Abhishek C. Sawant

An updated systematic review and meta-analysis of early outcomes after left atrial appendage occlusion

BACKGROUND Left atrial appendage occlusion (LAAO) is a promising intervention for stroke prevention in patients with non-valvular atrial fibrillation (NVAF). Early outcomes following LAAO have been published in many studies with variable results. OBJECTIVE This updated meta-analysis aims to provide a summary of the early outcomes of LAAO. METHODS Medline/Pubmed, Ovid Journals, Clinical trials, Abstract meetings, Cochrane databases were searched from January 1st, 1999 to November 30th, 2016. RESULTS This meta-analysis included 49 studies involving 12 415 patients. The median age was 73.5 years (IQR 72-75 years) and 43% were males. Hypertension and diabetes were present in 36% and 15% of the population, respectively. There was a prior history of stroke and congestive heart failure in 14% and 18% of the population, respectively. The median CHADS2 score was 2.9 (IQR 2.6-3.3) and the median HASBLED score was 3.3 (IQR 3-4). LAAO implantation was successful in 96.3% of patients (95.40-97.08, I2  = 76.1%). The pooled proportion of all-cause mortality was 0.28% (0.19-0.38, I2  = 0%). The pooled proportion of all-cause stroke was 0.31% (0.22-0.42, I2  = 9.4%), major bleeding requiring transfusion was 1.71% (1.13-2.41, I2  = 73.2%), and pericardial effusion was 3.25% (2.46-4.14, I2  = 79%). Sub analysis of randomized clinical trials comparing LAAO devices to warfarin showed lower mortality (P = 0.03) with similar bleeding risk (P = 0.20) with LAAO. CONCLUSIONS This meta-analysis concludes that LAAO occlusion is a safe and effective stroke prevention strategy in patients with NVAF.

Tpeak-Tend, Tpeak-Tend/QT ratio and Tpeak-Tend dispersion for risk stratification in Brugada Syndrome: A systematic review and meta-analysis

Brugada syndrome is an ion channelopathy that predisposes affected subjects to ventricular tachycardia/fibrillation (VT/VF), potentially leading to sudden cardiac death (SCD). Tpeak‐Tend intervals, (Tpeak‐Tend)/QT ratio and Tpeak‐Tend dispersion have been proposed for risk stratification, but their predictive values in Brugada syndrome have been challenged recently.

Fractional flow reserve guided percutaneous coronary intervention results in reduced ischemic myocardium and improved outcomes

To determine if fractional flow reserve guided percutaneous coronary intervention (FFR‐guided PCI) is associated with reduced ischemic myocardium compared with angiography‐guided PCI.

Valvuloarterial Impedance Predicts Heart Failure Readmissions in Patients Undergoing Transcatheter Aortic Valve Replacement

ABSTRACT Background: Elevated valvuloarterial impedance (Zva) has been associated with mortality in severe aortic stenosis (AS) patients. However, its role in predicting heart failure (HF) readmissions after transcatheter aortic valve replacement (TAVR) remains unknown. Methods: We evaluated 198 consecutive patients who underwent TAVR at our institution from 2012 to 2016. Clinical, laboratory, procedural, echocardiographic (ECHO) data and HF readmissions at 1-year were collected. Zva was calculated from ECHO as (systolic blood pressure + transvalvular gradient)/stroke volume index. Results: The mean age of all patients was 82 ± 7 years, 51% were males and 95% were Caucasians. Median duration of follow-up was 9 (Interquartile range: 12) months. The majority of patients had hypertension (93%) and 24.7% had heart failure symptoms with reduced EF (<50%). Use of beta-blockers was 64%, diuretics was 64%, angiotensin converting enzyme inhibitors was 25%, aldosterone receptor blockers was 16%, and potassium-sparing diuretics was 8%. Patients with a high pre-TAVR Zva (≥6.3 mmHg.mL−1.m2) were more likely to present with HF readmissions at 1-year in both unadjusted (34.2% vs. 18.1%, p = 0.03) and adjusted analysis (Hazards Ratio [HR] = 2.08 [95%CI: 1.00–4.29], p = 0.04). Patients with a Zva that either remained unchanged or increased post-TAVR had significantly higher mortality at 1-year post-procedure in the unadjusted (18.2% vs. 6.3%, p = 0.02) and adjusted analysis (HR = 2.97 [95%CI: 1.07–8.25], p = 0.04). Conclusion: Zva is a novel prognostic marker for HF readmissions at 1-year post-TAVR and can be routinely measured on ECHO. Further prospective studies validating the utility of Zva for risk stratification are warranted.

Quality of life outcomes in transcatheter aortic valve replacement patients requiring pacemaker implantation

Permanent pacemaker implantation is the most common complication after Transcatheter aortic valve replacement (TAVR) and is associated with worse outcomes and mortality. However, its impact on quality‐of‐life (QoL) outcomes remains unknown.

Neutrophil to Lymphocyte Ratio Predicts Heart Failure Readmissions and Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement

Objective Neutrophil-to-lymphocyte ratio (NLR) has prognostic value in acute coronary syndromes. We investigated its utility for predicting heart failure (HF) admissions and major adverse cardiac outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). Methods Data on clinical, laboratory, procedural, HF admissions, and major adverse cardiac events (MACEs) (all-cause mortality, recurrence of myocardial infarction requiring intervention, stroke) for 298 consecutive patients who underwent TAVR between 2012 and 2016 in our tertiary center were collected. Results Analysis included 298 patients. The mean age was 83 ± 8 years, 51% were males, and 95% were Caucasians. The median Society of Thoracic Surgeons risk score was 9 (interquartile range: 6.3–11.8). Receiver-operating curve analysis identified a cutoff value of NLR of 4.0 for MACE after TAVR and sensitivity of 68% and specificity of 68% {area under the curve [AUC] = 0.65 [95% confidence interval (CI): 0.51–0.79], p = 0.03}. An NLR of 4.0 for HF hospitalizations after TAVR and sensitivity of 60% and specificity of 57% [AUC = 0.61 (95% CI: 0.53–0.69), p = 0.01]. NLR ≥4.0 before TAVR significantly predicted MACE after TAVR (68.4% vs. 31.6%, p = 0.02) and HF hospitalizations (58.3% vs. 41.7%, p = 0.03). NLR with TAVR risk score increased the predictive value for MACE after TAVR from AUC = 0.61 (95% CI: 0.50–0.72, p = 0.06) to AUC = 0.69 (95% CI: 0.57–0.80, p = 0.007). Conclusion NLR predicts all-cause mortality, MACE, and HF hospitalization 1 year after TAVR. NLR with TAVR risk score improved predictability for MACE. Further studies for prognostication using NLR are warranted.

Left atrial hemodynamics and left ventricular remodeling -predictors of outcomes after Transcatheter mitral valve repair with the MitraClip device

Increased afterload and reduced left ventricular (LV) performance are sequela of mitral valve repair. However, hemodynamic left atrial and ventricular parameters that can predict outcome following mitral valve repair remain elusive.

Newly proposed electrocardiographic criteria for the diagnosis of left ventricular hypertrophy in a Chinese population

The electrocardiographic criteria currently available for the diagnosis of left ventricular hypertrophy (LVH) are low in sensitivity. Thus, we compared the diagnostic performance of newly proposed electrocardiographic criteria to the existing criteria in a Chinese population.

PREDICTORS OF POOR QUALITY OF LIFE AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT

Background: Poor quality of life (QOL) after Transcatheter Aortic Valve Replacement (TAVR) has been shown to have adverse outcomes in several studies. However, identifying patients likely to have poor QOL outcomes after TAVR remains challenging. Methods: We included 335 consecutive patients who

TCT-334 Predictors of Outcomes Among Nonagenarians Undergoing Percutaneous Coronary Intervention: A National Veterans Affairs Database Study

TCT-334 Predictors of Outcomes Among Nonagenarians Undergoing Percutaneous Coronary Intervention: A National Veterans Affairs Database Study Abhishek Sawant, Vasvi Singh, Kevin Josey, Meg Plomondon, Thomas Maddox, Ali Sheikh, Zaid Said, Bharath Rajagopalan, Deepak Bhatt, John Corbelli State University of New York at Buffalo, Buffalo, New York, United States; Clinical centre of Serbia; Clinical centre of Serbia; Niguarda Hospital; Kurume-univaersity; Kurume-univaersity; University of Glasgow; Golden Jubilee National Hospital; Brigham and Women’s Hospital, Boston, Massachusetts, United States; School of Medicine, University of California, Irvine