Amr E. Abbas

Aortic Valve Stenosis: To the Gradient and Beyond—The Mismatch Between Area and Gradient Severity

The clinical severity of aortic stenosis (AS) is based largely on symptoms. However, AS severity is primarily determined by estimating the aortic valve area (AVA) and pressure gradients (ΔP). Conditions may arise in which there is a mismatch in severity between AVA and ΔP determinations secondary to errors in measurement and/or assumption, alterations of flow, or variations in the magnitude of pressure recovery. The cause of discrepancy between area and gradient determinations must be deciphered so as to best counsel patients on the most ideal treatment strategy.

First-in-man use of intravascular near-infrared spectroscopy in the carotid arteries to characterize atherosclerotic plaque prior to carotid stenting.

Lipid-core plaque (LCP) detected by near-infrared spectroscopy (NIRS) in the coronary arteries is associated with acute coronary syndromes (ACS) [(1,2)][1]. Analogous to its role in acute coronary syndromes, LCP in the carotid arteries has been implicated in the pathogenesis of stroke [(3)][2]. It

Carotid Stenting in High-Risk Patients: Early and Late Outcomes

PURPOSE Some patients with severe carotid stenosis have anatomical or clinical comorbidities that place them at high risk for carotid endarterectomy (CEA). The early and late outcomes after carotid artery stenting (CAS) were evaluated in patients at high risk for CEA. METHODS Between 2002 and 2009, 186 patients were enrolled in a high-risk CAS institutional registry. The primary outcome was major adverse cardiac and cerberovascular events (MACCEs) at 30 days, including death, stroke, and myocardial infarction. Secondary outcomes were technical, procedural, and clinical success; nonstroke neurological events; and death and ipsilateral stroke at 5 years. RESULTS Twenty-five patients (13.2%) were symptomatic. Thirty day MACCE occurred in 2.6%, including death in 1 (0.5%), stroke in 3 (1.6%), and myocardial infraction in 1 (0.5%) patient. Strokes were nonfatal in 3 (1.6%), major in 2 (1.1%), and minor in 1 (0.5%) patients. Other neurological events included transient ischemic attack in 9 (4.7%) and retinal artery occlusion in 2 (1.1%) patients. After stroke, 2 patients had complete resolution of neurological deficit within 30 days, and 1 patient had improvement in neurological deficit. By Kaplan--Meier analysis, all-cause mortality was 47.5% and ipsilateral stroke was 4.5% at 5 years. CONCLUSIONS In patients who are high risk for CEA, CAS can be performed with low MACCE at 30 days and ipsilateral stroke at 5 years. However, nearly half of these patients die within 5 years from causes unrelated to stroke.

Predictors of Poor Outcome in Female Patients Undergoing Endovascular Intervention

BACKGROUND Peripheral arterial disease (PAD) is widely accepted as an independent predictor of cardiovascular morbidity and mortality. The majority of subjects studied in PAD literature have been male, leaving female patients an underrepresented population with regard to revascularization outcomes and prognosis. The purpose of our study was to determine predictors of poor outcomes in female patients undergoing endovascular intervention (EI) for symptomatic PAD. METHODS This study was conducted as a single-center retrospective chart review of 292 consecutive female patients who underwent EI for symptomatic PAD. Patient variables including baseline demographics, and procedural data were analyzed for statistical significance with regard to repeat EI including target vessel revascularization (TVR), amputation or vascular surgery, and death. RESULTS On multivariate analysis, increased preintervention creatinine > or =1.5 mg/dL (PRE-CR) and lower preprocedure hemoglobin were the strongest predictors of subsequent EI and TVR. Significant predictors for amputation or surgery included decreased body mass index (BMI) and increased Rutherford class at presentation. Only age, history of congestive heart failure (CHF), and PRE-CR remained significant predictors of mortality. CONCLUSIONS Our study is the first of its kind to specify predictors of poor outcomes after EI in female patients with symptomatic PAD. The strongest predictors of subsequent EI and TVR, limb loss, and vascular surgery, as well as death, were found to be chronic kidney disease (CKD; PRE-CR > 1.5 mg/dL), decreased BMI, Rutherford class, and anemia.

ASSESSMENT OF MARKEDLY ELEVATED PULMONARY VASCULAR RESISTANCE BY ECHOCARDIOGRAPHY

The ratio of peak tricuspid regurgitation velocity to the time velocity integral of the right ventricular outflow tract (TRV/TVIRVOT) distinguishes elevated versus normal invasive pulmonary vascular resistance (PVRcath). We aim to validate TRV/TVIRVOT as a correlate of PVRcath and compare TRV/

A novel mortality risk score for female patients undergoing endovascular interventions.

BACKGROUND Peripheral arterial disease (PAD) has been described as a rising epidemic in recent years. The majority of subjects studied in PAD literature have been male, leaving female patients an underrepresented population with regard to revascularization outcomes. The goal of our study was to determine the death rate and predictors of mortality in female patients undergoing endovascular intervention (EI) for symptomatic PAD. METHODS AND RESULTS This study was conducted as a single-center retrospective chart review of 292 female patients who underwent EI for symptomatic PAD. Patient variables including demographics and procedural data were analyzed for statistical significance with regard to mortality. Age, history of congestive heart failure (CHF), and chronic kidney disease (CKD) were found to be significant predictors of mortality on multivariable analysis. A death risk score was formulated based on the above variables, risk stratifying patients into low, medium, or high risk groups for mortality after EI. Overall, 76 patients (26%) fell into the low risk category with a mortality of 5.3%, 102 patients (35%) fell into the moderate risk with a mortality of 15.7%, and 112 patients (39%) fell into the high-risk group with a mortality of 45.5% (P < 0.0001). CONCLUSIONS Our study is the first of its kind to specify predictors of mortality in female patients with symptomatic PAD. This study also provides a tool to identify female PAD patients at high risk for death after EI. Finally, it highlights the effect of CKD, age, and CHF on mortality of patients with PAD. 

TCT-808 Invasive Characterization of Atherosclerotic Plaque in Patients with Peripheral Arterial Disease Using Near Infrared Spectroscopy Intravascular Ultrasound

nos: 810 813 TCT-810 Percutaneous Mitral Valve Repair for Management of Systolic Anterior Motion and Mitral Regurgitation Associated with Hypertrophic Cardiomyopathy Saurabh Gupta, Elizabeth Moe, Matthew Slater, Stephen Heitner OHSU, Portland, Oregon, United States; Medtronic, portland, Oregon, United States; Oregon Health & Science University, Portland, Oregon, United States; Oregon Health and Science University, Portland, Oregon, United States BACKGROUND Hypertrophic cardiomyopathy (HCM) can be associated with abnormalities of the mitral valve (MV) apparatus, left ventricular outflow tract obstruction (LVOTO) and mitral regurgitation (MR). Therapies for symptomatic patients include septal myomectomy (SM) or alcohol septal ablation (ASA) but subsets of patients are

TCT-753 Fascia Iliaca Compartment Block (FICB) and None to Light Sedation as an Alternative Minimalist Approach to Sedation for Patients Undergoing Transffemoral Transcatheter Aortic Valve Replacement (TF-TAVR): A Single Center 30-Day Outcome Experience.

TCT-752 Transcatheter Aortic Valve Replacement in Patients with Previous Mitral Surgery – A Multicentre Study Ignacio Amat-Santos, Carlos Cortes, Antonio Munoz, Jose Suarez De Lezo, Luis Nombela-Franco, Enrique Gutiérrez, Raul Moreno, Vicente Serra, Jose M. de la Torre Hernandez, Javier Castrodeza, Javier Tobar, Jose A. San Roman Institute of heart science, Valladolid, Spain; Hospital Clinico Universitario De Valladolid, Madrid, Spain; Unknown, Malaga, Spain; Hospital Universitario Reina Sofia, Cordoba, Spain; Quebec City, Quebec, Canada; Hospital Universitario Gregorio Marañón, Madrid; University Hospital La Paz, Madrid, Spain; H. Vall d’Hebron, sant cugat del valles, Spain; Hospital Universitario Marques de Valdecilla, Santander, Spain; Hospital Clínico Universitario de Valladolid, Spain; Hospital Clínico Universitario de Valladolid, Spain; Hospital Clínico Universitario de Valladolid, Spain

Anatomic-Pathophysiologic Approach to Hemodynamics: Complementary Roles of Noninvasive and Invasive Diagnostic Modalities

Symptoms and physical signs reflect distinct pathophysiologic derangements of anatomic components and mechanics, a construct that serves as the foundation for clinical evaluation of the cardiovascular system. Evaluation of hemodynamic derangements should be based on interrogation of a cardiac anatomic-physiologic approach to circulatory pathophysiology. This article illustrates a pragmatic problem-solving approach to 3 cardinal hemodynamic symptoms and clinical syndromes: right heart failure, dyspnea, and low-output hypotension. This treatise focuses primarily on the complementary roles of noninvasive and invasive diagnostic studies in clinical hemodynamic assessment.