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Article ; Online: Clinical predictive factors of coronary stenosis in patients with high‑risk valvular heart disease who received diagnostic coronary angiography prior to cardiac valve surgery.

Wara-Aswapati, Sirorat / Kaewkes, Danon / Chotmongkol, Verajit / Sawanyawisuth, Kittisak

2023 Volume 20, Issue 1, Page(s) 9

Abstract: Valvular heart disease (VHD) may lead to morbidities and mortality due to heart failure or sudden death. Concomitant coronary artery disease (CAD) is a crucial condition that needs to be explored in patients with VHD prior to cardiac valve surgery as it ... ...

Abstract	Valvular heart disease (VHD) may lead to morbidities and mortality due to heart failure or sudden death. Concomitant coronary artery disease (CAD) is a crucial condition that needs to be explored in patients with VHD prior to cardiac valve surgery as it may increase morbidity and mortality. Patient age >40 years and mitral regurgitation are key risk factors for CAD in patients with VHD. The present study aimed to identify clinical risk factors for coronary stenosis in patients with high-risk VHD. The retrospective cohort study recruited patients aged >40 years who received cardiac valve surgery and coronary angiogram prior to cardiac valve surgery. Clinical factors predictive of coronary stenosis were computed by logistic regression analysis. There were 533 patients; 114 patients (21.38%) had coronary stenosis. Four factors were positively associated with coronary stenosis including age, male sex, mitral regurgitation and hypertension, while two factors were negatively associated with coronary stenosis, namely estimated glomerular filtration rate and rheumatic heart disease. Hypertension had the highest adjusted odds ratio at 2.596, while rheumatic heart disease had the lowest adjusted odds ratio at 0.428. Patient age >55 years showed a sensitivity and specificity of coronary stenosis of 80.70 and 37.47%, respectively. Clinical factors predictive of coronary stenosis in patients with high-risk VHD were age >55 years, male sex, mitral regurgitation and hypertension, while a high estimated glomerular filtration rate and presence of rheumatic heart disease were protective factors.
Language	English
Publishing date	2023-11-23
Publishing country	England
Document type	Journal Article
ZDB-ID	2763624-0
ISSN	2049-9442 ; 2049-9434
ISSN (online)	2049-9442
ISSN	2049-9434
DOI	10.3892/br.2023.1697
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Article ; Online: Quality of Life, Procedural Success, and Clinical Outcomes following Transcatheter Mitral Valve Repair.

Natanzon, Sharon Shalom / Koseki, Keita / Kaewkes, Danon / Koren, Ofir / Patel, Vivek / Nakamura, Mamoo / Chakravarty, Tarun / Makkar, Raj

International journal of clinical practice

2023 Volume 2023, Page(s) 1977911

Abstract: Background: Limited data exist regarding the association between the quality of life (QoL) and clinical outcomes following transcatheter mitral valve repair (TMVr). We aimed to evaluate the prognostic significance of QoL assessment following TMVr and to ...

Abstract	Background: Limited data exist regarding the association between the quality of life (QoL) and clinical outcomes following transcatheter mitral valve repair (TMVr). We aimed to evaluate the prognostic significance of QoL assessment following TMVr and to characterize those who had procedural success, yet reported a low Kansas City Cardiomyopathy Questionnaire (KCCQ-12) score. Methods: We reported the experience of Cedars-Sinai Medical Center patients between 2013 and 2020. Patients were allocated into four groups according to the 30-day KCCQ: <25, 25-49, 50-74, and ≥75. Primary outcome included 1-year all-cause death or heart failure (HF) hospitalizations. We also examined the association between QoL and the primary outcome in those with procedural success. Results: A total of 555 patients were included in our analysis, median follow-up of 650 days (IQR 243-1113). The lower KCCQ groups had a higher prevalence of functional mitral regurgitation (65%, 60%, 56%, and 43%, Conclusion: QoL following TMVr is a powerful prognostic factor. KCCQ assessment is an important indicator for identifying patients prone to adverse outcomes even after procedural success.
MeSH term(s)	Humans ; Quality of Life ; Mitral Valve/surgery ; Heart Valve Prosthesis Implantation/adverse effects ; Treatment Outcome ; Mitral Valve Insufficiency/surgery ; Mitral Valve Insufficiency/etiology ; Heart Failure ; Cardiac Catheterization/adverse effects
Language	English
Publishing date	2023-03-06
Publishing country	India
Document type	Journal Article
ZDB-ID	1386246-7
ISSN	1742-1241 ; 1368-5031
ISSN (online)	1742-1241
ISSN	1368-5031
DOI	10.1155/2023/1977911
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Article ; Online: Implications of Mitral Annular Calcification on Outcomes Following Mitral Transcatheter Edge-to-Edge Repair.

Shechter, Alon / Lee, Mirae / Kaewkes, Danon / Patel, Vivek / Koren, Ofir / Chakravarty, Tarun / Koseki, Keita / Nagasaka, Takashi / Skaf, Sabah / Makar, Moody / Makkar, Raj R / Siegel, Robert J

Circulation. Cardiovascular interventions

2024 Volume 17, Issue 2, Page(s) e013424

Abstract: Background: Limited data exist regarding the impact of mitral annular calcification (MAC) on outcomes of transcatheter edge-to-edge repair for mitral regurgitation (MR).: Methods: We retrospectively analyzed 968 individuals (median age, 79 [ ... ...

Abstract	Background: Limited data exist regarding the impact of mitral annular calcification (MAC) on outcomes of transcatheter edge-to-edge repair for mitral regurgitation (MR). Methods: We retrospectively analyzed 968 individuals (median age, 79 [interquartile range, 70-86] years; 60.0% males; 51.8% with functional MR) who underwent an isolated, first-time intervention. Stratified by MAC extent per baseline transthoracic echocardiogram, the cohort was assessed for residual MR, functional status, all-cause mortality, heart failure hospitalizations, and mitral reinterventions post-procedure. Results: Patients with above-mild MAC (n=101; 10.4%) were older and more likely to be female, exhibited a greater burden of comorbidities, and presented more often with severe, primary MR. Procedural aspects and technical success rate were unaffected by MAC magnitude, as was the significant improvement from baseline in MR severity and functional status along the first postprocedural year. However, the persistence of above-moderate MR or functional classes III and IV at 1 year and the cumulative incidence of reinterventions at 2 years were overall more pronounced within the above-mild MAC group (significant MR or functional impairment, 44.7% versus 29.9%, Conclusions: Mitral transcatheter edge-to-edge repair in patients with and without above-mild MAC is equally feasible and safe; however, its postprocedural course is less favorable among those with primary MR.
MeSH term(s)	Male ; Humans ; Female ; Aged ; Retrospective Studies ; Heart Valve Prosthesis Implantation ; Treatment Outcome ; Mitral Valve/diagnostic imaging ; Mitral Valve/surgery ; Heart Valve Diseases ; Mitral Valve Insufficiency/diagnostic imaging ; Mitral Valve Insufficiency/surgery ; Calcinosis/diagnostic imaging ; Calcinosis/surgery ; Cardiac Catheterization ; Heart Failure
Language	English
Publishing date	2024-01-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2450797-0
ISSN	1941-7632 ; 1941-7640
ISSN (online)	1941-7632
ISSN	1941-7640
DOI	10.1161/CIRCINTERVENTIONS.123.013424
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Article ; Online: Prognostic Value of Left Ventricular Global Longitudinal Strain in Transcatheter Edge-to-Edge Repair for Chronic Primary Mitral Regurgitation.

Shechter, Alon / Hong, Gloria J / Kaewkes, Danon / Patel, Vivek / Visrodia, Parth / Tacon, P Ryan / Koren, Ofir / Koseki, Keita / Nagasaka, Takashi / Skaf, Sabah / Makar, Moody / Chakravarty, Tarun / Makkar, Raj R / Siegel, Robert J

European heart journal. Cardiovascular Imaging

2024

Abstract: Aims: Left ventricular global longitudinal strain (LVGLS) is a known outcome predictor in transcatheter edge-to-edge repair (TEER) for functional mitral regurgitation (MR). We aimed to assess its prognostic yield in the setting of TEER for chronic ... ...

Abstract	Aims: Left ventricular global longitudinal strain (LVGLS) is a known outcome predictor in transcatheter edge-to-edge repair (TEER) for functional mitral regurgitation (MR). We aimed to assess its prognostic yield in the setting of TEER for chronic primary MR. Methods and results: We conducted a single-center, retrospective analysis of 323 consecutive patients undergoing isolated, first-time procedures. Stratified by baseline LVGLS quartiles (≤-19%, -18.9-(-16)%, -15.9-(-12)%, > -12%), the cohort was evaluated for the primary composite outcome of all-cause mortality or heart failure hospitalizations, as well as secondary endpoints consisting of mitral reinterventions and the persistence of significant residual MR and/or functional disability - all along the first year after intervention. Subjects with worse (i.e., less negative) LVGLS exhibited higher comorbidity, more advanced HF, and elevated procedural risk. Post-TEER, those belonging to the worst LVGLS quartile group sustained increased mortality (16.9 vs 6.3%, Log-Rank p = 0.005, HR 1.75, 95% CI 1.08-4.74, p = 0.041) and, when affected by LV dysfunction/dilatation, more primary outcome events (21.1 vs 11.5%, Log-Rank p = 0.037, HR 1.68, 95% CI 1.02-5.46, p = 0.047). No association was demonstrated with other endpoints. Upon exploratory analysis, 1-month postprocedural LVGLS directly correlated with and was worse than its baseline counterpart by 1.6%, and a more impaired 1-month value - but not the presence/extent of deterioration - conferred heightened risk for the primary outcome. Conclusion: TEER for chronic primary MR is feasible, safe, and efficacious irrespective of baseline LVGLS. Yet, worse baseline LVGLS forecasts a less favorable postprocedural course, presumably reflecting a higher-risk patient profile.
Language	English
Publishing date	2024-03-26
Publishing country	England
Document type	Journal Article
ZDB-ID	2638345-7
ISSN	2047-2412 ; 2047-2404
ISSN (online)	2047-2412
ISSN	2047-2404
DOI	10.1093/ehjci/jeae083
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Article ; Online: Mitral Transcatheter Edge-to-Edge Repair in Nonagenarians.

Shechter, Alon / Chakravarty, Tarun / Kornowski, Ran / Kaewkes, Danon / Patel, Vivek / Taheri, Homa / Nagasaka, Takashi / Koren, Ofir / Koseki, Keita / Skaf, Sabah / Makar, Moody / Makkar, Raj R / Siegel, Robert J

The Canadian journal of cardiology

2024

Abstract: Background: There are scarce data regarding mitral transcatheter edge-to-edge repair (TEER) in individuals aged 90 years and above. We aimed to evaluate patient characteristics, procedural aspects, and outcomes in this rapidly growing group.: Methods!# ...

Abstract	Background: There are scarce data regarding mitral transcatheter edge-to-edge repair (TEER) in individuals aged 90 years and above. We aimed to evaluate patient characteristics, procedural aspects, and outcomes in this rapidly growing group. Methods: We retrospectively studied a single-centre database of 967 isolated, first-time interventions, 103 (10.7%) of which were performed in nonagenarians. Outcomes included all-cause mortality, heart failure (HF) hospitalizations, and the persistence of significant mitral regurgitation (MR) or New York Heart Association functional class III/IV during the first postprocedural year. Analyses were repeated on a 204-patient, propensity score-matched subcohort, controlling for MitraScore elements, sex, race, MR etiology, functional status, atrial fibrillation/flutter, and procedural urgency. Results: Compared with subjects below 90 years of age, nonagenarians were more likely to be white women of higher socioeconomic status; had a higher interventional risk, driven mainly by age and chronic kidney disease; presented more often with primary MR (71.8 vs 39.1%, P < 0.001); and exhibited less advanced biochemical/echocardiographic indices of cardiac remodelling. Further, their procedures were more commonly nonurgent and used fewer devices. A similarly high (> 97%) technical success rate was achieved in the 2 study groups. Likewise, no intergroup differences were observed in the rates or cumulative incidences of any of the explored endpoints, and neither of the outcomes' risks was associated with age 90 and above. Comparable outcomes were also noted in the propensity score-matched subgroups. Conclusions: In our experience, mitral TEER was equally feasible, safe, and efficacious in patients below and above 90 years of age.
Language	English
Publishing date	2024-02-02
Publishing country	England
Document type	Journal Article
ZDB-ID	632813-1
ISSN	1916-7075 ; 0828-282X
ISSN (online)	1916-7075
ISSN	0828-282X
DOI	10.1016/j.cjca.2024.01.033
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Article: Corynebacterium diphtheriae

Pachirat, Orathai / Kaewkes, Danon / Pussadhamma, Burabha / Watt, George

Cardiology research

2018 Volume 9, Issue 5, Page(s) 314–317

Abstract: Infective endocarditis due to non- ... ...

Abstract	Infective endocarditis due to non-toxigenic
Language	English
Publishing date	2018-10-07
Publishing country	Canada
Document type	Case Reports
ZDB-ID	2598593-0
ISSN	1923-2837 ; 1923-2829
ISSN (online)	1923-2837
ISSN	1923-2829
DOI	10.14740/cr741w
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Article: Racial disparities in characteristics and outcomes of patients undergoing mitral transcatheter edge-to-edge repair.

Shechter, Alon / Kaewkes, Danon / Makar, Moody / Patel, Vivek / Koren, Ofir / Koseki, Keita / Solanki, Aum / Dhillon, Manvir / Nagasaka, Takashi / Skaf, Sabah / Chakravarty, Tarun / Makkar, Raj R / Siegel, Robert J

Frontiers in cardiovascular medicine

2023 Volume 10, Page(s) 1111714

Abstract: Background: There are scarce data regarding the post-mitral transcatheter edge-to-edger repair (TEER) course in different racial groups.: Objective: To assess the impact of race on outcomes following TEER for mitral regurgitation (MR).: Methods: ... ...

Abstract	Background: There are scarce data regarding the post-mitral transcatheter edge-to-edger repair (TEER) course in different racial groups. Objective: To assess the impact of race on outcomes following TEER for mitral regurgitation (MR). Methods: This is a single-center, retrospective analysis of consecutive TEER procedures performed during 2013-2020. The primary outcome was the composite of all-cause mortality or heart failure (HF) hospitalizations along the first postprocedural year. Secondary outcomes included individual components of the primary outcome, New York Heart Association (NYHA) class, MR grade, and left ventricular mass index (LVMi). Results: Out of 964 cases, 751 (77.9%), 88 (9.1%), 68 (7.1%), and 57 (5.9%) were whites, blacks, Asians, and Hispanics, respectively. At baseline, non-whites and blacks were younger and more likely be female, based in lower socioeconomic areas, not fully insured, diagnosed with functional MR, and affected by biventricular dysfunction. Intra-procedurally, more devices were implanted in blacks. At 1-year, non-whites (vs. whites) and blacks (vs. non-blacks or whites) experienced higher cumulative incidence of the primary outcome (32.9% vs. 22.5%, Conclusion: Mitral TEER patients of different racial backgrounds exhibit major differences in baseline characteristics. Among those with functional MR, non-whites and blacks also experience a less favorable 1-year clinical outcome.
Language	English
Publishing date	2023-03-02
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2781496-8
ISSN	2297-055X
ISSN	2297-055X
DOI	10.3389/fcvm.2023.1111714
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Article ; Online: Prognostic value of mitral valve haemodynamic parameters obtained by intraprocedural echocardiography in transcatheter edge-to-edge repair.

Shechter, Alon / Natanzon, Sharon Shalom / Koseki, Keita / Kaewkes, Danon / Lee, Mirae / Koren, Ofir / Patel, Vivek / Skaf, Sabah / Chakravarty, Tarun / Makar, Moody / Makkar, Raj R / Siegel, Robert J

European heart journal. Cardiovascular Imaging

2023 Volume 24, Issue 7, Page(s) 938–948

Abstract: Aims: To assess whether intraprocedural transesophageal echocardiographic (TEE)-derived haemodynamic parameters predict outcomes in patients undergoing transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR).: Methods and results: This ...

Abstract	Aims: To assess whether intraprocedural transesophageal echocardiographic (TEE)-derived haemodynamic parameters predict outcomes in patients undergoing transcatheter edge-to-edge repair (TEER) for mitral regurgitation (MR). Methods and results: This is a single-centre, retrospective analysis encompassing 458 (IQR, 104-1035) days of follow-up after 926 consecutive patients [481 (52%) with functional MR] referred to an isolated mitral TEER between 2013 and 2020. Cases without actual clip deployment, or in whom prior mitral procedures had taken place, were excluded. The primary outcome was the combined rate of all-cause mortality or heart failure (HF) hospitalizations. Secondary endpoints included single components of the primary outcome, as well as MR severity at one month and one year following the procedure. A multivariable analysis identified two intraprocedural echocardiographic observations made after clip deployment as independent predictors of the primary outcome: an above mild MR (HR for whole study period 1.49, 95% CI 1.05-2.13, P = 0.026) and a 100% or more increase from baseline in the transmitral mean pressure gradient (TMPG) (HR for whole study period 1.32, 95% CI 1.01-1.72, P = 0.039). Also, MR grade of above mild and the absence of a normal pulmonary venous flow pattern (PVFP) bilaterally were associated with an increased risk for HF hospitalizations and greater-than-mild 1-month MR. No prognostic role was demonstrated for the change in MR severity, the absolute TMPG, or the mere improvement in PVFP. Conclusion: Immediate post-TEER MR severity and the relative change in TMPG are predictive of clinical and echocardiographic outcomes following the procedure.
MeSH term(s)	Humans ; Mitral Valve/diagnostic imaging ; Mitral Valve/surgery ; Retrospective Studies ; Heart Valve Prosthesis Implantation/methods ; Cardiac Catheterization/methods ; Mitral Valve Insufficiency/diagnostic imaging ; Mitral Valve Insufficiency/surgery ; Mitral Valve Insufficiency/complications ; Echocardiography, Transesophageal/methods ; Hemodynamics ; Treatment Outcome
Language	English
Publishing date	2023-02-08
Publishing country	England
Document type	Journal Article
ZDB-ID	2638345-7
ISSN	2047-2412 ; 2047-2404
ISSN (online)	2047-2412
ISSN	2047-2404
DOI	10.1093/ehjci/jead011
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Article ; Online: Correlates and prognostic implications of LVEF reduction after transcatheter edge-to-edge repair for primary mitral regurgitation.

Shechter, Alon / Kaewkes, Danon / Lee, Mirae / Makar, Moody / Patel, Vivek / Koren, Ofir / Koseki, Keita / Nagasaka, Takashi / Skaf, Sabah / Chakravarty, Tarun / Makkar, Raj R / Siegel, Robert J

European heart journal. Cardiovascular Imaging

2023 Volume 25, Issue 1, Page(s) 136–147

Abstract: Aims: To explore the characteristics and outcomes of patients undergoing transcatheter edge-to-edge repair (TEER) for primary mitral regurgitation (MR) according to the presence of left ventricular ejection fraction (LVEF) reduction post-procedure.: ... ...

Abstract	Aims: To explore the characteristics and outcomes of patients undergoing transcatheter edge-to-edge repair (TEER) for primary mitral regurgitation (MR) according to the presence of left ventricular ejection fraction (LVEF) reduction post-procedure. Methods and results: We retrospectively analysed 317 individuals [median age 83 (interquartile range, 75-88) years, 197 (62.1%) males] treated with an isolated, first-time TEER that was concluded by a successful clip deployment. Stratified by LVEF change at 1-month compared with baseline, the cohort was evaluated for residual MR and heart failure (HF) indices up to 1-year, as well as all-cause mortality and HF hospitalizations at 2-years. Overall, 212 (66.9%) patients displayed LVEF reduction, which was mainly driven by lowered total stroke volume and diffuse hypocontractility. While post-procedural MR, transmitral mean pressure gradient, and functional status were comparable in the two study groups, patients with LVEF reduction exhibited a greater decline in filling pressures intra-procedurally; left ventricular mass index, pulmonary arterial systolic pressure, and serum natriuretic peptide level at 1-month; and walking limitation at 1-year. Also, by 2 years, they were less likely to die (13.3% vs. 5.7%, P = 0.019), be readmitted for HF (17.1% vs. 9.0%, P = 0.033), and experience either of the two (23.8% vs. 12.7%, P = 0.012). Lastly, LVEF reduction was the only 1-month echocardiographic parameter to independently confer an attenuated risk for the composite of deaths or HF hospitalizations (HR 0.28, 95% CI 0.10-0.78, P = 0.016). Conclusion: LVEF reduction at 1-month post-TEER for primary MR is associated with better clinical outcomes, possibly reflecting a more pronounced unloading effect of the procedure.
MeSH term(s)	Male ; Humans ; Aged, 80 and over ; Female ; Mitral Valve Insufficiency/diagnostic imaging ; Mitral Valve Insufficiency/surgery ; Mitral Valve Insufficiency/complications ; Mitral Valve/surgery ; Stroke Volume ; Prognosis ; Ventricular Function, Left ; Retrospective Studies ; Treatment Outcome ; Risk Factors ; Heart Valve Prosthesis Implantation/methods
Language	English
Publishing date	2023-08-17
Publishing country	England
Document type	Journal Article
ZDB-ID	2638345-7
ISSN	2047-2412 ; 2047-2404
ISSN (online)	2047-2412
ISSN	2047-2404
DOI	10.1093/ehjci/jead210
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Article ; Online: Repeat Mitral Transcatheter Edge-to-Edge Repair for Recurrent Significant Mitral Regurgitation.

Shechter, Alon / Lee, Mirae / Kaewkes, Danon / Koren, Ofir / Skaf, Sabah / Chakravarty, Tarun / Koseki, Keita / Patel, Vivek / Makkar, Raj R / Siegel, Robert J

Journal of the American Heart Association

2023 Volume 12, Issue 9, Page(s) e028654

Abstract: Background There are limited data on repeat mitral transcatheter edge-to-edge repair for recurrent significant mitral regurgitation (MR). Methods and Results We conducted a single-center, retrospective analysis of consecutive patients referred to a ... ...

Abstract	Background There are limited data on repeat mitral transcatheter edge-to-edge repair for recurrent significant mitral regurgitation (MR). Methods and Results We conducted a single-center, retrospective analysis of consecutive patients referred to a second mitral transcatheter edge-to-edge repair after a technically successful first procedure. Clinical, laboratory, and echocardiographic measures were assessed up to 1 year after the intervention. The composite of all-cause death or heart failure (HF) hospitalizations constituted the primary outcome. A total of 52 patients (median age, 81 [interquartile range, 76-87] years, 29 [55.8%] men, 26 [50.0%] with functional MR) met the inclusion criteria. MR recurrences were mostly related to progression of the underlying cardiac pathology. All procedures were technically successful. At 1 year, most patients with available records (n=24; 96.0%) experienced improvement in MR severity or New York Heart Association functional class that was statistically significant but numerically modest. Fourteen (26.9%) patients died or were hospitalized due to HF. These were higher-risk cases with predominantly functional MR who mostly underwent an urgent procedure and exhibited more severe HF indices before the intervention, as well as an attenuated 1-month clinical and echocardiographic response. Overall, 1-year course was comparable to that experienced by patients who underwent only a first transcatheter edge-to-edge repair at our institution (n=902). Tricuspid regurgitation of greater than moderate grade was the only baseline parameter to independently predict the primary outcome. Conclusions Repeat mitral transcatheter edge-to-edge repair is feasible, safe, and clinically effective, especially in non-functional MR patients without concomitant significant tricuspid regurgitation.
MeSH term(s)	Male ; Humans ; Aged, 80 and over ; Female ; Mitral Valve Insufficiency/diagnostic imaging ; Mitral Valve Insufficiency/surgery ; Mitral Valve Insufficiency/etiology ; Tricuspid Valve Insufficiency ; Mitral Valve/diagnostic imaging ; Mitral Valve/surgery ; Retrospective Studies ; Heart Valve Prosthesis Implantation/adverse effects ; Treatment Outcome ; Heart Failure/etiology ; Cardiac Catheterization/adverse effects
Language	English
Publishing date	2023-04-29
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2653953-6
ISSN	2047-9980 ; 2047-9980
ISSN (online)	2047-9980
ISSN	2047-9980
DOI	10.1161/JAHA.122.028654
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