Cardiology

Elbadawi, A., Elgendy, I.Y., Megaly, M., Ugwu, J., Shahin, H.I., Al-Azizi, K., Garcia, S., Abbott, J.D., Gafoor, S., Kleiman, N.S. and Goel, S.S. (2021). “Trends and Outcomes of Transcatheter Aortic Valve Implantation Among Solid Organ Transplant Recipients.” Am J Cardiol 138: 122-124.

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Transcatheter aortic valve implantation (TAVI) has become an alternative treatment option for patients with severe aortic stenosis irrespective of their surgical risk. 1 With advances in surgical techniques, organ matching, and immune therapy, the number of solid-organ transplant recipients has exponentially increased, as well as the median survival time. 2 Traditional cardiovascular risk factors are more prevalent in the aging transplant recipients population, and they are at high risk for severe aortic stenosis. 2 Solid-organ transplant recipients are at higher risk for mortality and morbidity with surgical aortic valve replacement. 2 There is a paucity of data on the outcomes of TAVI in solid-organ transplant recipients, since they have been excluded from the pivotal trials. Hence, we aimed to examine the trends and outcomes of TAVI in solid organ receipts using a nationally representative database.

Colbert, G.B., Abra, G. and Lerma, E.V. (2020). “Update and review of renal artery stenosis.” Dis Mon Dec 7;101118. [Epub ahead of print].

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According to Carey et al., “resistant hypertension (RH) is defined as above-goal elevated blood pressure (BP) in a patient despite the concurrent use of 3 antihypertensive drug classes, commonly including a long-acting calcium channel blocker, a blocker of the renin-angiotensin system (RAAS) (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker), and a diuretic”.1 The causes of RH are: non-adherence with dietary salt restriction, drugs (prescription and non-prescription), obstructive sleep apnea, and secondary hypertension.[No abstract; excerpt from article].

Barker, C.M., Cork, D.P., McCullough, P.A., Mehta, H.S., Van Houten, J., Gunnarsson, C., Ryan, M., Irish, W., Mollenkopf, S. and Verta, P. (2020). “Comparison of Survival in Patients with Clinically Significant Tricuspid Regurgitation with and without Heart Failure (From the Optum Integrated File).” Am J Cardiol Dec 29;S0002-9149(20)31422-3. [Epub ahead of print].

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This study aimed to quantify survival rates for patients with Tricuspid Regurgitation (TR) using real-world data. Several clinical conditions are associated with tricuspid regurgitation (TR), including heart failure (HF), other valve disease (OVD), right-sided heart disease (RSHD), and others that impact mortality. Optum data from January 1, 2007, through December 31, 2018 included patients age ≥18 years with TR and 12 months of continuous health plan enrollment before TR. Exclusion criteria were end-stage renal disease or known/primary organ pathology. Cohorts were created hierarchically: (1) TR with HF; (2) TR with OVD (no HF); (3) TR with RSHD only (no OVD or HF); (4) TR only. Survival was estimated using a Cox hazard model with an interaction term for TR severity and adjusted for patient demographics and Elixhauser comorbidities. A total of 33,686 met study inclusion (1) TR with HF (26.6%); (2) TR with OVD (36.7%); (3) TR with RSHD only (17.1%); (4) TR only (19.6%). TR Patients (regardless of severity) with HF, OVD or RSHD had an increased risk of mortality compared to patients with TR alone. TR severity was also significantly associated (hazard ratio= 1.33; P=0.0002) with an increased risk of all-cause mortality. In conclusion, TR severity is significantly associated with an increased risk of all-cause mortality, independent of associated conditions including HF, OVD, or RSHD. In patients with severe TR, the mortality risk is most pronounced for patients who had RSHD without HF or OVD prior to their TR diagnosis.

Aulivola, B., Mitchell, E.L., Rowe, V.L., Smeds, M.R., Abramowitz, S., Amankwah, K.S., Chen, H.T., Dittman, J.M., Erben, Y., Humphries, M.D., Lahiri, J.A., Pascarella, L., Quiroga, E., Singh, T.M., Wang, L.J. and Eidt, J.F. (2020). “Ensuring Equity, Diversity and Inclusion in the Society for Vascular Surgery A Report of the Society for Vascular Surgery Task Force on Equity, Diversity and Inclusion.” J Vasc Surg Dec 14;S0741-5214(20)32602-1. [Epub ahead of print].

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Diversity, equity, and inclusion represent interconnected goals meant to ensure that all individuals, regardless of their innate identity characteristics, feel welcomed and valued amongst their peers. Equity is achieved when all individuals have equal access to leadership and career advancement opportunities as well as fair compensation for their work. It is well known that the unique backgrounds and perspectives contributed by a diverse workforce strengthen and improve medical organizations overall. The Society for Vascular Surgery (SVS) is committed to supporting the highest quality leadership, patient care, surgical education, and societal recommendations through promoting diversity, equity, and inclusion within the SVS. The overarching goal of this document is to provide specific context and guidance for enhancing diversity, equity, and inclusion within the SVS as well as setting the tone for conduct and processes beyond the SVS, within other national and regional vascular surgery organizations and practice settings.

Anker, S.D., Butler, J., Filippatos, G., Khan, M.S., Ferreira, J.P., Bocchi, E., Böhm, M., Rocca, H.P.B., Choi, D.J., Chopra, V., Chuquiure, E., Giannetti, N., Gomez-Mesa, J.E., Janssens, S., Januzzi, J.L., Gonzalez-Juanatey, J.R., Merkely, B., Nicholls, S.J., Perrone, S.V., Piña, I.L., Ponikowski, P., Senni, M., Seronde, M.F., Sim, D., Spinar, J., Squire, I., Taddei, S., Tsutsui, H., Verma, S., Vinereanu, D., Zhang, J., Jamal, W., Schnaidt, S., Schnee, J.M., Brueckmann, M., Pocock, S.J., Zannad, F. and Packer, M. (2020). “Baseline Characteristics of Patients with Heart Failure with Preserved Ejection Fraction in the EMPEROR-Preserved Trial.” Eur J Heart Fail Nov 20. [Epub ahead of print.].

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BACKGROUND: EMPEROR-Preserved is an ongoing trial evaluating the effect of empagliflozin in patients with heart failure with preserved ejection fraction (HFpEF). This report describes the baseline characteristics of the EMPEROR-Preserved cohort and compares it with patients enrolled in prior HFpEF trials. METHODS: EMPEROR-Preserved is a phase III randomized, international, double-blind, parallel-group, placebo-controlled trial in which 5988 symptomatic HFpEF patients (left ventricular ejection fraction [LVEF] >40%) with and without type 2 diabetes mellitus (T2DM) have been enrolled. Patients were required to have elevated N-terminal pro B-type natriuretic peptide (NT-proBNP) concentrations (i.e. >300 pg/mL in patients without and >900 pg/mL in patients with atrial fibrillation) along with evidence of structural changes in the heart or documented history of HF hospitalization. RESULTS: Among patients enrolled from various regions (45% Europe, 11% Asia, 25% Latin America, 12% North America), the mean age was 72±9 years, 45% were women. Almost all patients had New York Heart Association (NYHA) Class II or III symptoms (99.6%), and 23% had prior HF hospitalization within 12 months. Thirty-three percent of the patients had baseline LVEF of 41-50%. The mean LVEF (54±9%) was slightly lower while the median NT-proBNP (974 [499-1731] pg/mL) was higher compared with previous HFpEF trials. Presence of comorbidities such as diabetes (49%) and chronic kidney disease (50%) were common. The majority of the patients were on angiotensin converting enzyme inhibitors/angiotensin receptor blockers/ARNi’s (80%) and beta-blockers (86%), and 37% of patients were on mineralocorticoid receptor antagonists. CONCLUSION: When compared with prior trials in HFpEF, the EMPEROR-Preserved cohort has a somewhat higher burden of co-morbidities, lower LVEF, higher median NT-proBNP and greater use of mineralocorticoid receptor antagonists at baseline. Results of the EMPEROR-Preserved trial will be available in 2021.