SDD)的可行性数据缺乏。方法和结果本研究使用了2015年第四季度至2019年全国再入院数据库的数据，并使用索赔代码02RF3确定了接受TAVI的患者。共有158 591例TAVI加权住院病例纳入分析。在接受TAVI的患者中，961例(0.6%)出现了SDD。非SDDs包括65814例(41.5%)接受TAVI的患者，他们在第二天出院，91816例(57.9%)在第二天或第三天出院。TAVI后30天SDD再入院率与非SDD TAVI相似(9.8% vs 8.9%， P=0.31)。与第二天出院相比，30天内SDD再入院的累积发生率更高(log‐rank P=0.01)，但与第二天或第三天出院的发生率相当(log‐rank P=0.66)。在第30天，与非SDD相比，SDD的主要或次要血管并发症、心力衰竭或缺血性卒中没有差异。急性肾损伤、起搏器植入和出血并发症在SDD组较低。与SDD相关的预测因素包括年龄<85岁、男性和既往起搏器放置，而左束-支传导阻滞、右束-支传导阻滞、二度心脏传导阻滞、心力衰竭、既往经皮冠状动脉介入治疗和房颤与SDD呈负相关。结论:与非SDD相比，TAVI术后SDD与30天再入院率和并发症发生率相似。需要进一步的前瞻性研究来评估TAVI后SDD的安全性和可行性。
{"title":"Same‐Day Discharge After Transcatheter Aortic Valve Implantation: Insights from the Nationwide Readmission Database 2015 to 2019","authors":"S. Zahid, D. Rai, Mian Tanveer ud Din, M. Khan, W. Ullah, Muhammad Usman khan, Samarthkumar Thakkar, A. Hussein, Bipul Baibhav, M. Rao, Farhad Abtahian, Deepak L. Bhatt, Jeremiah P. Depta","doi":"10.1161/JAHA.121.024746","DOIUrl":"https://doi.org/10.1161/JAHA.121.024746","url":null,"abstract":"Background There is a paucity of data on the feasibility of same‐day discharge (SDD) following transcatheter aortic valve implantation (TAVI) at a national level. Methods and Results This study used data from the Nationwide Readmission Database from the fourth quarter of 2015 through 2019 and identified patients undergoing TAVI using the claim code 02RF3. A total of 158 591 weighted hospitalizations for TAVI were included in the analysis. Of the patients undergoing TAVI, 961 (0.6%) experienced SDD. Non‐SDDs included 65 814 (41.5%) patients who underwent TAVI who were discharged the next day, and 91 816 (57.9%) discharged on the second or third day. The 30‐day readmission rate for SDD after TAVI was similar to non‐SDD TAVI (9.8% versus 8.9%, P=0.31). The cumulative incidence of 30‐day readmissions for SDD was higher compared with next‐day discharge (log‐rank P=0.01) but comparable to second‐ or third‐day discharge (log‐rank P=0.66). At 30 days, no differences were observed in major or minor vascular complications, heart failure, or ischemic stroke for SDD compared with non‐SDD. Acute kidney injury, pacemaker implantation, and bleeding complications were lower with SDD. Predictors associated with SDD included age <85 years, male sex, and prior pacemaker placement, whereas left bundle‐branch block, right bundle‐branch block, second‐degree heart block, heart failure, prior percutaneous coronary intervention, and atrial fibrillation were negatively associated with SDD. Conclusions SDD following TAVI is associated with similar 30‐day readmission and complication rates compared with non‐SDD. Further prospective studies are needed to assess the safety and feasibility of SDD after TAVI.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75824285","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}
Ryohei Takeishi, T. Misaka, Yasuhiro Ichijo, S. Ishibashi, Mitsuko Matsuda, Yukio Yamadera, Himika Ohara, Y. Sugawara, Yu Hotsuki, Koichiro Watanabe, Fumiya Anzai, Yu Sato, Takamasa Sato, M. Oikawa, A. Kobayashi, T. Yamaki, K. Nakazato, A. Yoshihisa, Y. Takeishi
Background Although multiorgan networks are involved in the pathophysiology of heart failure (HF), interactions of the heart and the liver have not been fully understood. Hepatokines, which are synthesized and secreted from the liver, have regulatory functions in peripheral tissues. Here, we aimed to clarify the clinical impact of the hepatokine selenoprotein P in patients with HF. Methods and Results This is a prospective observational study that enrolled 296 participants consisting of 253 hospitalized patients with HF and 43 control subjects. First, we investigated selenoprotein P levels and found that its levels were significantly higher in patients with HF than in the controls. Next, patients with HF were categorized into 4 groups according to the presence of liver congestion using shear wave elastography and liver hypoperfusion by peak systolic velocity of the celiac artery, which were both assessed by abdominal ultrasonography. Selenoprotein P levels were significantly elevated in patients with HF with liver hypoperfusion compared with those without but were not different between the patients with and without liver congestion. Selenoprotein P levels were negatively correlated with peak systolic velocity of the celiac artery, whereas no correlations were observed between selenoprotein P levels and shear wave elastography of the liver. Kaplan‐Meier analysis demonstrated that patients with HF with higher selenoprotein P levels were significantly associated with increased adverse cardiac outcomes including cardiac deaths and worsening HF. Conclusions Liver‐derived selenoprotein P correlates with hepatic hypoperfusion and may be a novel target involved in cardiohepatic interactions as well as a useful biomarker for predicting prognosis in patients with HF.
{"title":"Increases in Hepatokine Selenoprotein P Levels Are Associated With Hepatic Hypoperfusion and Predict Adverse Prognosis in Patients With Heart Failure","authors":"Ryohei Takeishi, T. Misaka, Yasuhiro Ichijo, S. Ishibashi, Mitsuko Matsuda, Yukio Yamadera, Himika Ohara, Y. Sugawara, Yu Hotsuki, Koichiro Watanabe, Fumiya Anzai, Yu Sato, Takamasa Sato, M. Oikawa, A. Kobayashi, T. Yamaki, K. Nakazato, A. Yoshihisa, Y. Takeishi","doi":"10.1161/JAHA.121.024901","DOIUrl":"https://doi.org/10.1161/JAHA.121.024901","url":null,"abstract":"Background Although multiorgan networks are involved in the pathophysiology of heart failure (HF), interactions of the heart and the liver have not been fully understood. Hepatokines, which are synthesized and secreted from the liver, have regulatory functions in peripheral tissues. Here, we aimed to clarify the clinical impact of the hepatokine selenoprotein P in patients with HF. Methods and Results This is a prospective observational study that enrolled 296 participants consisting of 253 hospitalized patients with HF and 43 control subjects. First, we investigated selenoprotein P levels and found that its levels were significantly higher in patients with HF than in the controls. Next, patients with HF were categorized into 4 groups according to the presence of liver congestion using shear wave elastography and liver hypoperfusion by peak systolic velocity of the celiac artery, which were both assessed by abdominal ultrasonography. Selenoprotein P levels were significantly elevated in patients with HF with liver hypoperfusion compared with those without but were not different between the patients with and without liver congestion. Selenoprotein P levels were negatively correlated with peak systolic velocity of the celiac artery, whereas no correlations were observed between selenoprotein P levels and shear wave elastography of the liver. Kaplan‐Meier analysis demonstrated that patients with HF with higher selenoprotein P levels were significantly associated with increased adverse cardiac outcomes including cardiac deaths and worsening HF. Conclusions Liver‐derived selenoprotein P correlates with hepatic hypoperfusion and may be a novel target involved in cardiohepatic interactions as well as a useful biomarker for predicting prognosis in patients with HF.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83585845","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}
Background The prognostic implications of temporal change of previously stable high‐sensitivity cardiac troponin concentrations are unknown. We investigated the prognosis associated with temporal changes of stable high‐sensitivity cardiac troponin T (hs‐cTnT) concentrations. Methods and Results All patients presenting with cardiac symptoms and ≥2 hs‐cTnT measurements at the time of their first visit to 7 different emergency departments in Sweden between December 9, 2009, and December 31, 2016, were identified (n=66 159). We included all patients with stable hs‐cTnT but no acute coronary syndrome diagnosis who had ≥1 hs‐cTnT measured also at a second visit >30 days from the first visit. Hazard ratios (HRs) with 95% CIs were calculated for all‐cause mortality and cardiovascular events according to temporal change of hs‐cTnT between the visits, using patients without myocardial injury (<15 ng/L) at the first visit and persistently stable hs‐cTnT at the second visit as the reference. Altogether, 12 869 patients were included, of whom 5191 (40%) had myocardial injury (hs‐cTnT ≥15 ng/L). During a median follow‐up of 2.3 (interquartile range, 1.4–3.7) years, 3271 (25%) patients died. In patients with myocardial injury and a temporal increase in hs‐cTnT, the adjusted all‐cause and cardiovascular mortality was 4‐ and 5‐fold elevated (HR, 4.21; 95% CI, 3.55–5.00; and HR, 5.08; 95% CI, 3.73–6.92), and the adjusted risk of heart failure hospitalization almost 3‐fold (HR, 2.77; 95% CI, 2.26–3.39). Conclusions Temporal change of previously stable hs‐cTnT is associated with the risk of death and cardiovascular outcomes, with highest risks observed in patients with myocardial injury and increasing hs‐cTnT.
{"title":"Temporal Changes of Stable High‐Sensitivity Cardiac Troponin T Levels and Prognosis","authors":"A. Roos, G. Edgren, M. Holzmann","doi":"10.1161/JAHA.121.025082","DOIUrl":"https://doi.org/10.1161/JAHA.121.025082","url":null,"abstract":"Background The prognostic implications of temporal change of previously stable high‐sensitivity cardiac troponin concentrations are unknown. We investigated the prognosis associated with temporal changes of stable high‐sensitivity cardiac troponin T (hs‐cTnT) concentrations. Methods and Results All patients presenting with cardiac symptoms and ≥2 hs‐cTnT measurements at the time of their first visit to 7 different emergency departments in Sweden between December 9, 2009, and December 31, 2016, were identified (n=66 159). We included all patients with stable hs‐cTnT but no acute coronary syndrome diagnosis who had ≥1 hs‐cTnT measured also at a second visit >30 days from the first visit. Hazard ratios (HRs) with 95% CIs were calculated for all‐cause mortality and cardiovascular events according to temporal change of hs‐cTnT between the visits, using patients without myocardial injury (<15 ng/L) at the first visit and persistently stable hs‐cTnT at the second visit as the reference. Altogether, 12 869 patients were included, of whom 5191 (40%) had myocardial injury (hs‐cTnT ≥15 ng/L). During a median follow‐up of 2.3 (interquartile range, 1.4–3.7) years, 3271 (25%) patients died. In patients with myocardial injury and a temporal increase in hs‐cTnT, the adjusted all‐cause and cardiovascular mortality was 4‐ and 5‐fold elevated (HR, 4.21; 95% CI, 3.55–5.00; and HR, 5.08; 95% CI, 3.73–6.92), and the adjusted risk of heart failure hospitalization almost 3‐fold (HR, 2.77; 95% CI, 2.26–3.39). Conclusions Temporal change of previously stable hs‐cTnT is associated with the risk of death and cardiovascular outcomes, with highest risks observed in patients with myocardial injury and increasing hs‐cTnT.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78435047","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}
J. Rymer, Deepak L. Bhatt, D. Angiolillo, M. Díaz, K. Garratt, R. Waksman, Laura Edwards, G. Tasissa, K. Salahuddin, Hijrah El-Sabae, C. Dell'anna, L. Davidson-Ray, J. Washam, E. Ohman, Tracy Y. Wang
Background In clinical trials, cangrelor has been shown to reduce percutaneous coronary intervention–related ischemic complications without increasing major bleeding. This study was performed to examine cangrelor use and transition to oral P2Y12 inhibitors in routine clinical practice. Methods and Results The CAMEO (Cangrelor in Acute Myocardial Infarction: Effectiveness and Outcomes) registry is a multicenter, retrospective observational study of platelet inhibition strategies for patients with myocardial infarction undergoing percutaneous coronary intervention. In phase 1, data were collected on consecutive patients with myocardial infarction (n=482) treated with any P2Y12 inhibitor to understand cangrelor use by hospital. In phase 2, data were collected in a 2:1 (cangrelor‐: non‐cangrelor‐treated) ratio of patients with myocardial infarction (n=873). In phase 1, cangrelor use varied across hospitals (overall, 50.4% [range, 6.0%–100%]). Of patients receiving cangrelor in both phases (n=819), 3.3% received either the bolus or infusion only. Cangrelor was infused for a median of 121 (76–196) minutes; and 38.3% received an infusion for <2 hours. Most patients transitioned from cangrelor to ticagrelor (ticagrelor, 85.3%; clopidogrel, 9.5%; prasugrel, 5.2%). Many patients (16.4%) had a >1‐hour gap between cangrelor cessation and oral P2Y12 inhibitor initiation; this was highest among those transitioned to clopidogrel (56.6% versus 34.5% prasugrel versus 10.8% ticagrelor; P<0.001). Only 27.3% were dosed with cangrelor and transitioned to an oral P2Y12 inhibitor in a fashion consistent with the pivotal trials and US Food and Drug Administration label. Conclusions This multicenter registry demonstrated interhospital variability in how cangrelor was administered and transitioned to an oral P2Y12 inhibitor. These findings highlight opportunities for optimization of cangrelor dosing, infusion duration, and transition of care from the catheterization laboratory to the ward setting.
在临床试验中，canrelor已被证明可以减少经皮冠状动脉介入相关的缺血性并发症，而不会增加大出血。本研究旨在检查康格洛在常规临床实践中的使用和向口服P2Y12抑制剂的过渡。方法和结果CAMEO (angrelor在急性心肌梗死中的疗效和结果)登记是一项多中心、回顾性观察性研究，旨在观察经皮冠状动脉介入治疗的心肌梗死患者的血小板抑制策略。在i期研究中，收集了连续接受P2Y12抑制剂治疗的心肌梗死患者(n=482)的数据，以了解医院对康格瑞洛的使用情况。在第二阶段，心肌梗死患者(n=873)的数据以2:1的比例(cangrelor治疗组:非cangrelor治疗组)收集。在第一阶段，不同医院的康格瑞洛使用率不同(总体为50.4%[范围，6.0%-100%])。在两期均接受康奈洛治疗的患者中(n=819)， 3.3%的患者只接受了大剂量或输注治疗。Cangrelor输注时间中位数为121分钟(76-196分钟);38.3%的患者在康格瑞洛停止和口服P2Y12抑制剂开始之间间隔1小时接受输注;在过渡到氯吡格雷的人群中，这一比例最高(56.6% vs 34.5%，普拉格雷vs 10.8%，替格瑞;P < 0.001)。只有27.3%的患者服用康格瑞洛后转为口服P2Y12抑制剂，这与关键试验和美国食品和药物管理局的标签一致。结论:这个多中心注册显示了医院间的差异性，在康格瑞洛如何给药以及如何转变为口服P2Y12抑制剂。这些发现强调了优化cangrelor剂量、输注时间和从导管实验室到病房环境的护理过渡的机会。
{"title":"Cangrelor Use Patterns and Transition to Oral P2Y12 Inhibitors Among Patients With Myocardial Infarction: Initial Results From the CAMEO Registry","authors":"J. Rymer, Deepak L. Bhatt, D. Angiolillo, M. Díaz, K. Garratt, R. Waksman, Laura Edwards, G. Tasissa, K. Salahuddin, Hijrah El-Sabae, C. Dell'anna, L. Davidson-Ray, J. Washam, E. Ohman, Tracy Y. Wang","doi":"10.1161/JAHA.121.024513","DOIUrl":"https://doi.org/10.1161/JAHA.121.024513","url":null,"abstract":"Background In clinical trials, cangrelor has been shown to reduce percutaneous coronary intervention–related ischemic complications without increasing major bleeding. This study was performed to examine cangrelor use and transition to oral P2Y12 inhibitors in routine clinical practice. Methods and Results The CAMEO (Cangrelor in Acute Myocardial Infarction: Effectiveness and Outcomes) registry is a multicenter, retrospective observational study of platelet inhibition strategies for patients with myocardial infarction undergoing percutaneous coronary intervention. In phase 1, data were collected on consecutive patients with myocardial infarction (n=482) treated with any P2Y12 inhibitor to understand cangrelor use by hospital. In phase 2, data were collected in a 2:1 (cangrelor‐: non‐cangrelor‐treated) ratio of patients with myocardial infarction (n=873). In phase 1, cangrelor use varied across hospitals (overall, 50.4% [range, 6.0%–100%]). Of patients receiving cangrelor in both phases (n=819), 3.3% received either the bolus or infusion only. Cangrelor was infused for a median of 121 (76–196) minutes; and 38.3% received an infusion for <2 hours. Most patients transitioned from cangrelor to ticagrelor (ticagrelor, 85.3%; clopidogrel, 9.5%; prasugrel, 5.2%). Many patients (16.4%) had a >1‐hour gap between cangrelor cessation and oral P2Y12 inhibitor initiation; this was highest among those transitioned to clopidogrel (56.6% versus 34.5% prasugrel versus 10.8% ticagrelor; P<0.001). Only 27.3% were dosed with cangrelor and transitioned to an oral P2Y12 inhibitor in a fashion consistent with the pivotal trials and US Food and Drug Administration label. Conclusions This multicenter registry demonstrated interhospital variability in how cangrelor was administered and transitioned to an oral P2Y12 inhibitor. These findings highlight opportunities for optimization of cangrelor dosing, infusion duration, and transition of care from the catheterization laboratory to the ward setting.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89779915","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}
Laura D. Flannery, Muhammad Etiwy, Alexander Camacho, Ran Liu, Nilay K. Patel, Arpi Tavil‐Shatelyan, V. Tanguturi, J. Dal-Bianco, E. Yucel, R. Sakhuja, A. Jassar, N. Langer, I. Inglessis, J. Passeri, J. Hung, S. Elmariah
Background Many patients with severe aortic stenosis (AS) and an indication for aortic valve replacement (AVR) do not undergo treatment. The reasons for this have not been well studied in the transcatheter AVR era. We sought to determine how patient‐ and process‐specific factors affected AVR use in patients with severe AS. Methods and Results We identified ambulatory patients from 2016 to 2018 demonstrating severe AS, defined by aortic valve area ≤1.0 cm2. Propensity scoring analysis with inverse probability of treatment weighting was used to evaluate associations between predictors and the odds of undergoing AVR at 365 days and subsequent mortality at 730 days. Of 324 patients with an indication for AVR (79.3±9.7 years, 57.4% men), 140 patients (43.2%) did not undergo AVR. The odds of AVR were reduced in patients aged >90 years (odds ratio [OR], 0.24 [95% CI, 0.08–0.69]; P=0.01), greater comorbid conditions (OR, 0.88 per 1‐point increase in Combined Comorbidity Index [95% CI, 0.79–0.97]; P=0.01), low‐flow, low‐gradient AS with preserved left ventricular ejection fraction (OR, 0.11 [95% CI, 0.06–0.21]), and low‐gradient AS with reduced left ventricular ejection fraction (OR, 0.18 [95% CI, 0.08–0.40]) and were increased if the transthoracic echocardiogram ordering provider was a cardiologist (OR, 2.46 [95% CI, 1.38–4.38]). Patients who underwent AVR gained an average of 85.8 days of life (95% CI, 40.9–130.6) at 730 days. Conclusions The proportion of ambulatory patients with severe AS and an indication for AVR who do not receive AVR remains significant. Efforts are needed to maximize the recognition of severe AS, especially low‐gradient subtypes, and to encourage patient referral to multidisciplinary heart valve teams.
{"title":"Patient‐ and Process‐Related Contributors to the Underuse of Aortic Valve Replacement and Subsequent Mortality in Ambulatory Patients With Severe Aortic Stenosis","authors":"Laura D. Flannery, Muhammad Etiwy, Alexander Camacho, Ran Liu, Nilay K. Patel, Arpi Tavil‐Shatelyan, V. Tanguturi, J. Dal-Bianco, E. Yucel, R. Sakhuja, A. Jassar, N. Langer, I. Inglessis, J. Passeri, J. Hung, S. Elmariah","doi":"10.1161/JAHA.121.025065","DOIUrl":"https://doi.org/10.1161/JAHA.121.025065","url":null,"abstract":"Background Many patients with severe aortic stenosis (AS) and an indication for aortic valve replacement (AVR) do not undergo treatment. The reasons for this have not been well studied in the transcatheter AVR era. We sought to determine how patient‐ and process‐specific factors affected AVR use in patients with severe AS. Methods and Results We identified ambulatory patients from 2016 to 2018 demonstrating severe AS, defined by aortic valve area ≤1.0 cm2. Propensity scoring analysis with inverse probability of treatment weighting was used to evaluate associations between predictors and the odds of undergoing AVR at 365 days and subsequent mortality at 730 days. Of 324 patients with an indication for AVR (79.3±9.7 years, 57.4% men), 140 patients (43.2%) did not undergo AVR. The odds of AVR were reduced in patients aged >90 years (odds ratio [OR], 0.24 [95% CI, 0.08–0.69]; P=0.01), greater comorbid conditions (OR, 0.88 per 1‐point increase in Combined Comorbidity Index [95% CI, 0.79–0.97]; P=0.01), low‐flow, low‐gradient AS with preserved left ventricular ejection fraction (OR, 0.11 [95% CI, 0.06–0.21]), and low‐gradient AS with reduced left ventricular ejection fraction (OR, 0.18 [95% CI, 0.08–0.40]) and were increased if the transthoracic echocardiogram ordering provider was a cardiologist (OR, 2.46 [95% CI, 1.38–4.38]). Patients who underwent AVR gained an average of 85.8 days of life (95% CI, 40.9–130.6) at 730 days. Conclusions The proportion of ambulatory patients with severe AS and an indication for AVR who do not receive AVR remains significant. Efforts are needed to maximize the recognition of severe AS, especially low‐gradient subtypes, and to encourage patient referral to multidisciplinary heart valve teams.","PeriodicalId":17189,"journal":{"name":"Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88656306","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}
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