Structural Heart最新文献_第4页

Impact of Prior Q-Wave Myocardial Infarction in Transcatheter Aortic Valve Replacement Patients With Reduced Ejection Fraction 既往q波心肌梗死对经导管主动脉瓣置换术患者射血分数降低的影响

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-11-01 DOI: 10.1016/j.shj.2025.100731

Siddhartha Mengi MD , Marina Urena MD, PhD , Gabriela Veiga-Fernandez MD, PhD , Alberto Alperi MD, PhD , Luis Nombela-Franco MD, PhD , Victoria Vilalta MD, PhD , Ander Regueiro MD, PhD , Jules Mesnier MD , Victor Fradejas-Sastre RN, PhD , Pablo Avanzas MD, PhD , Ricardo Ortiz Lozada MD , Elena de Oliveira-Cañedo MD , Giovanni Occhipinti MD , Pedro Cepas-Guillén MD, PhD , Marisa Avvedimento MD , Josep Rodés-Cabau MD, PhD

Background

Coronary artery disease is prevalent in transcatheter aortic valve replacement (TAVR) patients, but the specific impact of prior Q-wave myocardial infarction (QWMI), a marker of transmural infarction, remains underexplored. This study evaluated the clinical impact of QWMI in TAVR patients with left ventricular ejection fraction (LVEF) < 50%.

Methods

Multicenter study including 1172 consecutive patients undergoing TAVR with contemporary devices, stratified according to prior QWMI. The primary outcome was all-cause mortality or heart failure hospitalization (HFH) over a median follow-up of 3 (1-4) years. Secondary endpoints included changes in LVEF and independent predictors of adverse outcomes.

Results

Prior QWMI was present in 106 (9.0%) patients. Those with QWMI were younger (77.3 vs 80.6 years; p < 0.001) and had lower baseline LVEF (36.3 vs. 38.3%; p = 0.048). Unadjusted analysis showed higher all-cause mortality (49.1 vs 31.7%; p < 0.001) and combined death or HFH (54.8 vs 36.7%; p < 0.001). LVEF improvement at 30 days was attenuated in QWMI patients, particularly with anterior MI. After adjustment, QWMI was not independently associated with mortality or combined death/HFH. Chronic kidney disease (hazard ratio: 1.26; p = 0.042) and permanent atrial fibrillation (hazard ratio: 1.30; p = 0.013) were independent predictors of adverse outcomes.

Conclusions

Up to 1 out of 10 TAVR patients with reduced LVEF had prior QWMI, which was associated with impaired LVEF recovery, especially in those with anterior QWMI, and worse clinical outcomes at 3-year follow-up, largely driven by comorbidities. These findings underscore the importance of advanced preprocedural imaging, tailored therapeutic strategies, and integrated multidisciplinary care to enhance outcomes in this high-risk TAVR population.

背景冠状动脉疾病在经导管主动脉瓣置换术（TAVR）患者中很普遍，但既往q波心肌梗死（QWMI）的具体影响仍未得到充分研究，QWMI是一种跨壁梗死的标志。本研究评估QWMI对左室射血分数(LVEF)≥50%的TAVR患者的临床影响。方法采用多中心研究，包括1172例使用现代器械接受TAVR的患者，根据既往QWMI进行分层。主要结局是全因死亡率或心力衰竭住院（HFH），中位随访时间为3（1-4）年。次要终点包括LVEF的变化和不良结局的独立预测因子。结果106例（9.0%）患者存在既往QWMI。QWMI患者更年轻（77.3 vs 80.6岁；p < 0.001），基线LVEF更低（36.3 vs 38.3%; p = 0.048）。未经调整的分析显示，全因死亡率（49.1% vs 31.7%; p < 0.001）和HFH合并死亡率（54.8% vs 36.7%; p < 0.001）较高。QWMI患者，尤其是前路心肌梗死患者，30天LVEF改善减弱。调整后，QWMI与死亡率或合并死亡/HFH无关。慢性肾病（危险比：1.26;p = 0.042）和永久性房颤（危险比：1.30;p = 0.013）是不良结局的独立预测因素。结论10例LVEF减少的TAVR患者中有1例既往有QWMI，这与LVEF恢复受损有关，尤其是前路QWMI患者，并且在3年随访时临床结果较差，主要由合并症驱动。这些发现强调了先进的术前成像、量身定制的治疗策略和综合多学科护理对提高TAVR高危人群预后的重要性。

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引用次数: 0

Same-Day Discharge Post-Transcatheter Aortic Valve Implantation: An Emerging Paradigm in Aortic Valve Intervention? 经导管主动脉瓣植入术后当日出院：主动脉瓣介入治疗的新模式？

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-11-01 DOI: 10.1016/j.shj.2025.100733

Ander Regueiro MD, PhD , Amr Abdelrahman MBBS

引用次数: 0

Clinical Impact of Prosthesis Oversizing in Self-Expanding Intra-Annular Transcatheter Aortic Valve Replacement 假体过大对经导管自扩张环形主动脉瓣置换术的临床影响

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-11-01 DOI: 10.1016/j.shj.2025.100730

Andrea Ruberti MD , Giovanni Occhipinti MD , Matias Mon Noboa MD , Luis Nombela-Franco MD, PhD , Daijiro Tomii MD , Thomas Pilgrim MD, PhD , Manel Sabaté MD, PhD , Endaitz Estebanez , Nieves Gonzalo MD, PhD , Pilar Jimenez-Quevedo MD, PhD , Gabriela Tirado-Conte MD, PhD , Laura Sanchis MD, PhD , Omar Abdul-Jawad Altisent MD, PhD , Eduardo Flores-Umanzor MD, PhD , Francisco Campelo-Parada MD, PhD , Xavier Freixa MD, PhD , Ander Regueiro MD, PhD

Background

Among patients undergoing transcatheter aortic valve replacement (TAVR), valve sizing is essential to guarantee procedural success and long-term durability of transcatheter heart valves (THVs). The optimal sizing strategy for self-expanding (SE) intra-annular THVs remains unclear. The aim of this study is to evaluate the impact of prosthesis oversizing on procedural and clinical outcomes in patients undergoing TAVR with the Portico and Navitor THVs.

Methods

This retrospective, multicenter study included patients who underwent TAVR with SE intra-annular THVs between October 2017 and September 2024. Patients were stratified by the median oversizing value (14%) into low- (≤14%) and high- (>14%) oversizing groups. The primary endpoint was technical success. Secondary outcomes included 30-day device success, permanent pacemaker implantation, cardiovascular mortality, heart failure–related hospitalization, and valve dysfunction at 12 months.

Results

A total of 400 patients (mean age 83.0 ± 6.0 years; 65.8% female) were included. Technical success was higher in the low-oversizing group (96.7 vs. 92.1%; p = 0.048). Valve embolization occurred only in the high-oversizing group (0 vs. 2.1%; p = 0.035). No significant differences were observed in 30-day device success (93.0 vs. 88.3%; p = 0.171) and moderate-to-severe paravalvular regurgitation (2.9 vs. 1.8%; p = 0.724). No differences emerged in permanent pacemaker implantation rates (24.5 vs. 25.7%; p = 0.712). At 12 months, cardiovascular mortality (4.6 vs. 4.9%; p = 0.884) and heart failure hospitalization rates (6.9 vs. 4.9%; p = 0.497) were similar.

Conclusions

In patients undergoing TAVR with SE intra-annular THVs, low-oversizing (≤14%) was associated with higher technical success and fewer valve-related complications.

背景：在接受经导管主动脉瓣置换术（TAVR）的患者中，瓣膜尺寸是保证手术成功和经导管心脏瓣膜（thv）长期耐用性的关键。自膨胀（SE）环内thv的最佳尺寸策略尚不清楚。本研究的目的是评估假体过大对使用Portico和Navitor thv的TAVR患者的手术和临床结果的影响。方法这项回顾性、多中心研究纳入了2017年10月至2024年9月期间接受TAVR合并SE环内THVs的患者。根据中位过大值（14%）将患者分为低（≤14%）和高（>14%）过大组。主要终点是技术上的成功。次要结局包括30天装置成功、永久性起搏器植入、心血管死亡率、心力衰竭相关住院和12个月时的瓣膜功能障碍。结果共纳入400例患者，平均年龄83.0±6.0岁，女性占65.8%。低尺寸组的技术成功率更高（96.7 vs 92.1%; p = 0.048）。瓣膜栓塞仅发生在高过径组（0比2.1%;p = 0.035）。30天装置成功率（93.0 vs. 88.3%, p = 0.171）和中重度瓣旁反流（2.9 vs. 1.8%, p = 0.724）无显著差异。永久性起搏器植入率无差异（24.5% vs. 25.7%; p = 0.712）。12个月时，心血管死亡率（4.6 vs. 4.9%; p = 0.884）和心力衰竭住院率（6.9 vs. 4.9%; p = 0.497）相似。结论在接受TAVR合并SE环内THVs的患者中，低尺寸（≤14%）与更高的技术成功率和更少的瓣膜相关并发症相关。

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引用次数: 0

Outcomes of Transcatheter Edge-to-Edge Mitral Valve Repair in Hypertrophic Cardiomyopathy: A Patient-Level Meta-Analysis 肥厚性心肌病患者经导管边缘对边缘二尖瓣修复的结果：一项患者水平的meta分析

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-11-01 DOI: 10.1016/j.shj.2025.100664

Lorraine Mascarenhas DO , Gloria Yang BS , Alok Sharma MD , Stefan Bertog MD , Scott Hubers MD , Selcuk Adabag MD, MS

Background

Hypertrophic cardiomyopathy (HCM) is commonly associated with left ventricular outflow tract (LVOT) obstruction and mitral regurgitation (MR). Transcatheter edge-to-edge repair (TEER) of the mitral valve has been introduced as a therapeutic alternative for individuals with LVOT obstruction and concurrent MR, but there are insufficient outcome data. We aim to perform a systematic review and patient-level meta-analysis of the studies reporting the outcomes of TEER of the mitral valve in HCM.

Methods

Original studies published in PubMed and Google Scholar were included if ≥1 of the following pre- and post-TEER measures were reported: peak resting or provoked LVOT gradients, MR grade, mitral valve gradient, or New York Heart Association (NYHA) functional class. One unpublished case from the Minneapolis Veterans Affairs Medical Center was also included.

Results

Nineteen publications and 37 patients (mean age 70.1 [±15.2] years, 50% male, mean follow-up time of 9.2 [±6.4] months) were analyzed. Compared to baseline measurements, there was a significant reduction in the mean peak resting and provoked LVOT gradients (69.2 [±40.3] mmHg vs. 11.7 [±8.6] mmHg and 98.2 [±53.4] mmHg vs. 14.1 [±13.9] mmHg, respectively), median MR grade (4.0 [3.0-4.0] vs. 1.0 [1.0-1.0]), and proportion of patients with an NYHA functional class ≥3 (100 vs. 7%) post-TEER (all p < 0.001). There was a significant increase in mean mitral valve gradients post-TEER (2.2 [±1.0] mmHg vs. 4.3 [±1.3] mmHg, p < 0.001).

Conclusions

TEER can be an effective therapeutic option for improving LVOT obstruction, MR severity, and NYHA functional class in patients with HCM.

背景肥厚性心肌病（HCM）通常与左心室流出道（LVOT）阻塞和二尖瓣反流（MR）相关。经导管二尖瓣边缘到边缘修复（TEER）已被引入作为LVOT阻塞和并发MR的个体的治疗选择，但没有足够的结果数据。我们的目标是对报道HCM患者二尖瓣TEER结果的研究进行系统回顾和患者水平的荟萃分析。方法：在PubMed和谷歌Scholar上发表的原始研究，如果报告了teer前后≥1项测量：静息或激发LVOT峰值梯度、MR分级、二尖瓣梯度或纽约心脏协会（NYHA）功能分级。明尼阿波利斯退伍军人事务医疗中心的一个未发表的病例也包括在内。结果共收集文献19篇，患者37例，平均年龄70.1[±15.2]岁，男性占50%，平均随访时间9.2[±6.4]个月。与基线测量值相比，teer后平均静息峰和诱发LVOT梯度（分别为69.2[±40.3]mmHg和98.2[±53.4]mmHg，分别为11.7[±8.6]mmHg和14.1[±13.9]mmHg）、MR中位等级（4.0[3.0-4.0]比1.0[1.0-1.0]）和NYHA功能分级≥3的患者比例（100比7%）显著降低（均p <； 0.001）。teer后的平均二尖瓣梯度显著增加（2.2[±1.0]mmHg vs. 4.3[±1.3]mmHg, p < 0.001）。结论steer可有效改善HCM患者LVOT阻塞、MR严重程度和NYHA功能分级。

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引用次数: 0

Aims & Scope 目标及范围

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-11-01 DOI: 10.1016/S2474-8706(25)00360-4

引用次数: 0

Self-Expandable Transcatheter Aortic Valves in Patients With Small Aortic Annulus: The SWEDEHEART Registry 经导管主动脉瓣在小主动脉环患者中的自膨胀：SWEDEHEART注册

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-11-01 DOI: 10.1016/j.shj.2025.100680

Antros Louca MD , Anna Myredal MD, PhD , Monér Alchay MD , Henrik Hagström MD, PhD , Dan Ioanes MD, PhD , Stefan James MD, PhD , Sasha Koul MD, PhD , Araz Rawshani MD, PhD , Björn Redfors MD, PhD , Andreas Rück MD, PhD , Kristofer Skoglund MD, PhD , Sebastian Völz MD, PhD , Petur Petursson MD, PhD , Truls Råmunddal MD, PhD , Oskar Angerås MD, PhD

Background

Small aortic annulus is associated with poorer hemodynamic outcomes in transcatheter aortic valve replacement (TAVR). In these cases, supra-annular (SA) self-expandable valves (SEVs) may offer better results than intra-annular SEVs (IA SEVs). This study evaluated clinical and hemodynamic outcomes for SA SEVs (Evolut valves, Acurate valves) and IA SEVs (Portico/Navitor valves).

Methods

We analyzed data from patients who underwent TAVR in Sweden between 2013 and 2022 with an annular diameter ≤23 mm, using inverse probability of treatment weighting. Endpoints included mortality, device, and technical success as per Valve Academic Research Consortium 3 definitions. Other endpoints were the incidence of post-TAVR mean or peak gradients over 20 and 40 mmHg, respectively, significant paravalvular leakage, new pacemaker implantation, and postprocedural aortic valve gradients.

Results

The study included 1068 patients, with a median age of 81.2 years, and 88% were women. After inverse probability of treatment weighting adjustment, no differences were observed in the outcomes apart from a marginally lower risk of postprocedural mortality in the Portico/Navitor valves compared to the Evolut valves (adjusted odds ratio: 0.99; p = 0.05; 95% CI: 0.98-1.00). Hemodynamically, the Evolut valves showed the lowest mean gradients, followed by the Portico/Navitor valves and the Acurate valves (7.97 vs 9.02 mmHg vs. 0.84 mmHg, respectively, p < 0.001; 95% CI: 0.35-1.00).

Conclusions

SA and IA SEVs show comparable clinical outcomes and excellent hemodynamic performance in patients with small aortic annuli. Further studies, including randomized trials, are needed to provide clearer guidance on valve selection.

背景：经导管主动脉瓣置换术（TAVR）中，小主动脉环与较差的血流动力学结果相关。在这些情况下，环空上（SA）自膨胀阀（sev）可能比环内sev （IA sev）效果更好。本研究评估了SA sev （Evolut瓣膜、accurate瓣膜）和IA sev （Portico/Navitor瓣膜）的临床和血流动力学结果。方法：采用治疗加权逆概率法，分析2013 - 2022年间瑞典接受TAVR的环径≤23 mm患者的数据。根据Valve学术研究联盟3的定义，终点包括死亡率、设备和技术成功。其他终点分别为tavr后平均梯度或峰值梯度超过20和40 mmHg的发生率、显著瓣旁渗漏、新起搏器植入和术后主动脉瓣梯度。结果纳入1068例患者，中位年龄81.2岁，其中88%为女性。在对治疗权重进行逆概率调整后，除了Portico/Navitor瓣膜的术后死亡风险略低于Evolut瓣膜外，结果无差异（校正优势比：0.99;p = 0.05; 95% CI: 0.98-1.00）。血流动力学方面，Evolut瓣膜的平均梯度最低，其次是Portico/Navitor瓣膜和accuracy瓣膜（分别为7.97 vs 9.02 mmHg vs 0.84 mmHg, p < 0.001; 95% CI: 0.35-1.00）。结论sa和IA sev在小主动脉环患者中具有相当的临床效果和良好的血流动力学表现。需要进一步的研究，包括随机试验，为瓣膜选择提供更明确的指导。

{"title":"Self-Expandable Transcatheter Aortic Valves in Patients With Small Aortic Annulus: The SWEDEHEART Registry","authors":"Antros Louca MD , Anna Myredal MD, PhD , Monér Alchay MD , Henrik Hagström MD, PhD , Dan Ioanes MD, PhD , Stefan James MD, PhD , Sasha Koul MD, PhD , Araz Rawshani MD, PhD , Björn Redfors MD, PhD , Andreas Rück MD, PhD , Kristofer Skoglund MD, PhD , Sebastian Völz MD, PhD , Petur Petursson MD, PhD , Truls Råmunddal MD, PhD , Oskar Angerås MD, PhD","doi":"10.1016/j.shj.2025.100680","DOIUrl":"10.1016/j.shj.2025.100680","url":null,"abstract":"<div><h3>Background</h3><div>Small aortic annulus is associated with poorer hemodynamic outcomes in transcatheter aortic valve replacement (TAVR). In these cases, supra-annular (SA) self-expandable valves (SEVs) may offer better results than intra-annular SEVs (IA SEVs). This study evaluated clinical and hemodynamic outcomes for SA SEVs (Evolut valves, Acurate valves) and IA SEVs (Portico/Navitor valves).</div></div><div><h3>Methods</h3><div>We analyzed data from patients who underwent TAVR in Sweden between 2013 and 2022 with an annular diameter ≤23 mm, using inverse probability of treatment weighting. Endpoints included mortality, device, and technical success as per Valve Academic Research Consortium 3 definitions. Other endpoints were the incidence of post-TAVR mean or peak gradients over 20 and 40 mmHg, respectively, significant paravalvular leakage, new pacemaker implantation, and postprocedural aortic valve gradients.</div></div><div><h3>Results</h3><div>The study included 1068 patients, with a median age of 81.2 years, and 88% were women. After inverse probability of treatment weighting adjustment, no differences were observed in the outcomes apart from a marginally lower risk of postprocedural mortality in the Portico/Navitor valves compared to the Evolut valves (adjusted odds ratio: 0.99; <em>p</em> = 0.05; 95% CI: 0.98-1.00). Hemodynamically, the Evolut valves showed the lowest mean gradients, followed by the Portico/Navitor valves and the Acurate valves (7.97 vs 9.02 mmHg vs. 0.84 mmHg, respectively, <em>p</em> < 0.001; 95% CI: 0.35-1.00).</div></div><div><h3>Conclusions</h3><div>SA and IA SEVs show comparable clinical outcomes and excellent hemodynamic performance in patients with small aortic annuli. Further studies, including randomized trials, are needed to provide clearer guidance on valve selection.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"9 11","pages":"Article 100680"},"PeriodicalIF":2.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789924","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}

引用次数: 0

Cardiac Damage Staging in Moderate or Greater Aortic Regurgitation: A New Framework for Risk Stratification 中度或重度主动脉反流心脏损伤分期：风险分层的新框架

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-10-31 DOI: 10.1016/j.shj.2025.100748

Francisco B. Alexandrino MD , Ian Persits DO , Joseph Hajj MD , Ziad Zalaquett MD , V. Karthik MD , Travis Howard MD , Vincent Chen MD , Samir R. Kapadia MD , Serge C. Harb MD , Rishi Puri MD, PhD

Background

Cardiac damage staging is an established prognostic tool in aortic stenosis, and an initial application to aortic regurgitation (AR) showed prognostic relevance, mainly in advanced stages. No dedicated framework currently exists for AR. We aimed to characterize the extent and prognostic implications of multistructural cardiac damage in patients with moderate or greater AR.

Methods

We retrospectively analyzed 432 adult patients with ≥ moderate AR who underwent transthoracic echocardiography at Cleveland Clinic between 2008 and 2021. Cardiac damage was staged hierarchically from no damage (stage 0) to right ventricular dysfunction (stage 3) based on echocardiographic assessment of left ventricular (LV) global longitudinal strain, LV ejection fraction, chamber dimensions, valvular abnormalities, pulmonary pressures, and right ventricular function. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization.

Results

Over a median follow-up of 5.2 years (interquartile range, 1.9–9.3 years), advancing cardiac damage stage was associated with worsening LV function, progressive atrial and ventricular remodeling, and elevated pulmonary pressures (p < 0.001 for all trends). Five-year cumulative incidence of the primary endpoint increased from 3.8% in stage 0 (n = 28), 17.3% in stage 1 (n = 101), 26.2% in stage 2 (n = 210) to 60.7% in stage 3 (n = 93). In multivariable Cox analysis, each stage increment portended a significantly higher risk of adverse outcomes (hazard ratio 2.1 per stage; 95% CI, 1.6–2.6; p < 0.0001).

Conclusions

In patients with moderate or greater AR, the burden of cardiac damage incrementally stratified long-term risk. A dedicated staging model specific to AR may refine prognostic assessment and support earlier aortic valve interventions.

背景：心脏损伤分期是主动脉狭窄的一种成熟的预后工具，最初应用于主动脉反流（AR）显示预后相关性，主要是在晚期。目前还没有专门的AR框架。我们的目的是表征中度或更严重AR患者多结构心脏损伤的程度和预后意义。方法我们回顾性分析了2008年至2021年间在克利夫兰诊所接受经胸超声心动图检查的432例≥中度AR成年患者。根据超声心动图对左室（LV）整体纵向应变、左室射血分数、心室尺寸、瓣膜异常、肺动脉压力和右室功能的评估，将心脏损伤从无损伤（0期）到右室功能障碍（3期）进行分级。主要终点是全因死亡率和心力衰竭住院率的综合。结果在中位随访5.2年（四分位间距为1.9-9.3年）中，心脏损伤阶段的进展与左室功能恶化、心房和心室重构进行性以及肺动脉压升高相关（所有趋势p <； 0.001）。主要终点的5年累积发病率从0期3.8% （n = 28）、1期17.3% （n = 101）、2期26.2% （n = 210）增加到3期60.7% （n = 93）。在多变量Cox分析中，每个阶段的增加都预示着不良结局的风险显著增加（每个阶段的风险比为2.1；95% CI为1.6-2.6;p < 0.0001）。结论中度及以上AR患者心脏损害负担的长期风险呈递增分层。专门针对AR的分期模型可以改进预后评估并支持早期主动脉瓣介入治疗。

{"title":"Cardiac Damage Staging in Moderate or Greater Aortic Regurgitation: A New Framework for Risk Stratification","authors":"Francisco B. Alexandrino MD , Ian Persits DO , Joseph Hajj MD , Ziad Zalaquett MD , V. Karthik MD , Travis Howard MD , Vincent Chen MD , Samir R. Kapadia MD , Serge C. Harb MD , Rishi Puri MD, PhD","doi":"10.1016/j.shj.2025.100748","DOIUrl":"10.1016/j.shj.2025.100748","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac damage staging is an established prognostic tool in aortic stenosis, and an initial application to aortic regurgitation (AR) showed prognostic relevance, mainly in advanced stages. No dedicated framework currently exists for AR. We aimed to characterize the extent and prognostic implications of multistructural cardiac damage in patients with moderate or greater AR.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 432 adult patients with ≥ moderate AR who underwent transthoracic echocardiography at Cleveland Clinic between 2008 and 2021. Cardiac damage was staged hierarchically from no damage (stage 0) to right ventricular dysfunction (stage 3) based on echocardiographic assessment of left ventricular (LV) global longitudinal strain, LV ejection fraction, chamber dimensions, valvular abnormalities, pulmonary pressures, and right ventricular function. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization.</div></div><div><h3>Results</h3><div>Over a median follow-up of 5.2 years (interquartile range, 1.9–9.3 years), advancing cardiac damage stage was associated with worsening LV function, progressive atrial and ventricular remodeling, and elevated pulmonary pressures (<em>p</em> < 0.001 for all trends). Five-year cumulative incidence of the primary endpoint increased from 3.8% in stage 0 (n = 28), 17.3% in stage 1 (n = 101), 26.2% in stage 2 (n = 210) to 60.7% in stage 3 (n = 93). In multivariable Cox analysis, each stage increment portended a significantly higher risk of adverse outcomes (hazard ratio 2.1 per stage; 95% CI, 1.6–2.6; <em>p</em> < 0.0001).</div></div><div><h3>Conclusions</h3><div>In patients with moderate or greater AR, the burden of cardiac damage incrementally stratified long-term risk. A dedicated staging model specific to AR may refine prognostic assessment and support earlier aortic valve interventions.</div></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":"10 1","pages":"Article 100748"},"PeriodicalIF":2.8,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617324","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}

引用次数: 0

WATCHMAN Complications Revisited Using Ultra-High Resolution Photon-Counting Computed Tomography 使用超高分辨率光子计数计算机断层扫描重新审视WATCHMAN并发症

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-10-30 DOI: 10.1016/j.shj.2025.100753

Alexander Diamant MD , Connor P. Murray MBBS , Joseph Hanna MBBS

引用次数: 0

Mission M-Possible: Mitral Transcatheter Edge-to-Edge Repair in Mitral Annular Calcification Using the Crab-Walk Technique 任务m -可能：二尖瓣经导管边缘对边缘修复二尖瓣环钙化使用蟹步技术

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-10-29 DOI: 10.1016/j.shj.2025.100736

John Abdelmalek MD , Muhammad Qudrat-Ullah MD , Ahmed Souka MD , Sibi Thomas DO , Ralph Matar MD , Lee Hafen MD , Karim Al-Azizi MD

Background

Mitral annular calcification (MAC) complicates transcatheter interventions for degenerative mitral regurgitation (DMR), particularly with small mitral valve orifice areas (MVOAs).

Case Summary

An 83-year-old woman with severe DMR, severe MAC, and MVOA of 3.8 cm² presented post-heart failure hospitalization with declining function. High surgical risk and unfavorable transcatheter mitral valve replacement anatomy (neo-LVOT 0.30 cm²) limited options to transcatheter edge-to-edge repair (TEER). Using the Edwards PASCAL precision system and the “Crab-Walk” technique (independent leaflet clasp manipulation for MAC-related challenges), TEER reduced mitral regurgitation to mild (1+), with a 2 mmHg gradient at 3 months. The patient was weaned off oxygen and remains asymptomatic at 1 year.

Discussion

This first reported mitral TEER case in DMR with significant MAC and small MVOA highlights the “Crab-Walk” technique’s innovation.

Take-Home Messages

TEER with novel techniques is viable for DMR with MAC when transcatheter mitral valve replacement is prohibitive.

背景：二尖瓣环钙化（MAC）使经导管介入治疗退行性二尖瓣反流（DMR）复杂化，特别是二尖瓣口面积小（MVOAs）。一例83岁女性，重度DMR，重度MAC， MVOA 3.8 cm2，心力衰竭住院，功能下降。高手术风险和不利的经导管二尖瓣置换术解剖（新lvot 0.30 cm2）限制了经导管边缘到边缘修复（TEER）的选择。使用Edwards PASCAL精密系统和“蟹式行走”技术（针对mac相关挑战的独立小叶卡扣操作），TEER将二尖瓣反流降低至轻度（1+），3个月时梯度为2mmhg。患者停用氧气，1年后仍无症状。这是首次报道的二尖瓣TEER病例，伴有明显的MAC和较小的MVOA，突出了“螃蟹行走”技术的创新。当经导管二尖瓣置换术禁止时，采用新技术的Take-Home MessagesTEER对于MAC的DMR是可行的。

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引用次数: 0

The Impact of Prosthesis-Patient Mismatch on Bioprosthetic Valve Durability After Transcatheter Aortic Valve Replacement 经导管主动脉瓣置换术后假体-患者不匹配对生物假体瓣膜耐久性的影响

IF 2.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Structural Heart

Pub Date : 2025-10-27 DOI: 10.1016/j.shj.2025.100741

Revathy Sampath-Kumar MD, Erika Padilla BS, David Torres Barba MD, PhD, Niki Aramburo CVT, Ori Ben-Yehuda MD, Ehtisham Mahmud MD

Background

Prosthesis-patient mismatch (PPM) is associated with structural valve deterioration after surgical aortic valve replacement. Limited evidence exists regarding its impact on hemodynamic valve deterioration (HVD) and bioprosthetic valve failure (BVF) following transcatheter aortic valve replacement (TAVR).

Methods

Patients who underwent TAVR from 2013 to 2022 at UC San Diego Health with echocardiographic follow-up were retrospectively analyzed. PPM, determined by measured indexed effective orifice area, and outcomes of moderate or severe HVD and BVF were defined per Valve Academic Research Consortium 3 guidelines. Fine and Gray regression, with all-cause death as a competing risk, was used to compare the cumulative incidence of outcomes in patients with and without PPM.

Results

A total of 555 patients (38.7% female, median age 81 years, median Society of Thoracic Surgeons risk score 4.2%, 96.8% balloon-expandable valves) were included. PPM occurred in 66 (11.9%) patients and was associated with higher initial post-implant mean gradient (15 mmHg IQR: 10-22 vs. 11 mmHg IQR: 8-15; p < 0001) and peak velocity (2.6 m/s IQR: 2.2-3.2 vs. 2.3 m/s IQR: 1.9-2.6; p < 0.001). Valve-in-valve TAVR (adjusted odds ratio: 7.84; 95% CI: 3.37-18.20; p < 0.001) and valve diameter ≤23 mm (adjusted odds ratio: 2.39; 95% CI: 1.12-5.10; p = 0.024) were independent predictors of PPM. The adjusted cumulative incidence of moderate or severe HVD (adjusted hazard ratio: 2.10; 95% CI: 1.02-4.30; p = 0.04) and BVF (adjusted hazard ratio: 4.32; 95% CI: 1.81-10.31; p = 0.001) was higher with PPM. Aortic valve reintervention was higher with PPM (4.5 vs. 0.6%; p = 0.03).

Conclusions

In this single-center cohort, PPM was associated with an over two-fold increased risk of moderate or severe HVD and an over four-fold increased risk of BVF following TAVR, emphasizing the importance of pre-implant prevention.

背景：主动脉瓣置换术后假体-患者不匹配（PPM）与瓣膜结构恶化有关。关于其对经导管主动脉瓣置换术（TAVR）后血流动力学瓣膜恶化（HVD）和生物假体瓣膜衰竭（BVF）的影响的证据有限。方法回顾性分析2013年至2022年在加州大学圣地亚哥分校健康中心接受TAVR的患者，并进行超声心动图随访。PPM由测量的指数有效孔口面积决定，中度或重度HVD和BVF的结果根据瓣膜学术研究联盟3指南进行定义。Fine和Gray回归，将全因死亡作为竞争风险，用于比较有和无PPM患者的累积结局发生率。结果共纳入555例患者，其中女性38.7%，中位年龄81岁，胸外科学会中位风险评分4.2%，球囊可膨胀瓣膜96.8%。66例（11.9%）患者发生了PPM，并且与较高的初始种植后平均梯度（15 mmHg IQR: 10-22 vs 11 mmHg IQR: 8-15; p < 0001）和峰值流速（2.6 m/s IQR: 2.2-3.2 vs 2.3 m/s IQR: 1.9-2.6; p < 0.001）相关。阀中TAVR（校正优势比：7.84;95% CI: 3.37-18.20; p < 0.001）和阀径≤23 mm（校正优势比：2.39;95% CI: 1.12-5.10; p = 0.024）是PPM的独立预测因子。中度或重度HVD（校正风险比：2.10;95% CI: 1.02-4.30; p = 0.04）和BVF（校正风险比：4.32;95% CI: 1.81-10.31; p = 0.001）的校正累积发病率随PPM升高。主动脉瓣再介入治疗在PPM组较高（4.5 vs 0.6%; p = 0.03）。结论：在这个单中心队列中，PPM与TAVR后中度或重度HVD风险增加2倍以上，BVF风险增加4倍以上相关，强调了植入前预防的重要性。

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引用次数: 0