Chetan Huded

The impact of delirium on healthcare utilization and survival after transcatheter aortic valve replacement

We assessed whether post‐operative delirium is associated with healthcare utilization and overall survival after trans‐catheter aortic valve replacement.

Outcomes in Asymptomatic Severe Aortic Stenosis With Preserved Ejection Fraction Undergoing Rest and Treadmill Stress Echocardiography

Background In asymptomatic patients with severe aortic stenosis and preserved left ventricular ejection fraction, we sought to assess the incremental prognostic value of resting valvuloarterial impedence (Zva) and left ventricular global longitudinal strain (LV‐GLS) to treadmill stress echocardiography. Methods and Results We studied 504 such patients (66±12 years, 78% men, 32% with coronary artery disease who underwent treadmill stress echocardiography between 2001 and 2012. Clinical and exercise variables (% of age‐sex predicted metabolic equivalents [%AGP‐METs]) were recorded. Resting Zva ([systolic arterial pressure+mean aortic valve gradient]/[LV‐stroke volume index]) and LV‐GLS (measured offline using Velocity Vector Imaging, Siemens) were obtained from the baseline resting echocardiogram. Death was the primary outcome. There were no major adverse cardiac events during treadmill stress echocardiography. Indexed aortic valve area, Zva, and LV‐GLS were 0.46±0.1 cm2/m2, 4.5±0.9 mm Hg/mL per m2 and −16±4%, respectively; only 50% achieved >100% AGP‐METs. Sixty‐four percent underwent aortic valve replacement. Death occurred in 164 (33%) patients over 8.9±3.6 years (2 within 30 days of aortic valve replacement). On multivariable Cox survival analysis, higher Society of Thoracic Surgeons score (hazard ratio or HR 1.06), lower % AGP‐METS (HR 1.16), higher Zva (HR 1.25) and lower LV‐GLS (HR 1.12) were associated with higher longer‐term mortality, while aortic valve replacement (HR 0.45) was associated with improved survival (all P<0.01). Sequential addition of ZVa and LV‐GLS to clinical model (Society of Thoracic Surgeons score and %AGP‐METs) increased the c‐statistic from 0.65 to 0.69 and 0.75, respectively, both P<0.001); findings were similar in the subgroup of patients who underwent aortic valve replacement. Conclusions In asymptomatic patients with severe aortic stenosis undergoing treadmill stress echocardiography, LV‐GLS and ZVa offer incremental prognostic value.

The impact of operator experience during institutional adoption of trans-radial cardiac catheterization.

We studied the impact of operator experience on trans‐radial (TR) cardiac catheterization performance in contemporary practice.

Early experience with transcatheter mitral valve replacement: successes, challenges, and future directions

Over the past decade, transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of patients with severe aortic stenosis (AS). TAVR gained a foothold as a viable aortic valve replacement (AVR) strategy in patients deemed inoperable, and early clinical trials in this setting confirmed a clear and dramatic survival advantage of TAVR over palliative medical therapy (1).

Moderate aortic valve stenosis in patients with left ventricular systolic dysfunction—insights on prognosis and the potential role of early aortic valve replacement

Aortic valve replacement (AVR) is the only definitive therapy for patients with hemodynamically significant aortic stenosis (AS), and the most pivotal issue in the longitudinal management of patients with AS is to identify the optimal timing for AVR when the benefits of the procedure most outweigh the risks.

Percutaneous Left Atrial Appendage Closure: is there a Role in Valvular Atrial Fibrillation

Atrial fibrillation, a chronic and highly morbid cardiovascular condition which affects over 33 million people worldwide, can be broadly categorized as valvular vs non-valvular in etiology. However, definitions of valvular atrial fibrillation have varied widely in the literature, and there is no clear consensus definition to date. Historically, patients with atrial fibrillation in the setting of rheumatic mitral valve disease have constituted a particularly high risk group for cardioembolic stroke, and for this reason many contemporary trials of pharmaceutical and device therapies for atrial fibrillation have systematically excluded patients with valvular heart disease. Therefore, vitamin K antagonism remains the favored approach to mitigate stroke risk in valvular atrial fibrillation, and the optimal strategy to treat atrial fibrillation patients with valvular heart disease who cannot tolerate oral anticoagulation therapy is unknown. Recent trials have demonstrated an important role for percutaneous left atrial appendage occlusion devices in patients with non-valvular atrial fibrillation, but the role of these devices in patients with valvular atrial fibrillation is uncertain. Given the worldwide burden of valvular atrial fibrillation, future trials intended to clarify the role of percutaneous left atrial appendage closure devices in valvular atrial fibrillation should provide important insight for the care of millions of patients.

When research evidence is misleading.

Our system of medical education and postgraduate medical training rewards the accumulation of publications (abstracts, posters, presentations, and papers) rather than the pursuit of truths. The consequences of all this bad science are not felt by researchers, whose careers may be propelled by these erroneous results, but by the patients who are subject to medical practices the validity of which is uncertain.