Clinical outcomes of transcatheter aortic valve replacement stratified by left ventricular ejection fraction : a single centre pilot study

Introduction: To define baseline echocardiographic, electrocardiographic (ECG) and computed tomographic (CT) findings of patients with heart failure undergoing transcatheter aortic valve replacement (TAVR) and analyze their overall procedural outcomes. Methods: Between 2018 and 2021, patients with severe aortic stenosis (AS) who performed transcatheter aortic valve replacement (TAVR) in Sabah Al Ahmad Cardiac Centre, Al Amiri Hospital were identified. A retrospective review of patients' parameters including pre-, intra-, and post-procedural data was conducted. Patients were grouped in 2 subgroups according to their EF: EF <40% (HFrEF) and EF ≥ 40%. The data included patients’ baseline characteristics, electrocardiographic and echocardiographic details along with pre-procedural CT assessment of aortic valve dimensions. Primary outcomes including post-operative disturbances, pacemaker implantation and in-hospital mortality following TAVR were additionally analyzed. Results: A total of 61 patients with severe AS underwent TAVR. The mean age was 73.5 ± 9, and 21 (34%) of the patients were males. The mean ejection fraction (EF) was 55.5 ± 9.7%. Of 61 patients, 12 (20%) were identified as heart failure with reduced EF (<40%). These patients were younger, more often males, and were more likely to have coronary artery disease (75% versus 53.1%). Left ventricular hypertrophy and diastolic dysfunction was documented in 75% and 58.3% of patients with heart failure with reduced ejection fraction (HFrEF) respectively. Post TAVR conduction disturbances, with the commonest being LBBB was observed in 41.7%. Permanent pacemaker was implanted in 3 of patients with HFrEF (25%). There were no significant differences between the two groups with regards to in hospital mortality (p = 0.618). Conclusion: Severe AS with EF <40% constitute a remarkable proportion of patients undergoing TAVR. Preliminary results of post-operative conduction disturbances and in hospital mortality in HFrEF patients were concluded to not differ from patients with LVEF ≥40%

Validation of R-hf risk score for risk stratification in ischemic heart failure patients : a prospective cohort study

Background: The aim of this study was to validate R-heart failure (R-hf) risk score in ischemic heart failure patients. Methods: We prospectively recruited a cohort of 179 ischemic and 107 non-ischemic heart failure patients. This study mainly focused on ischemic heart failure patients. Non-ischemic heart failure patients were included for the purpose of validation of the risk score in various heart failure groups. Patients were stratified in high risk, moderate risk and low risk groups according to R-hf risk score. Results: A total of 179 participants with ischemic heart failure were included. Based on R-hf risk score, 82 had high risk, 50 had moderate risk and 47 had low risk heart failure scores. More than half of the patients having R-hf score of <5 had renal failure (n = 91, 50.8%) and anemia (n = 99, 55.3%). Notably, HFrEF was more prevalent in patients with high risk score (74, 90.2%). Patients with high risk score had significantly higher creatinine (2.63 ± 1.96, p < 0.001), Troponin-T HS (59.9 ± 38.0, p < 0.001) and PRO BNP (17842 ± 6684, p < 0.001) when compared to patients with low and moderate risk score. Patients with low risk score had significantly higher Hb (13.2 ± 1.85, p < 0.001), Albumin (3.69 ± 0.42, p < 0.001) and GFR (90.0 ± 8.04, p < 0.001). A R-hf score of <5 was a significant predictor of mortality in ischemic (OR = 50.34; 95% CI [16.94–194.00, p < 0.001) and non-ischemic (OR = 46.34; 95% CI [12.97–225.39], p < 0.001) heart failure patients. Conclusions: Lower R-hf risk score is a significant predictor of mortality in ischemic and non-ischemic heart failure patients. Risk score can be accessed at https://www.hfriskcalc.in

Clinical characteristics, incidence, and outcomes of transcatheter aortic valve implantation stratified by new‐onset left bundle branch block : a single‐center pilot study

Clinical outcomes after transcatheter aortic valve implantation (TAVI) patients have not been reported in the Gulf region. Objectives: To define the baseline electrocardiographic (ECG), echocardiographic, and computed tomographic findings of patients undergoing TAVI and analyze the predictors of developing new‐onset persistent left bundle branch block (LBBB). Methods: Patients with severe aortic stenosis who underwent TAVI between 2013 and 2021 at the Sabah Al‐Ahmed Cardiac Centre in Al‐Amiri Hospital in the state of Kuwait were included in this study. Baseline characteristics, electrocardiography (ECG), echocardiography, and preprocedural computed tomography data were extracted. The primary outcome was new‐onset LBBB. Results: A total of 61 patients were included (65.6% females; mean age: 73.5 ± 9 years; baseline ejection fraction: 55.5% ± 9.7%). Of these, 18 developed new‐onset LBBB. Those who developed LBBB tended to have lower ejection fraction (52.5 ± 9.6 vs. 56.8% ± 9.5%; P = 0.116). Those who developed LBBB were more likely to develop 1st degree atrioventricular block post‐TAVI (P = 0.001). Conclusion: The incidence of new‐onset LBBB post‐TAVI was 29.5%. The new‐onset LBBB group was more likely to develop conduction abnormalities requiring permanent pacemaker implantation

Ethnic disparities and outcomes of Edwards SAPIEN transcatheter aortic valve implantation in Kuwait : A single-center pilot study

Introduction: Clinical outcomes after transcatheter aortic valve implantation (TAVI) have not been reported in the Gulf region. This study aims to identify baseline characteristics of patients undergoing TAVI, based on nationality, and analyze their overall outcomes at a single center in Kuwait. Methods: A retrospective study of 61 patients with severe aortic stenosis undergoing TAVI between 2018 and 2021 in Sabah Al Ahmad Cardiac Centre in Kuwait. Clinical and baseline demographics data along with preprocedural computed tomography (CT) and echocardiography were reviewed. Postprocedural outcomes, including conduction disturbances and inhospital mortality rates, were analyzed. Patients were analyzed according to Kuwaiti and non-Kuwaiti citizens\u27 status. Results: The mean age of Kuwaiti patients was 72.2 ± 9.2, whereas the mean age of non-Kuwaiti citizens was 78.8 ± 5.5. No significant differences were observed between Kuwaiti and non-Kuwaiti in electrocardiogram (ECG) and CT parameters ( P \u3e 0.05). A statistically significant difference among Kuwaiti and non-Kuwaiti patients was observed only laboratory parameters, white blood cell (WBC) count, international normalized ratio (INR), and C-reactive protein (CRP). The mean value of WBC count (WBC), INR, and CRP was higher among non-Kuwaiti patients when compared to Kuwaiti patients ( P \u3c 0.05). Inhospital mortality was low 1/61 (1.6%). Conclusion: Cumulative inhospital mortality in TAVI was 1.6%. TAVI experience in Kuwait with Edwards SAPIEN valve is comparable to international cohorts. No significant differences in procedural outcomes, including conduction disturbance and mortality, were observed between the two subgroups