Transcatheter versus surgical aortic valve replacement in intermediate risk patients: a meta-analysis

 

Transcatheter versus surgical aortic valve replacement in intermediate risk patients: a meta-analysis

Authors: Sameer Arora, Jacob A. Misenheimer, Wesley Jones, Amol Bahekar, Melissa Caughey, Cassandra J. Ramm, Thomas G. Caranasos, Michael Yeung, John P. Vavalle

Abstract

Background: Transcatheter aortic valve replacement (TAVR) has been approved in patients with high or prohibited surgical risk for surgery for treatment of severe symptomatic aortic stenosis. Prospective studies examining the benefits of TAVR in intermediate risk patients are ongoing. Other smaller studies including lower risk patients have been conducted, but further meta-analysis of these studies is required to draw more broad comparisons.
Methods: A Medline search was conducted using standard methodology to search for clinical trials and observational studies including intermediate risk patients. We limited our meta-analysis to studies matching patient populations by propensity scores or randomization and examined clinical outcomes between TAVR and surgical aortic valve replacement (SAVR).
Results: Analysis of the TAVR and SAVR cohorts revealed no significant differences in the outcomes of 30-day [OR (95% CI): 0.85 (0.57, 1.26)] or 1-year mortality [OR (95% CI): 0.96 (0.75, 1.23)]. A trend towards benefit with TAVR was noted in terms of neurological events and myocardial infarction (MI) without statistical significance. A statistically significant decrease in risk of post-procedural acute renal failure in the TAVR group [OR (95% CI): 0.52 (0.27, 0.99)] was observed, but so was a significantly higher rate of pacemaker implantations for the TAVR group [OR (95% CI): 6.51 (3.23, 13.12)].
Conclusions: We conclude that in intermediate risk patients undergoing aortic valve replacement, the risk of mortality, neurological outcomes, and MI do not appear to be significantly different between TAVR and SAVR. However, there appears to be a significant reduction in risk of acute renal failure at the expense of an increased risk of requiring a permanent pacemaker in low and intermediate risk patients undergoing TAVR compared to SAVR.
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Call for Papers Focused Issue: Advanced venous imaging and image-guided venous inter-ventions Guest Editors: Suvranu (Shoey) Ganguli and Sasan Partovi

Call for Papers Focused Issue: Advanced venous imaging and image-guided venous inter-ventions Guest Editors: Suvranu (Shoey) Ganguli and Sasan Partovi

 

Venous disease, particularly venous thromboembolism, is associated with significant mortality and morbidity. If the disease remains undetected, long-term morbidity can be significant. Up to 40% of patients with symptomatic deep vein thrombosis (DVT) develop post-thrombotic syndrome within 2 years. Furthermore, approximately 5% of patients with pulmonary embolism (PE) secondary to venous thrombotic disease develop chronic pulmonary hypertension with decreased cardiopulmonary capacity. Ultrasound is the first line modality for the detection of DVT. CT and MR venography may play a complimentary role to ultrasound, especially for iliofemoral or subclavian DVT.
A variety of minimally invasive image-guided interventions can be performed for treatment of venous thromboembolism. Catheter-directed thrombolysis with or without mechanical thrombectomy in acute DVT can clear thrombus from the veins. Those patients who develop post thrombotic syndrome as a sequela of DVT with iliac vein occlusion may benefit from venous stenting. Superficial venous reflux in the setting of post thrombotic syndrome can also be treated with image guided radiofrequency or laser ablation techniques. Treatment options for chronic lower extremity venous insufficiency include endovascular radiofrequency or laser ablation techniques as well as sclerotherapy based approaches. In massive and submassive acute PE, mechanical clot maceration and ultrasound-assisted catheter directed thrombolysis may improve outcome and are associated with low rates of major bleeding events.
This focused issue will encompass recent advancements in venous imaging and image-guided interventions. Topics will include:
● Clinical Aspects of Venous Thromboembolism, Namely Deep Venous Thrombosis and Pulmonary Embolism
● Clinical Aspects of Lower Extremity Venous Insufficiency
● CT Venography
● Contrast and Non-contrast MR Venography
● Catheter Directed Thrombolysis of Deep Venous Thrombosis
● Inferior Vena Cava Filters
● Ultrasound Assisted Catheter Directed Thrombolysis in Pulmonary Embolism
● Venous Stenting
● Endovascular Radiofrequency or Laser Ablation for Lower Extremity Venous Insufficiency
● Image Guided Sclerotherapy Based Lower Extremity Venous Insufficiency
● Venous Compression Syndrome
We encourage you to contribute original research manuscripts, meta-analysis and systematic analysis to the focused issue. The final submission deadline is July 1st 2016. To avoid overlap of topics, please first send the tentative title of your manuscript to the Guest Editors or Editor-in-Chief (editor@thecdt.org). Please note that:
1) All submitted manuscripts will go through a thorough peer review process and acceptance to this Focused Issue is not guaranteed;
2) No publication fee is needed for these invited papers.
We are a looking forward to the submissions for the Focused Issue of Cardiovascular Diagnosis and Therapy entitled“Advanced venous imaging and image-guided venous interventions”.
Focused Issue Editors
Suvranu (Shoey) Ganguli, MD
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
Sasan Partovi, MD
Department of Radiology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio

Temperature-related morbidity and mortality in Sub-Saharan Africa: A systematic review of the empirical evidence.

Temperature-related morbidity and mortality in Sub-Saharan Africa: A systematic review of the empirical evidence.

Environ Int. 2016 Mar 4;91:133-149. doi: 10.1016/j.envint.2016.02.027. [Epub ahead of print]

Temperature-related morbidity and mortality in Sub-Saharan Africa: A systematic review of the empirical evidence.

BACKGROUND:

Sub-Saharan Africa (SSA) contributes very little to overall climate change and yet it is estimated to bear the highest burden ofclimate change, with 34% of the global DALYs attributable to the effects of climate change found in SSA. With the exception of vector-bornediseases, particularly malaria, there is very limited research on human health effects of climate change in SSA, in spite of growing awareness of the region’s vulnerability to climate change.

OBJECTIVES:

Our objective is to systematically review all studies investigating temperature variability and non-vector borne morbidity and mortality in SSA to establish the state and quality of available evidence, identify gaps in knowledge, and propose future research priorities.

METHODS:

PubMed, Ovid Medline and Scopus were searched from their inception to the end of December 2014. We modified the GRADE guidelines to rate the quality of the body of evidence.

RESULTS:

Of 6745 studies screened, 23 studies satisfied the inclusion criteria. Moderate evidence exists to associate temperature variability with cholera outbreaks, cardiovascular disease hospitalization and deaths, and all-cause deaths in the region. The quality of evidence on child undernutrition is low, and for diarrhea occurrence, meningitis, Ebola, asthma and respiratory diseases, and skin diseases, very low.

CONCLUSIONS:

The evidence base is somehow weakened by the limited number of studies uncovered, methodological limitations of the studies, and notable inconsistencies in the study findings. Further research with robust study designs and standardized analytical methods is thus needed to produce more credible evidence base to inform climate change preparedness plans and public health policies for improved adaptive capacity in SSA. Investment in meteorological services, and strengthening of health information systems is also required to guarantee timely, up-to-date and reliable data.

Vol 6, No 2 (April 2016): Cardiovascular Diagnosis and Therapy

Vol 6, No 2 (April 2016): Cardiovascular Diagnosis and Therapy

Vol 6, No 2 (April 2016): Cardiovascular Diagnosis and Therapy

Review Article

Peri-procedural imaging for transcatheter mitral valve replacement
Navin Natarajan, Parag Patel, Thomas Bartel, Samir Kapadia, Jose Navia, William Stewart, E. Murat Tuzcu, Paul Schoenhagen
Mortality after percutaneous edge-to-edge mitral valve repair: a contemporary review
Friso A. Kortlandt, Thomas de Beenhouwer, Martin J. Swaans, Marco C. Post, Jan A. S. van der Heyden, Frank D. Eefting, Benno J. W. M. Rensing

Case Report

A case of ascending aortic dissection mimicking acute myocardial infarction and complicated with pericardial tamponade
Amer Hawatmeh, Ahmad Abu Arqoub, Ahmad Isbitan, Fayez Shamoon
Real-time transesophageal echocardiography facilitates antegrade balloon aortic valvuloplasty
Yoshihisa Shimada, Kazato Ito, Kentaro Yano, Chiharu Tanaka, Tomohiro Nakashoji, Daisuke Tonomura, Kosuke Takehara, Naoto Kino, Masataka Yoshida, Toshiya Kurotobi, Takao Tsuchida, Hitoshi Fukumoto
A heart team and multi-modality imaging approach to percutaneous closure of a post-myocardial infarction ventricular septal defect
Sunil Iyer, Thurston Bauer, Michael Yeung, Cassandra Ramm, Andy C. Kiser, Thomas G. Caranasos, John P. Vavalle

Imaging in Cardiology

Recanalized chronic coronary thrombus: unraveling a hazy coronary lesion by intravascular ultrasound
Grigoris V. Karamasis, Shayna Chotai, Azhar A. Khokhar, Paul A. Kelly

Arts and Medicine

Art under the microscope
Shimin Zhang, Yahong Bai

CDT: Top 10 Popular Articles | March 2016

The Top 10 Popular Articles | March 2016

Editor’s Choice
The Top 10 Popular Articles | March 2016
drug 4D flow imaging with MRI »Zoran Stankovic, Bradley D. Allen, et al.

The 4D flow MRI can potentially provide an improved assessment of hemodynamics which might aid in the diagnosis and therapeutic management of cardiovascular diseases…
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drug Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis »Yoko Yokoyama, Neal D. Barnard, et al.

Evidence from clinical trials has shown that vegetarian diets reduce HbA1c levels, suggesting that they may be beneficial in the prevention and management of type 2 diabetes…
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drug Spontaneous coronary artery dissection—A review »Amelia Yip, Jacqueline Saw

The epidemiology, etiology, presentation, diagnosis and management of spontaneous coronary artery dissection are reviewed in this article…
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drug Cardiac MR imaging: current status and future direction »Maythem Saeed, Tu Anh Van, et al.

Cardiac MRI will be an indispensible tool in the diagnosis of cardiac diseases, coronary intervention and myocardial therapeutic delivery in the near future…
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drug Myocardial T1 mapping: modalities and clinical applications »Christine L. Jellis, Deborah H. Kwon

The rapid development of cardiac MRI heralds a new era of promising techniques for identification of extracellular matrix accumulation within the heart and surrounding structures…
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drug Cardiac rehabilitation past, present and future: an overview »Warner M. Mampuya

Cardiac rehabilitation programs have become an integral part of the standard of care in modern cardiology…
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drug microRNA-based diagnostics and therapy in cardiovascular disease—Summing up the facts »Christian Schulte, Tanja Zeller

This article reviews the current knowledge of miRNAs in cardiovascular disease focusing on coronary artery disease and myocardial infarction…
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drug Kounis syndrome: a monster for the atopic patient »Nicholas G Kounis

Kounis syndrome has broadening clinical manifestations, covers a wide spectrum of mast cell activation disorders and involves numerous and continuously increasing causes…
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drug The coronary slow flow phenomenon: characteristics, mechanisms and implications »Xiao Wang, Shao-Ping Nie

The coronary slow flow phenomenon is an angiographic clinical entity, characterized by delayed distal vessel opacification in the absence of significant epicardial coronary stenosis…
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drug Low gradient “severe” aortic stenosis with preserved left ventricular ojection fraction »Alper Ozkan

This review discusses the reasons of inconsistent grading of aortic valve stenosis and possible pathophysiological mechanisms underlying low flow/low gradient severe aortic stenosis…
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Cardiovascular Magnetic Resonance Imaging for Structural and Valvular Heart Disease Interventions.

Cardiovascular Magnetic Resonance Imaging for Structural and Valvular Heart Disease Interventions.

Cavalcante JL, Lalude OO, Schoenhagen P, Lerakis S.

JACC Cardiovasc Interv. 2016 Mar 14;9(5):399-425. doi: 10.1016/j.jcin.2015.11.031. Review.

PMID:26965931

Abstract

The field of percutaneous interventions for the treatment of structural and valvular heart diseases has been expanding rapidly in the last 5 years. Noninvasive cardiac imaging has been a critical part of the planning, procedural guidance, and follow-up of these procedures. Although echocardiography and cardiovascular computed tomography are the most commonly used and studied imaging techniques in this field today, advances in cardiovascular magnetic resonance imaging continue to provide important contributions in the comprehensive assessment and management of these patients. In this comprehensive paper, we will review and demonstrate how cardiovascular magnetic resonance imaging can be used to assist in diagnosis, treatment planning, and follow-up of patients who are being considered for and/or who have undergone interventions for structural and valvular heart diseases.

Current utilization of cardiac computed tomography in mainland China: A national survey.

http://www.ncbi.nlm.nih.gov/pubmed/26699712

 

Current utilization of cardiac computed tomography in mainland China: A national survey.

Liu K, Hsieh C, Zhuang N, Gao Y, Li Z, Ren X, Yang L, Zhang J, Budoff MJ, Lu B.

J Cardiovasc Comput Tomogr. 2016 Jan-Feb;10(1):76-81

Abstract

BACKGROUND:

Surveys that describe the utilization of cardiac CT are available for the United States, Germany, and Taiwan, but not mainland China.

OBJECTIVES:

To analyze the clinical utilization of cardiac CT in mainland China.

METHODS:

A 25-item questionnaire was created and 240 tertiary hospitals were randomly selected to participate. Survey data were collected and confirmed by email as well as phone interviews.

RESULTS:

In total, 237 (99%) hospitals consented to this survey, but 85 were excluded because of lack of cardiac CT patient volume or advanced technology. Finally, 152 (64%) questionnaires were available for analysis. Median patient volume was 1,037 patients (range: 150-8,072) annually. The most common clinical indications for coronary CT angiography were exclusion of coronary artery disease in patients with low to intermediate pretest likelihood, asymptomatic individuals with cardiovascular risk factors, and follow-up after coronary bypass grafting. The median heart rate threshold for beta blocker administration was >70 beats/min; most centers (86%) used sublingual nitroglycerin. Prospectively ECG triggered acquisition was the predominant technique in 44% of hospitals. Most (59%) providers adjusted the tube current to the body mass, but few (16%) adjusted the contrast injection rate. Per case, the mean examination duration was 14.2 min; post-processing time 13.6 min; and reporting time 18.0 min.

CONCLUSIONS:

Cardiac CT is widely established in clinical practice in mainland China but there is a need for more uniform standards regarding performance and clinical utilization.