Research Spotlight

Squiers, J. J. and J. M. DiMaio (2021). “SYNTAX Score II 2020: A Remake Worth the Price of Admission?” J Am Coll Cardiol 78(12): 1239-1241.

Full text of this article.

The SYNTAX score has been widely applied in clinical trial design and clinical practice to objectively measure and stratify the anatomical complexity of coronary artery disease (CAD) (1). Calculation of the SYNTAX score to inform heart team decision-making for patients with multivessel CAD has also been recommended in the 2014 American guidelines and 2018 European guidelines. Defining the complexity of CAD by the SYNTAX score has proven useful as an independent predictor of long-term survival and major adverse cardiovascular events (MACE) in patients undergoing percutaneous coronary intervention (PCI) but not those undergoing coronary artery bypass grafting (CABG). Thus, the value of the SYNTAX score for treatment selection between CABG and PCI by the heart team is uncertain. [No abstract; excerpt from article].

Gordon, E. J., J. Uriarte, J. Lee, R. Kang, M. Shumate, R. Ruiz, A. K. Mathur, D. P. Ladner and J. C. Caicedo (2021). “Effectiveness of a culturally competent care intervention in reducing disparities in Hispanic live donor kidney transplantation: A hybrid trial.” Am J Transplant. [Epub ahead of print].

Full text of this article.

Hispanic patients receive disproportionately fewer living donor kidney transplants (LDKTs) than non-Hispanic Whites (NHW). The Northwestern Medicine Hispanic Kidney Transplant Program (HKTP), designed to increase Hispanic LDKTs, was evaluated as a non-randomized, implementation-effectiveness hybrid trial of patients initiating transplant evaluation at two intervention and two similar control sites. Using a mixed method, observational design, we evaluated the fidelity of the HKTP implementation at the two intervention sites. We tested the impact of the HKTP intervention by evaluating the likelihood of receiving LDKT comparing pre-intervention (1/2011-12/2016) and post-intervention (1/2017-3/2020), across ethnicity and centers. The HKTP study included 2,063 recipients. Intervention Site A exhibited greater implementation fidelity than intervention Site B. For Hispanic recipients at Site A, the likelihood of receiving LDKTs was significantly higher at post-intervention compared to pre-intervention [odds ratio (OR)=3.17 95% confidence interval (1.04, 9.63)], but not at the paired control Site C [OR=1.02 (0.61, 1.71)]. For Hispanic recipients at Site B, the likelihood of receiving a LDKT did not differ between pre- and post-intervention [OR=0.88 (0.40, 1.94)]. The LDKT rate was significantly lower for Hispanics at paired control Site D [OR=0.45 (0.28, 0.90)]. The intervention significantly improved LDKT rates for Hispanic patients at the intervention site that implemented the intervention with greater fidelity.

Roberts, W. C. and Y. M. Salam (2021). “Frequency of Congruence and Incongruence Between the Clinical and Morphological Diagnoses in Patients Having Orthotopic Heart Transplantations at the Baylor University Medical Center at Dallas From 1993 to 2020.” Am J Cardiol 156: 114-122.

Full text of this article.

We studied the explanted hearts of 519 patients having Orthotopic Heart Transplant (OHT) at Baylor University Medical Center from 2013 to 2020 and compared the morphologic diagnoses to the clinical diagnoses before OHT. We then combined these findings with the findings from 314 patients who had been studied in the laboratory from 1993 to 2012. Thus, the total number of patients included in the overall study were 833. Among the 833 patients the morphologic and clinical diagnoses were congruent in 760 (91%) and incongruent in 73 (9%) cases. Most of the incongruity occurred among the patients with cardiac sarcoidosis (27/36 [75%]), arrhythmogenic right ventricular cardiomyopathy (11/19 [58%]), and hypertrophic cardiomyopathy (8/25 [32%]). The frequency of incongruence among 833 patients having OHT in an 27 year period was 9%, with no significant difference between the 314 patients studied from 1998 to 2012, and the 519 studied from 2013 to 2020.

Michelena, H. I., A. Della Corte, A. Evangelista, J. J. Maleszewski, W. D. Edwards, M. J. Roman, R. B. Devereux, B. Fernández, F. M. Asch, A. J. Barker, L. M. Sierra-Galan, L. De Kerchove, S. M. Fernandes, P. W. M. Fedak, E. Girdauskas, V. Delgado, S. Abbara, E. Lansac, S. K. Prakash, M. M. Bissell, B. A. Popescu, M. D. Hope, M. Sitges, V. H. Thourani, P. Pibarot, K. Chandrasekaran, P. Lancellotti, M. A. Borger, J. K. Forrest, J. Webb, D. M. Milewicz, R. Makkar, M. B. Leon, S. P. Sanders, M. Markl, V. A. Ferrari, W. C. Roberts, J. K. Song, P. Blanke, C. S. White, S. Siu, L. G. Svensson, A. C. Braverman, J. Bavaria, T. M. Sundt, G. E. Khoury, R. De Paulis, M. Enriquez-Sarano, J. J. Bax, C. M. Otto and H. J. Schäfers (2021). “Summary: international consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes.” Eur J Cardiothorac Surg 60(3): 481-496.

Full text of this article.

This International evidence-based nomenclature and classification consensus on the congenital bicuspid aortic valve and its aortopathy recognizes 3 types of bicuspid aortic valve: 1. Fused type, with 3 phenotypes: right-left cusp fusion, right-non cusp fusion and left-non cusp fusion; 2. 2-sinus type with 2 phenotypes: Latero-lateral and antero-posterior; and 3. Partial-fusion or forme fruste. This consensus recognizes 3 bicuspid-aortopathy types: 1. Ascending phenotype; root phenotype; and 3. extended phenotypes.

Michelena, H. I., A. Della Corte, A. Evangelista, J. J. Maleszewski, W. D. Edwards, M. J. Roman, R. B. Devereux, B. Fernández, F. M. Asch, A. J. Barker, L. M. Sierra-Galan, L. De Kerchove, S. M. Fernandes, P. W. M. Fedak, E. Girdauskas, V. Delgado, S. Abbara, E. Lansac, S. K. Prakash, M. M. Bissell, B. A. Popescu, M. D. Hope, M. Sitges, V. H. Thourani, P. Pibarot, K. Chandrasekaran, P. Lancellotti, M. A. Borger, J. K. Forrest, J. Webb, D. M. Milewicz, R. Makkar, M. B. Leon, S. P. Sanders, M. Markl, V. A. Ferrari, W. C. Roberts, J. K. Song, P. Blanke, C. S. White, S. Siu, L. G. Svensson, A. C. Braverman, J. Bavaria, T. M. Sundt, G. El Khoury, R. De Paulis, M. Enriquez-Sarano, J. J. Bax, C. M. Otto and H. J. Schäfers (2021). “International consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes.” Eur J Cardiothorac Surg 60(3): 448-476.

Full text of this article.

This International Consensus Classification and Nomenclature for the congenital bicuspid aortic valve condition recognizes 3 types of bicuspid valves: 1. The fused type (right-left cusp fusion, right-non-coronary cusp fusion and left-non-coronary cusp fusion phenotypes); 2. The 2-sinus type (latero-lateral and antero-posterior phenotypes); and 3. The partial-fusion (forme fruste) type. The presence of raphe and the symmetry of the fused type phenotypes are critical aspects to describe. The International Consensus also recognizes 3 types of bicuspid valve-associated aortopathy: 1. The ascending phenotype; 2. The root phenotype; and 3. Extended phenotypes.