Luke Kim

Impact of Genetic Insights Into Mendelian Disease on Cardiovascular Clinical Practice

Recent advances in the field of genetics have significantly enhanced our understanding of many cardiovascular conditions and improved diagnosis as well as management of these disorders. However, mendelian cardiovascular diseases still pose unique challenges to clinicians, especially when presented with inherited conditions that have a wide range of phenotypic presentations. In cardiovascular single-gene disorders with potentially devastating initial manifestations, such as sudden cardiac death (SCD) or aortic dissection, appropriate and prompt identification of individuals at risk is imperative. In addition, the management of the disease is not only applicable to the individuals at risk but also extends to other members in the family. Therefore, the general approach to patients with such diseases and their affected family members needs to be considered in the context of fundamental principles of mendelian inheritance. Numerous examples of cardiovascular mendelian disorders exist in which the importance of genetics has been clearly recognized, and most common monogenic cardiovascular disorders are transmitted in families in an autosomal dominant fashion. In such autosomal dominant disorders, it is important to remember the overriding principle that any first-degree relative of an individual with an autosomal dominant multigenerational familial cardiovascular disorder has a 50% chance of also being affected by this genetic trait. Thus, when added to a family history, any symptom or sign on history, clinical evaluation, or testing that is consistent with the diagnosis in question creates a >50% likelihood that the family member is affected by the disorder as well. In this review, we will focus on a few examples of such autosomal dominant disorders to highlight the current state of clinical practice in these mendelian disorders as shaped by classic and modern genetics.nn### Hypertrophic CardiomyopathynnHypertrophic cardiomyopathy (HCM) is an important inherited cardiovascular disorder for which genetic principles have significant impact on our evaluation and approach to patients. HCM …

In-Hospital Cardiovascular Complications After Pancreas Transplantation in the United States from 2003 to 2012

Large database studies detailing the risk of perioperative cardiovascular complications after pancreas transplant has been limited, perhaps because these outcomes are not captured by transplant registries. Greater data on the incidence and risks of such outcomes could provide additional insight for referring physicians and inform potential recipients of their risk. We performed a serial, cross-sectional analysis of the National Inpatient Sample, the largest publicly available inpatient database in the United States, to assess for the risk of cardiovascular complications after pancreas transplants in the United States from 2003 to 2012 (nxa0= 13,399). Using multivariable logistic regression models, the risk of cardiovascular outcomes after simultaneous pancreas-kidney transplants (SPK) was compared with solitary pancreas transplants (pancreas after kidney and pancreas transplant alone [PAKxa0+ PTA]). The unadjusted prevalence of in-hospital cardiovascular complications was higher in SPK than PAKxa0+ PTA (5.5% vs 3.7%, p <0.001). After multivariable adjustment, SPK remained associated with significantly higher odds of any cardiovascular complication (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.21 to 1.80, pxa0= 0.01), and particularly stroke (OR 13.41, 95% CI 4.78 to 37.63, p <0.001), compared with PAKxa0+ PTA. However, there was no difference in perioperative mortality (OR 0.78, 95% CI 0.54 to 1.12, pxa0= 0.18). In conclusion, these findings highlight the association between uremia and stroke in pancreas transplant patients, as well as the need for improved preoperative cardiac risk assessment and perioperative management, especially in those who underwent SPK.

Absence of electrocardiographic left ventricular hypertrophy is associated with increased mortality after transcatheter aortic valve replacement

Electrocardiographic (ECG) left ventricular hypertrophy (LVH) has been associated with increased mortality in patients with asymptomatic aortic stenosis (AS) and hypertension. However, patients with symptomatic AS undergoing transcatheter aortic valve replacement (TAVR) have higher percentages of myocardial fibrosis or amyloidosis that have been associated with decreased ECG voltage and worse outcomes.

IN-HOSPITAL CLINICAL OUTCOMES FOLLOWING CONCOMITANT CORONARY ARTERY BYPASS GRAFT AND HEART VALVE SURGERY IN WOMEN

Background: In-hospital clinical outcomes following concomitant coronary artery bypass graft [CABG] with heart valve surgery [HVS] is not well characterized. We sought to delineate the in-hospital outcomes in female patients [FP] following such complex surgery.nnMethod: All patients [pts] who had

THE INFLUENCE OF GENDER ON IN-HOSPITAL CLINICAL OUTCOMES IN HISPANICS FOLLOWING SURGICAL AND TRANSCATHETER AORTIC VALVE REPLACEMENT

Background: Despite being the largest minority group, reports on the clinical outcomes in Hispanics undergoing either surgical [SAVR] or transcatheter aortic valve replacement [TAVR] is lacking.nnMethod: Using the 2011-2013 National Inpatient Sample [NIS] data, we compared the in-hospital adverse

TCT-709 Trans-apical Transcatheter Aortic Valve Replacement in Patients with History of Coronary Artery Bypass Grafting: An Analysis from the National Inpatient Sample Database

TCT-708 Safety and Efficacy of the Percutaneous Transaxillary Access for Transcatheter Aortic Valve Implantation using various Transcatheter Heart Valves in 100 Consecutive Patients Ulrich Schafer, Florian Deuschl, Niklas Schofer, Christian Frerker, Daniel Reichart, Johannes Schirmer, Tobias Schmidt, Karl-Heinz Kuck, Felix Kreidel, Izamu Mizote, Hermann Reichenspurner, Stefan Blankenberg, Lenard Conradi Universitaeres Herzzentrum Hamburg, Hamburg, Germany; University Hospital Hamburg Eppendorf, Hamburg, Germany; University Heart Center Hamburg, 20246, Germany; Asklepiosklinikum St. Georg, Hamburg, Germany; University Heart Center Hamburg, Hamburg, Germany; Cardiovascular Surgeon, Hamburg, Germany; Asklepios Klinik St. Georg, Hamburg, Germany; Asklepios Hospital St. Georg, Hamburg, Germany; Asklepios Klinik St. Georg, Hamburg, Germany; University Heart Center Hamburg; University Heart Center Hamburg; Universitäres Herzzentrum Hamburg, Hamburg, Germany; University Heart Center Hamburg, Hamburg, Germany

DISPARITIES IN REVASCULARIZATION FOR ST-ELEVATION MYOCARDIAL INFARCTION PERSIST FOR PATIENTS WITH SEVERE MENTAL ILLNESS

Prior research has shown that patients with severe mental illness (SMI = bipolar disorder and/or schizophrenia) are less likely to receive revascularization in the setting of ST-elevation myocardial infarction (STEMI). It is unknown whether this disparity has persisted over time.nnWe conducted a

TCT-745 In-Hospital Clinical Outcomes Post Transcatheter Aortic Valve Replacement (TAVR) in Patients with History of Non-Cardiac Transplantation: Insights from the National Inpatient Sample (NIS) Database

Peri-procedural clinical outcomes in patients (pts) with prior history of non-cardiac transplantation (NCT) undergoing TAVR is currently unknown.nnWe sought to compare the clinical characteristics and in-hospital procedural outcomes in pts with and without prior history of NCT undergoing TAVR using

TCT-700 Impact of Gender on Procedural Outcomes Following Surgical and Transcatheter Aortic Valve Replacement in the United States

METHODS 806 patients in the PARTNER S3 intermediate risk registry with severe, symptomatic aortic stenosis were included. NAA was assessed by multi-slice computed tomography (CT) or 3D echo. Annular calcium was graded by CT. Baseline stroke volume index (SVI) and left ventricular ejection fraction (LVEF) as well as 30d postTAVR EOA and paravalvular regurgitation (PVR) were measured. A post-TAVR anatomic deployment index (ADI) was calculated as: [EOA/ NAA]x100. The percentage of area oversizing (%Oversizing) was calculated as: [(THV nominal area/NAA) -1]x100. RESULTS Post-TAVR EOA correlated with valve size (r1⁄40.42, p<0.001), NAA (r1⁄40.48, p<.001), SVI (r1⁄40.10, p<0.0001) and postdilatation (estimate1⁄40.12, p1⁄40.0001) but was not related to %Oversizing (p1⁄40.22), annular calcium (p1⁄40.93), and LVEF (p 1⁄4 0.24). PostTAVR ADI was not significantly different by valve size (p1⁄40.44). There was a significant association between ADI and %Oversizing (r 1⁄4 0.24, p<0.0001), annular calcium (r1⁄4-0.09, p1⁄40.0006), SVI (r1⁄40.14, p<0.0001) and LVEF (r 1⁄4 0.26, p<0.0001). There was no relation between ADI and PVR, all-cause death, cardiovascular death, re-hospitalization, or stroke.

CHARACTERIZATION AND IMPACT OF COMORBIDITY AMONG GENDER AND RACIAL SUBGROUPS HOSPITALIZED WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION

Heart failure with preserved ejection fraction (HFpEF) is challenging to treat in part due to its phenotypic heterogeneity. There are limited data on differences in characteristics and outcomes of gender and race subgroups.nnUsing the Nationwide Inpatient Sample, we examined 2,102,780