P3722Platelet reactivity changes following transcatheter aortic valve implantation

Abstract Introduction Although recent studies described changes in platelet reactivity (PR) in days following transcatheter aortic valve implantation (TAVI), precise time course and duration of these changes have not been fully investigated. Purpose To investigate PR changes during and after TAVI. Methods Study included 42 consecutive patients with severe and symptomatic aortic stenosis undergoing TAVI procedure in our institution. Patients' clinical characteristics were collected from medical records. All patients who did not have chronic dual antiplatelet therapy received loading dose of aspirin and clopidogrel (300 mg) one day before the procedure followed by their standard maintenance doses for next three months. PR was measured in six time points: just before induction of anaesthesia (T1), after heparin administration (T2), at the end of procedure (T3), and on 3rd, 6th and 30th postoperative day (T4–6). PR was measured using impedance aggregometer (Multiplate® analyzer, Roche, Munich, Germany) in response to three platelet aggregation agonists: arachidonic acid (ASPItest), ADP (ADPtest) and thrombin receptor activating peptide-6 (TRAPtest). Results Mean patient age was 82.1 years with majority of patients being male 57.1% (N=24). Mean valve area and mean transvalvular gradient prior to procedure were 0.71±0.21 cm2 and 49.1±18.7 mmHg, respectively. All patients underwent successful TAVI procedure using either self-expandable (N=25, 59.5%) or balloon-expandable valve. Two patients (4.7%) underwent transapical TAVI, while transfemoral approach was used in all other patients. Mean postimplantation gradient was 10.2±7.1 mmHg. Mean PR on T1 was 24.3±23.1 U for ASPItest, 41.6±26.5 U for ADPtest and 90.1±33.3 U for TRAPtest. There was no significant difference in PR on T2. However, on T3, ignificant reduction of PR in all 3 tests was observed (ASPI 9.4±10.1 U (p=0.001), ADP 23.1±15.0 U (p&lt;0.001) and TRAP 64.5±27.3 U (p&lt;0.001)). Lowest PR values for all tests were reached on T4, after which incline in PR has been observed. On T5, value of ASPItest reached levels not significantly different to those on T1 (15.1±17.2 U, p=0.13), while ADPtest and TRAPtest remained significantly lower (27.3±18.5 U, p=0.007 and 68.6±33.2 U, p=0.003, respectively). All PR values returned to initial levels on T6 (figure 1). Conclusions Our results show that successful TAVI procedure induces transient decrease in PR regardless of the platelet activation pathway. These findings add new knowledge in understanding complexed relations in intravascular milieu following TAVI. Further research on a larger number of patients is needed to confirm and asses clinical significance of these results. Acknowledgement/Funding Croatian Science Foundation </jats:sec

Impact of mitral annular calcification on hemodynamic effect in mitral stenosis in multiple valve disease: relevant or not

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Prevalence of mitral annulus calcification (MAC) and degenerative mitral stenosis thus elevated transmitral gradient (TMG) is increased with age and multivalve involvement. The management of degenerative multivalve disease is challenging, as is identification of the presence of multivalve involvement and its hemodynamic impact because of interaction between two or more valve lesions especially in degenerative valve disease. Hemodynamic interaction between significant aortic stenosis and mitral annular calcification is often combined with diastolic disfunction which can result in LA enlargement and abnormal atrioventricular coupling and left atrial and ventricular remodeling.  Purpose Study aimed to assess the effect of MAC on mitral valve stenosis in patients with multiple valve disease of degenerative origin. Method We retrospectively analyzed 78 patients with elevated transmitral gradient defined as an elevated TMG &amp;gt;4mmHg, MAC in multivalve involvement, mainly degenerative significant aortic valve stenosis who were treated in our clinic from 2018 to 2021. We excluded patients with prior cardiac surgery, congenital heart disease, hypertrophic obstructive cardiomyopathy and with heart rate &amp;gt;100 bpm at time of study and significant mitral regurgitation. Baseline demographic data were extracted from the electronic medical record and echocardiographic data were analyzed from electronic saved data. Results Study identified a total of 78 patients (average age 71,89 years, 64% females). Of 57 analyzed patients 32% patients had severe MAC and calcification of chordae, and 68% patients had MAC and mild or no significant chordae calcification. Patients with aortic gradients, severe aortic stenosis (AVAi 0,80 cm/m2) were observed more often in patients with severe MAC and significant chordae calcification than in those with nonsevere MAC (p &amp;lt; 0.043).There was no significant difference in mitral annular distension between groups. Baseline mean MV gradients were 6,5+-1.5 mm Hg. Mean MVA (continuity equation) was 1,5+-0.4 cm2, and MVAi 0,8+-0,2 cm/m2, mean LA volume 70 ml/m2, mean E/e 35, mean EF LV 68% and mean GLS -14. Conclusion Result suggest that increasing transmitral gradient if superimposed on severe MAC with only modest mitral stenosis will result in a high mean transmitral gradient. The presence of elevated pressure transmitral gradient in patients with more severe aortic stenosis and more severe MAC combined with chordae calcification may imply hemodynamic effect or stress on mitral valve degeneration in multiple valve involvement. Other imaging modalities and further investigation for better understanding effect of hemodynamic stress in multiple valve disease are needed. These observations need to be evaluated on larger cohorts of patients during a longer period of time. </jats:sec

Global and regional myocardial function and outcomes after transcatheter aortic valve implantation for aortic stenosis and preserved ejection fraction

AimTo investigate the effects of transcatheter aortic valve implantation (TAVI) on early recovery of global and segmental myocardial function in patients with severe symptomatic aortic stenosis and preserved left ventricular ejection fraction (LVEF) and to determine if parameters of deformation correlate with outcomes.MethodsThe echocardiographic (strain analysis) and outcome (hospitalizations because of heart failure and mortality) data of 62 consecutive patients with preserved LVEF (64.54±7.97%) who underwent CoreValve prosthesis implantation were examined.ResultsEarly after TAVI (5±3.9 days), no significant changes in LVEF or diastolic function were found, while a significant drop of systolic pulmonary artery pressure (PAP) occurred (42.3±14.9 vs. 38.1±13.9mmHg, P=0.028). After TAVI global longitudinal strain (GLS) did not change significantly, whereas significant improvement in global mid-level left ventricular (LV) radial strain (GRS) was found (-16.71±2.42 vs. -17.32±3.25%; P=0.33; 16.57±6.6 vs. 19.48±5.97%, P=0.018, respectively). Early significant recovery of longitudinal strain was found in basal lateral and anteroseptal segments (P=0.038 and 0.048). Regional radial strain at the level of papillary muscles [P=0.038 mid-lateral, P<0.001 mid-anteroseptum (RSAS)] also improved. There was a significant LV mass index reduction in the late follow-up (152.42±53.21 vs. 136.24±56.67g/m2, P=0.04). Mean follow-up period was 3.5±1.9 years. Parameters associated with worse outcomes in univariable analysis were RSAS pre-TAVI, LV end-diastolic diameter after TAVI, relative wall thickness, and mitral E and E/A after TAVI.ConclusionGlobal and regional indices of myocardial function improved early after TAVI, suggesting the potential of myocardium to recover with a reduced risk for clinical deterioration

Predictors of embolism and death in left-sided infective endocarditis:the European Society of Cardiology EURObservational Research Programme European Infective Endocarditis registry

BACKGROUND AND AIMS: Even though vegetation size in infective endocarditis (IE) has been associated with embolic events (EEs) and mortality risk, it is unclear whether vegetation size associated with these potential outcomes is different in left-sided IE (LSIE). This study aimed to seek assessing the vegetation cut-off size as predictor of EE or 30-day mortality for LSIE and to determine risk predictors of these outcomes. METHODS: The European Society of Cardiology EURObservational Research Programme European Infective Endocarditis is a prospective, multicentre registry including patients with definite or possible IE throughout 2016-18. Cox multivariable logistic regression analysis was performed to assess variables associated with EE or 30-day mortality. RESULTS: There were 2171 patients with LSIE (women 31.5%). Among these affected patients, 459 (21.1%) had a new EE or died in 30 days. The cut-off value of vegetation size for predicting EEs or 30-day mortality was &gt;10 mm [hazard ratio (HR) 1.38, 95% confidence interval (CI) 1.13-1.69, P = .0015]. Other adjusted predictors of risk of EE or death were as follows: EE on admission (HR 1.89, 95% CI 1.54-2.33, P &lt; .0001), history of heart failure (HR 1.53, 95% CI 1.21-1.93, P = .0004), creatinine &gt;2 mg/dL (HR 1.59, 95% CI 1.25-2.03, P = .0002), Staphylococcus aureus (HR 1.36, 95% CI 1.08-1.70, P = .008), congestive heart failure (HR 1.40, 95% CI 1.12-1.75, P = .003), presence of haemorrhagic stroke (HR 4.57, 95% CI 3.08-6.79, P &lt; .0001), alcohol abuse (HR 1.45, 95% CI 1.04-2.03, P = .03), presence of cardiogenic shock (HR 2.07, 95% CI 1.29-3.34, P = .003), and not performing left surgery (HR 1.30 95% CI 1.05-1.61, P = .016) (C-statistic = .68). CONCLUSIONS: Prognosis after LSIE is determined by multiple factors, including vegetation size

Risk calculator to predict 30-day mortality in left-sided infective endocarditis. The EURO-ENDO score

Background/Introduction Infective endocarditis (IE) is associated with high in-hospital mortality, despite improvements in therapeutic strategies. Nonetheless, there is no prospective risk model to estimate IE mortality. Purpose We sought to develop and validate a calculator to predict 30-day mortality risk regarding to perform surgery or medical treatment alone in left-sided IE. Methods This is a prospective, multicenter registry that included patients between January 2016 and March 2018 with a diagnosis of IE based on ESC 2015 diagnostic criteria. Patients with possible or definite left-sided IE were included in the analyses. Clinical, biological, microbiological and imaging data were collected. The primary end point was 30-day mortality in patients with left-sided IE. The risk calculator was based on multivariable Cox regression models. The accuracy of the logistic regression models was assessed by discrimination and calibration using C-statistic and Hosmer-Lemeshow test. Results Among 3116 patients included, 2171 patients presented left-sided IE and 257 patients (11.8%) died during the first 30 days of IE diagnosis. After multivariable Logistic regression analysis, eleven variables were associated with 30-days mortality and were included in the calculator: previous cardiac surgery, previous stroke/TIA, creatinine &gt;2 mg/dL, S. aureus infection, embolic events on admission, heart failure or cardiogenic shock, vegetation size &gt;14 mm, presence of abscess, severe regurgitation, double left-sided IE and no left valve surgery. There was an excellent correlation between the predicted 30-days mortality in both models with or without performing left valve surgery (area under the receiver operator curve: 0.798 and 0.758, respectively). Moreover, calibration by Hosmer-Lemeshow were 0.085 and 0.09, respectively). Conclusion(s) Our risk score in patients with left-sided IE provides an accurate individualized estimation of 30-day mortality according to perform or not perform left-valve surgery. It allows medical professionals to determine whether submitting patients to surgery or not, and thus improve their prognosis. Funding Acknowledgement Type of funding sources: None

Infective endocarditis in adult patients with congenital heart disease: results from the ESC EORP EURO-ENDO registry

Abstract Background Congenital Heart Disease (CHD) predisposes to Infective Endocarditis (IE) Purpose To characterize and to determine the prognosis of IE in this specific population. Methods The ESC EORP EURO-ENDO study is a prospective international study in patients (n=3111) diagnosed with IE. In this pre-specified ancillary analysis, we aimed to describe adult patients with CHD (n=365, 11·7%) and compare them with patients without CHD (non-CHD, n=2746) in terms of baseline characteristics and 1-year outcome. Results CHD patients (73% men, age 44·8±16·6 years) were younger and had less comorbidities. Of the CHD patients, 14% had a dental procedure in the 6 months before hospitalization versus 7% in non-CHD patients (p&amp;lt;0·001) and more often positive blood cultures for Streptococcus viridans (16·4% vs 8·8%, p&amp;lt;0·001). As in non-CHD patients, IE affected most often the left-sided valves. For CHD patients, in-hospital mortality was 9·0% vs 18·1% in non-CHD patients (p&amp;lt;0·001), and also 1-year outcome was more favourable (log-rank for all-cause mortality p&amp;lt;0·0001), even after adjustment for age (Hazard Ratio (HR) 0·61; 95% CI 0·45–0·81). Within the CHD population, multivariable Cox regression revealed the following predictors for mortality: fistula (HR 6·97), cerebral embolus (HR 4·64), renal insufficiency (HR 3·44), Staphylococcus aureus as causative agent (HR 2·06) and failure to undertake surgery when indicated (HR 5·93). Conclusion CHD patients with IE have better outcome in terms of all-cause mortality. The observed high incidence of dental procedures prior to IE fuels the discussion about the need for antibiotic prophylaxis. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Since the start of EORP, the following companies have supported the program: Abbott Vascular Int. (2011–2021), Amgen Cardiovascular (2009–2018), AstraZeneca (2014–2021), Bayer AG (2009–2018), Boehringer Ingelheim (2009–2019), Boston Scientific (2009–2012), The Bristol Myers Squibb and Pfizer Alliance (2011–2019), Daiichi Sankyo Europe GmbH (2011–2020), The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company (2014–2017), Edwards (2016–2019), Gedeon Richter Plc. (2014–2016), Menarini Int. Op. (2009–2012), MSD-Merck &amp; Co. (2011–2014), Novartis Pharma AG (2014–2020), ResMed (2014–2016), Sanofi (2009–2011), Servier (2009–2021), Vifor (2019–2022). Survival CHD vs non-CHD patients </jats:sec

Predictors of mortality in patients with right-side and cardiac device-related infective endocarditis, the esc-eorp euro-endo registry

Abstract Background/Introduction Mortality in right-sided infective endocarditis (RSIE) and cardiac device-related IE (CDRIE) rates have increased mainly due derived complications and heterogeneity of the disease. A better understanding of associated risk factors to mortality in these entities are required in order to develop an efficient therapy. Purpose The aim of this study was to assess 30-day mortality rate and variables associated in RSIE and CDRIE. Methods The ESC-EORP EURO-ENDO registry is a prospective multicenter observational study of patients presenting with definite or possible IE in Europe and ESC-affiliated/non-affiliated countries. Patients were included from January 2016 to 31 March 2018 in 156 centers from 40 countries. Clinical data, blood test analysis and multi-modality imaging tests (echocardiography, computed tomography, PET-CT, magnetic resonance) were collected. Primary endpoint was 30-day mortality. Univariable analysis was performed to assess variables associated with 30-day mortality. Results Among 269 patients with RSIE, 24 patients (9.8%) died during the first 30-day of IE diagnosis. Cut-off value for best vegetation size related to 30-day mortality was vegetation length &amp;gt;19mm, with a HR = 2.88 (95% CI 1.26–6.58, p=0.01) and a Harrell's Concordance of 0.632. Factors associated with 30-days mortality by univariable analysis were: vegetation size &amp;gt;19mm (OR = 2.99, 95% CI [1.31–6.84], p=0.009), previous stroke or transient ischemic attack (OR = 5.10, 95% CI [1.19–21.88], p=0.029), HIV infection (OR = 3.52, 95% CI [1.03–12.10], p=0.046), chronic renal failure (OR = 2.66, 95% CI [1.06–6.71], p=0.038), congestive heart failure at admission (OR = 2.34, 95% CI [1.00–5.47], p=0.050) and severe regurgitation (OR = 3.77, 95% CI [1.56–9.09], p=0.003). On the other side, among the 227 patients with CDRIE, 24 patients (8.8%) died during the first 30-day of IE diagnosis. Factors associated with an increase in 30-day mortality by univariate analysis were: age per 10 years (OR = 1.49, 95% CI [1.02–2.18], p=0.039), heart failure history (OR = 3.88, 95% CI [1.39–10.80], p=0.009), congestive heart failure on admission (OR = 5.80, 95% CI [2.31–14.55], p&amp;lt;0.001) and cardiogenic shock on admission (OR = 13.37, 95% CI [3.75–47.64], p&amp;lt;0.001). An increase in left ventricular ejection fraction (LVEF) per 10% was a protective factor (OR = 0.66, 95% CI [0.49–0.90], p=0.008). Conclusions Patients with RSIE and CDRIE had a not negligible 30-day mortality rate (9.8% and 8.8%, respectively). Factors associated with RSIE and CDRIE mortality are different; while in the right side location, the mortality was related with vegetation size and comorbidities, in the case of CDRIE, the mortality was mainly associated to the presence of heart failure. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Euro-Endo registry by European Society of Cardiology </jats:sec

Predictors of mortality in patients with left-side infective endocarditis, the ESC-EORP EURO-ENDO registry

Abstract Background/Introduction Infective endocarditis (IE) is associated with high in-hospital mortality, ranging from 16% to 25%, despite improvement in diagnostic and therapeutic strategies, mainly due to complications and heterogeneity of the disease. Baseline risk stratification is essential, in order to focus an aggressive management toward high-risk patients. Purpose We sought to assess the association between surgery and 30-day mortality rate as related to vegetation size. Methods The ESC-EORP EURO-ENDO registry is a prospective multicentre observational study of patients presenting with definite or possible IE in Europe and ESC-affiliated/non-affiliated countries. Patients were included from January 2016 to 31 March 2018 in 156 centers from 40 countries. Clinical data, blood test analysis and multi-modality imaging tests (echocardiography, computed tomography, PET-CT, magnetic resonance) were collected. Primary endpoint was 30-day mortality. Multivariable logistic regression analysis was performed to assess variables associated with 30-day mortality. Besides, univariable analysis was performed to assess best vegetation size cut-off related to 30-day mortality. Results Among 2171 patients with left-side IE, 257 patients (11.8%) died during the first 30 days of IE diagnosis. Patient characteristics and univariable analysis are summarized in TABLE 1. Cut-off value for best vegetation size related to 30-day mortality was vegetation length &amp;gt;14mm, with a HR =2.00 (95% CI 1.59–2.51, p&amp;lt;0.0001) and a Harrell's Concordance of 0.58. After multivariable logistic regression analysis, factors associated with 30-day mortality risk were: vegetation size &amp;gt;14mm (OR =2.68, 95% CI [1.96–3.67], p&amp;lt;0.0001), previous stroke or transient ischemic attack (TIA) (OR =1.60, 95% CI [1.07–2.40], p=0.0235), creatinine &amp;gt;2mg/dL (OR =2.45, 95% CI [1.73–3.47], p&amp;lt;0.0001), presence of embolic events (OR =2.64, 95% CI [1.86–3.74], p&amp;lt;0.0001), hemorrhagic stroke (OR=3.71, 95% CI [1.80–7.64], p=0.0004), presence of heart failure or cardiogenic shock (OR =3.50, 95% CI [2.57–4.77], p&amp;lt;0.0001) and no cardiac surgery during the event (OR =4.07, 95% CI [2.93–5.67], p&amp;lt;0.0001). The C-statistic of the logistic model to predict 30-day mortality was 0.795. Conclusion Left-side infective endocarditis had a high 30-day mortality rate (11.8%). Presence of a large vegetation size (&amp;gt;14mm), embolic events, hemorrhagic stroke, renal failure, presence of heart failure or cardiogenic shock were associated with an increase in 30-day mortality. Performing cardiac surgery had a protective effect. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): ESC-EORP EURO-ENDO project from the ESC society </jats:sec