Low permanent pacemaker rates following Lotus device implantation for transcatheter aortic valve replacement due to modified implantation protocol

Background: Conduction disturbances requiring permanent pacemaker implantation following transcatheter aortic valve replacement (TAVR) are a common problem. Pacemaker implantation rates after TAVR appear to be higher compared to conventional aortic valve replacement. The aim of this study was to analyze whether a high annulus implantation conveys the benefit of a decreased rate of permanent pacemaker implantation while being safe and successful according to Valve Academic Research Consortium 2 (VARC2)-criteria. Methods: A total of 23 patients with symptomatic severe aortic valve stenosis, an aortic annulus of 19–27 mm and at high risk for surgery were treated with the Lotus valve. In all patients the valve was implanted in a high annulus position via femoral access. The primary device performance endpoint was VARC2-defined device success after 30 days and the primary safety endpoint was the need for permanent pacemaker implantation. Results: The mean age was 73.23 ± 7.65 years, 46% were female, 38% were New York Heart Association class III/IV at baseline. Thirty-day follow-up data were available for all patients. The VARC2-defined device success rate after 30 days was 22/23 (96%). 2/21 (10%) patients required a newly implanted pacemaker due to 3rd degree atrioventricular block. 25% of the patients developed a new left bundle branch block after valvuloplasty or device implantation. 21 of the 23 patients (96%) had no other signs of conduction disturbances after 30 days. Conclusions: The approach of the modified implantation technique of Lotus TAVR device was safe and effective. The incidence of need for a permanent pacemaker following TAVR could be significantly reduced due to adopted implantation protocol

Prognostic impact of acute pulmonary triggers in patients with Takotsubo syndrome : new insights from the International Takotsubo Registry

© 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License.Aims: Acute pulmonary disorders are known physical triggers of takotsubo syndrome (TTS). This study aimed to investigate prevalence of acute pulmonary triggers in patients with TTS and their impact on outcomes. Methods and results: Patients with TTS were enrolled from the International Takotsubo Registry and screened for triggering factors and comorbidities. Patients were categorized into three groups (acute pulmonary trigger, chronic lung disease, and no lung disease) to compare clinical characteristics and outcomes. Of the 1670 included patients with TTS, 123 (7%) were identified with an acute pulmonary trigger, and 194 (12%) had a known history of chronic lung disease. The incidence of cardiogenic shock was highest in patients with an acute pulmonary trigger compared with those with chronic lung disease or without lung disease (17% vs. 10% vs. 9%, P = 0.017). In-hospital mortality was also higher in patients with an acute pulmonary trigger than in the other two groups, although not significantly (5.7% vs. 1.5% vs. 4.2%, P = 0.13). Survival analysis demonstrated that patients with an acute pulmonary trigger had the worst long-term outcome (P = 0.002). The presence of an acute pulmonary trigger was independently associated with worse long-term mortality (hazard ratio 2.12, 95% confidence interval 1.33-3.38; P = 0.002). Conclusions: The present study demonstrates that TTS is related to acute pulmonary triggers in 7% of all TTS patients, which accounts for 21% of patients with physical triggers. The presence of acute pulmonary trigger is associated with a severe in-hospital course and a worse long-term outcome.C. T. has been supported by the H.H. Sheikh Khalifa binHamad Al-Thani Research Programme and the Swiss HeartFoundation. The InterTAK Registry is supported by the BissDavies Charitable Trust. L. S. M. has been supported by EUHORIZON 2020(SILICOFCM ID777204)info:eu-repo/semantics/publishedVersio

Clinical correlates and prognostic impact of neurologic disorders in Takotsubo syndrome

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Cardiac alterations are frequently observed after acute neurological disorders. Takotsubo syndrome (TTS) represents an acute heart failure syndrome and is increasingly recognized as part of the spectrum of cardiac complications observed after neurological disorders. A systematic investigation of TTS patients with neurological disorders has not been conducted yet. The aim of the study was to expand insights regarding neurological disease entities triggering TTS and to investigate the clinical profile and outcomes of TTS patients after primary neurological disorders. The International Takotsubo Registry is an observational multicenter collaborative effort of 45 centers in 14 countries (ClinicalTrials.gov, identifier NCT01947621). All patients in the registry fulfilled International Takotsubo Diagnostic Criteria. For the present study, patients were included if complete information on acute neurological disorders were available. 2402 patients in whom complete information on acute neurological status were available were analyzed. In 161 patients (6.7%) an acute neurological disorder was identified as the preceding triggering factor. The most common neurological disorders were seizures, intracranial hemorrhage, and ischemic stroke. Time from neurological symptoms to TTS diagnosis was ≤ 2 days in 87.3% of cases. TTS patients with neurological disorders were younger, had a lower female predominance, fewer cardiac symptoms, lower left ventricular ejection fraction, and higher levels of cardiac biomarkers. TTS patients with neurological disorders had a 3.2-fold increased odds of in-hospital mortality compared to TTS patients without neurological disorders. In this large-scale study, 1 out of 15 TTS patients had an acute neurological condition as the underlying triggering factor. Our data emphasize that a wide spectrum of neurological diseases ranging from benign to life-threatening encompass TTS. The high rates of adverse events highlight the need for clinical awareness.The International Takotsubo Registry was supported by the Biss Davies Charitable Trust. Dr. Scheitz has been supported by the Corona Foundation. Dr. Templin has been supported by the H.H. Sheikh Khalifa bin Hamad Al-Thani Research Programme and the Swiss Heart Foundation.info:eu-repo/semantics/publishedVersio

Ethnic comparison in takotsubo syndrome : novel insights from the International Takotsubo Registry

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Background: Ethnic disparities have been reported in cardiovascular disease. However, ethnic disparities in takotsubo syndrome (TTS) remain elusive. This study assessed differences in clinical characteristics between Japanese and European TTS patients and determined the impact of ethnicity on in-hospital outcomes. Methods: TTS patients in Japan were enrolled from 10 hospitals and TTS patients in Europe were enrolled from 32 hospitals participating in the International Takotsubo Registry. Clinical characteristics and in-hospital outcomes were compared between Japanese and European patients. Results: A total of 503 Japanese and 1670 European patients were included. Japanese patients were older (72.6 ± 11.4 years vs. 68.0 ± 12.0 years; p < 0.001) and more likely to be male (18.5 vs. 8.4%; p < 0.001) than European TTS patients. Physical triggering factors were more common (45.5 vs. 32.0%; p < 0.001), and emotional triggers less common (17.5 vs. 31.5%; p < 0.001), in Japanese patients than in European patients. Japanese patients were more likely to experience cardiogenic shock during the acute phase (15.5 vs. 9.0%; p < 0.001) and had a higher in-hospital mortality (8.2 vs. 3.2%; p < 0.001). However, ethnicity itself did not appear to have an impact on in-hospital mortality. Machine learning approach revealed that the presence of physical stressors was the most important prognostic factor in both Japanese and European TTS patients. Conclusion: Differences in clinical characteristics and in-hospital outcomes between Japanese and European TTS patients exist. Ethnicity does not impact the outcome in TTS patients. The worse in-hospital outcome in Japanese patients, is mainly driven by the higher prevalence of physical triggers.Open Access funding provided by Universität Zürich. CT has been supported by the H.H. Sheikh Khalifa bin Hamad Al-Thani Research Programme and the Swiss Heart Foundation. L.S.M. has been supported by EU HORIZON 2020 (SILICOFCM ID777204). J.R.G has received a grant “Filling the gap” from the University of Zurich. The InterTAK Registry is supported by The Biss Davies Charitable Trust.info:eu-repo/semantics/publishedVersio

Clinical Predictors and Prognostic Impact of Recovery of Wall Motion Abnormalities in Takotsubo Syndrome: Results From the International Takotsubo Registry

Background-Left ventricular (LV) recovery in takotsubo syndrome (TTS) occurs over a wide-ranging interval, varying from hours to weeks. We sought to investigate the clinical predictors and prognostic impact of recovery time for TTS patients.Methods and Results-TTS patients from the International Takotsubo Registry were included in this study. Cut-off for early LV recovery was determined to be 10 days after the acute event. Multivariable logistic regression was used to assess factors associated with the absence of early recovery. In-hospital outcomes and 1-year mortality were compared for patients with versus without early recovery. We analyzed 406 patients with comprehensive and serial imaging data regarding time to recovery. Of these, 191 (47.0%) had early LV recovery and 215 (53.0%) demonstrated late LV improvement. Patients without early recovery were more often male (12.6% versus 5.2%; P=0.011) and presented more frequently with typical TTS (76.3% versus 67.0%, P=0.040). Cardiac and inflammatory markers were higher in patients without early recovery than in those with early recovery. Patients without early recovery showed unfavorable 1-year outcome compared with patients with early recovery (P=0.003). On multiple logistic regression, male sex, LV ejection fraction <45%, and acute neurologic disorders were associated with the absence of early recovery.Conclusions-TTS patients without early LV recovery have different clinical characteristics and less favorable 1-year outcome compared with patients with early recovery. The factors associated with the absence of early recovery included male sex, reduced LV ejection fraction, and acute neurologic events

Ethnic comparison in takotsubo syndrome: novel insights from the International Takotsubo Registry

Background Ethnic disparities have been reported in cardiovascular disease. However, ethnic disparities in takotsubo syndrome (TTS) remain elusive. This study assessed differences in clinical characteristics between Japanese and European TTS patients and determined the impact of ethnicity on in-hospital outcomes.Methods TTS patients in Japan were enrolled from 10 hospitals and TTS patients in Europe were enrolled from 32 hospitals participating in the International Takotsubo Registry. Clinical characteristics and in-hospital outcomes were compared between Japanese and European patients.Results A total of 503 Japanese and 1670 European patients were included. Japanese patients were older (72.6 +/- 11.4 years vs. 68.0 +/- 12.0 years; p Conclusion Differences in clinical characteristics and in-hospital outcomes between Japanese and European TTS patients exist. Ethnicity does not impact the outcome in TTS patients. The worse in-hospital outcome in Japanese patients, is mainly driven by the higher prevalence of physical triggers.</p

Angiographic analysis of patients with stent implantation of the left main coronary artery and balloon angioplasty of the side branch

Hintergrund: Perkutane Koronarinterventionen (PTCA) von Stenosen im distalen Bereich des Hauptstammes der linken Koronararterie mit Beteiligung der Bifurkation sind mit deutlich schlechteren Langzeit-Ergebnissen assoziiert als PTCAs von Stenosen im Bereich des ostialen und des medialen Hauptstammes. Zahlreiche Techniken wurden zur Behandlung von Stenosen im Bereich der distalen Bifurkation untersucht, inklusive Ein-Stent- und Zweistentstrategien. Die bisherigen Ergebnisse deuten an, dass die Einstentstrategie der Zweistentstrategie überlegen ist. Eine Strategie, in der die Stenose des Hauptstammes der linken Koronararterie mittels Stent-Implantation behandelt wird und der ostiale LCx mittels eines medikamenten-beschichteten Ballons behandelt wird, wurde bisher nicht untersucht. In dieser Studie haben wir diese Strategie angiographisch analysiert, in der die Stenosen im Hauptstamm mit einer Stent-Implantation behandelt wurden und der Seitenast entweder mittels eines konventionellen Ballons oder aber mittels eines medikamenten- beschichteten Ballons behandelt wurde. Methode: In diese Studie wurden Patienten eingeschlossen, die sich zu einer elektiven PTCA einer Stenose im distalen Bereich des Hauptstammes der linken Koronararterie vorgestellt haben. Bei allen Patienten wurde zunächst die Stenose des Hauptstammes mittels eines medikamenten-beschichteten Stents versorgt, gefolgt von einer Ballondilatation in Doppelballontechnik des Hauptstammes und der ostialen Ramus circumflex (LCX) entweder mittels medikamenten-beschichteten Ballon im Seitenast (DEB Gruppe) oder mittels konventionellem Ballon im Seitenast (Kontroll-Gruppe). Klinische und angiographische Parameter wurden zwischen beiden Gruppen während der initialen Untersuchung und nach 6 Monaten im klinischen und angiographischen Follow-up miteinander verglichen. Resultate: 20 Patienten wurden in dieser Studie eingeschlossen (12 Patienten in der DEB Gruppe und 8 Patienten in der Kontroll-Gruppe). Es zeigten sich weder in den klinischen Parametern vor der Untersuchung noch in den angiographischen Parametern vor der PTCA zwischen beiden Gruppen signifikante Unterschiede. Bei allen Patienten erfolgte die Intervention erfolgreich und es traten keine periprozeduralen Komplikationen auf. Postinterventionell und in der Kontrollkoronarangiographie nach 6 Monaten zeigten sich angiographisch keine signifikanten Unterschiede bezüglich des Hauptstammes der linken Koronararterie und bezüglich der LCx zwischen den beiden Gruppen. Es zeigte sich jedoch angiographisch ein signifikant geringerer später Lumendurchmesserverlust in der DEB-Gruppe (DEB-Gruppe: 0,06 +/- 0,76 mm im Vergleich zu der Kontroll-Gruppe: -1,34+/- 0,51 mm, p= 0,001). Weiterhin zeigte sich klinisch ein deutlich geringerer Trend bezüglich der erneuten Revaskularisationsrate im Zielgefäß in der DEB-Gruppe (DEB 0% (0/12) im Vergleich zu der Kontroll-Gruppe: 25% (2/8)). Schlussfolgerung: Eine interventionelle Strategie mit Stent-Implantation des Hauptstammes der linken Koronararterie und PTCA mittels medikamenten-beschichteten Ballon der LCx ist sicher und reduziert signifikant den späten Lumendurchmesserverlust der LCX.Background: Percutaneous coronary intervention (PCI) of distal unprotected left main (UPLM) lesions are associated with worse outcomes than those following PCI of disease confined to the ostium or mid shaft. Various techniques have been used to treat distal ULM disease including single-vessel and two-vessel stenting. Comparisons between conventional and drug eluting balloon strategies for treatment of the side branch in UPLM coronary bifurcation disease are rare. This study assessed the angiographic impact in patients with distal left main disease. Methods: Patients undergoing non- emergent PCI for distal ULM coronary disease comprised the study cohort. All patients underwent PCI and drug eluting stenting of the LCA towards the LAD (main vessel) and kissing balloon of the main vessel and side vessel using either a conventional balloon or a drug eluting balloon for the CX (side vessel). Baseline characteristics and angiographic outcomes at follow-up were compared for patients undergoing PCI of the side branch with a conventional balloon versus PCI using a drug eluting balloon Results: 20 patients (12 in a DEB Group vs. 8 in the control group) underwent treatment of distal UPLM coronary disease with PCI. Baseline characteristics of both groups were not significantly different. No periprocedural events occurred in both groups and there were no MACE in both groups after 6 month. Angiographic results at baseline and at the follow-up for the main vessel did not differ significantly in both groups (main vessel minimum lumen diameter before PCI: DEB: Median: 1,475 mm; Q1: 1,015 mm; Q3: 2,1575 mm vs control: Median: 2,34 mm; Q1: 1,565 mm; Q3: 2,7 mm, p=0,11, main vessel minimum lumen diameter after PCI: DEB 2,89 +/- 0,46 mm vs control: 3,39 +/- 0,63 mm, p=0,69, main vessel minimum lumen diameter at follow-up: DEB: Median: 3 mm; Q1: 2,75 mm; Q3: 3,21 mm vs control: Median: 2,88 mm; Q1: 2,7 mm; Q3 3,1 mm, p=0,77; acute gain: DEB 1,29 +/- 0,56 mm vs control: 1,08+/- 0,75 mm, p=0,925 and late loss (DEB 0,03 +/- 0,47 mm vs control: -0,31+/- 0,71 mm, p= 0,176). Angiographic results at baseline and at the follow-up for the side vessel did again not differ significantly in both groups (side vessel minimum lumen diameter before PCI: DEB 1,91 +/- 0,82 mm vs control: 1,84 +/- 0,86 mm, p=0,91, side vessel minimum lumen diameter after PCI of the main vessel: DEB 1,36 +/- 0,65 mm vs control: 1,33 +/- 0,67 mm, p=0,93; side vessel minimum lumen diameter after kissing balloon: DEB 2,11 +/- 0,63 mm vs control: 2,06 +/- 0,74 mm, p=0,88; side vessel minimum lumen diameter at follow-up: DEB 2,28 +/- 0,76 mm vs control: 1,86 +/- 0,42 mm, p=0,232),; acute gain: DEB 0,31 +/- 0,85 mm vs control: 1,35+/- 0,9 mm, p=0,3. However there was a significantly lower late loss in the DEB group (DEB 0, 06 +/- 0, 76 mm vs control: -1, 34+/- 0,51 mm, p= 0,001) and less target vessel revascularisation (TVR) in the DEB group (DEB 0% (0/12) vs control: 25% (2/8)): Conclusion: Using PCI with a drug eluting balloon strategy for treatment of the side branch in UPLM coronary bifurcation disease is safe, significantly reduces late loss and reduces the rate of TV

Impact of Atrial Fibrillation on Outcome in Takotsubo Syndrome: Data From the International Takotsubo Registry

Background Atrial fibrillation (AF) is a major risk factor for mortality. The prevalence, clinical correlates, and prognostic impact of AF in Takotsubo syndrome (TTS) have not yet been investigated in a large patient cohort. This study aimed to investigate the prevalence, clinical correlates, and prognostic impact of AF in patients with TTS. Methods and Results Patients with TTS were enrolled from the International Takotsubo Registry, which is a multinational network with 26 participating centers in Europe and the United States. Patients were dichotomized according to the presence or absence of AF at the time of admission. Of 1584 patients with TTS, 112 (7.1%) had AF. The mean age was higher (P<0.001), and there were fewer women (P=0.046) in the AF than in the non-AF group. Left ventricular ejection fraction was significantly lower (P=0.001), and cardiogenic shock was more often observed (P<0.001) in the AF group. Both in-hospital (P<0.001) and long-term mortality (P<0.001) were higher in the AF group. Multivariable Cox regression analysis revealed that AF was independently associated with higher long-term mortality (hazard ratio, 2.31; 95% CI, 1.50-3.55; P<0.001). Among patients with AF on admission, 42% had no known history of AF before the acute TTS event, and such patients had comparable in-hospital and long-term outcomes compared with those with a history of AF. Conclusions In patients presenting with TTS, AF on admission is significantly associated with increased in-hospital and long-term mortality rates. Whether antiarrhythmics and/or cardioversion are beneficial in TTS with AF should thus be tested in a future trial. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01947621