Aishwarya Bhardwaj

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.

HEART SCORE DOES NOT PREDICT THE SEVERITY OF ANATOMICAL CORONARY ARTERY DISEASE IN PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT WITH CHEST PAIN

Heart Score (HS) is being increasingly utilized in the US to guide management of patients presenting to the emergency department (ED) with chest pain. Coronary CT angiography (CCTA) allows for rapid triaging of such patients and carries prognostic value. We hypothesize that HS will predict the