23 results on '"Tay, Edgar"'
Search Results
2. Clinical and echocardiographic features of paradoxical low-flow and normal-flow severe aortic stenosis patients with concomitant mitral regurgitation
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Ngiam, Jinghao Nicholas, Chew, Nicholas, Teng, Rebecca, Kochav, Jonathan D., Kochav, Stephanie M., Tan, Benjamin Yong-Qiang, Sim, Hui Wen, Sia, Ching-Hui, Kong, William K. F., Tay, Edgar Lik Wui, Yeo, Tiong-Cheng, and Poh, Kian-Keong
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- 2020
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3. Left ventricular remodelling in bicuspid aortic valve disease.
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Butcher, Steele C, Pio, Stephan M, Kong, William K F, Singh, Gurpreet K, Ng, Arnold C T, Perry, Rebecca, Sia, Ching-Hui, Poh, Kian Keong, Almeida, Ana G, González, Ariana, Shen, Mylène, Yeo, Tiong Cheng, Shanks, Miriam, Popescu, Bogdan A, Gay, Laura Galian, Fijałkowski, Marcin, Liang, Michael, Tay, Edgar, Marsan, Nina Ajmone, and Selvanayagam, Joseph
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RESEARCH ,REPORTING of diseases ,CONFIDENCE intervals ,VENTRICULAR remodeling ,CONGENITAL heart disease ,ACQUISITION of data ,MEDICAL records ,DESCRIPTIVE statistics ,AORTIC valve diseases ,SYMPTOMS - Abstract
Aims Characterization of left ventricular (LV) geometric pattern and LV mass could provide an important insight into the pathophysiological adaptations of the LV to pressure and/or volume overload in patients with bicuspid aortic valve (BAV) and significant (≥moderate) aortic valve (AV) disease. This study aimed to characterize LV remodelling and its prognostic impact in patients with BAV according to the predominant type of valvular dysfunction. Methods and results In this international, multicentre BAV registry, 1345 patients [51.0 (37.0–63.0) years, 71% male] with significant AV disease were identified. Patients were classified as having isolated aortic stenosis (AS) (n = 669), isolated aortic regurgitation (AR) (n = 499) or mixed aortic valve disease (MAVD) (n = 177). LV hypertrophy was defined as a LV mass index >115 g/m
2 in males and >95 g/m2 in females. LV geometric pattern was classified as (i) normal geometry: no LV hypertrophy, relative wall thickness (RWT) ≤0.42, (ii) concentric remodelling: no LV hypertrophy, RWT >0.42, (iii) concentric hypertrophy: LV hypertrophy, RWT >0.42, and (iv) eccentric hypertrophy: LV hypertrophy, RWT ≤0.42. Patients were followed-up for the endpoints of event-free survival (defined as a composite of AV repair/replacement and all-cause mortality) and all-cause mortality. Type of AV dysfunction was related to significant variations in LV remodelling. Higher LV mass index, i.e. LV hypertrophy, was independently associated with the composite endpoint for patients with isolated AS [hazard ratio (HR) 1.08 per 25 g/m2 , 95% confidence interval (CI) 1.00–1.17, P = 0.046] and AR (HR 1.19 per 25 g/m2 , 95% CI 1.11–1.29, P < 0.001), but not for those with MAVD. The presence of concentric remodelling, concentric hypertrophy and eccentric hypertrophy were independently related to the composite endpoint in patients with isolated AS (HR 1.54, 95% CI 1.06–2.23, P = 0.024; HR 1.68, 95% CI 1.17–2.42, P = 0.005; HR 1.59, 95% CI 1.03–2.45, P = 0.038, respectively), while concentric hypertrophy and eccentric hypertrophy were independently associated with the combined endpoint for those with isolated AR (HR 2.49, 95% CI 1.35–4.60, P = 0.004 and HR 3.05, 95% CI 1.71–5.45, P < 0.001, respectively). There was no independent association observed between LV remodelling and the combined endpoint for patients with MAVD. Conclusions LV hypertrophy or remodelling were independently associated with the composite endpoint of AV repair/replacement and all-cause mortality for patients with isolated AS and isolated AR, although not for patients with MAVD. [ABSTRACT FROM AUTHOR]- Published
- 2022
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4. Novel predictive role for mid-regional proadrenomedullin in moderate to severe aortic stenosis.
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Tan, Eugene S. J., Yen Yee Oon, Siew Pang Chan, Oi Wah Liew, Chong, Jenny P. C., Tay, Edgar, Wern Miin Soo, Yip, James W. L., Gong, Lingli, Lunaria, Josephine B., Quek Wei Yong, Min Lee, Evelyn, Yeo, Daniel P. S., Zee Pin Ding, Hak Chiaw Tang, See Hooi Ewe, Chin, Calvin C. W., Siang Chew Chai, A. Mark, Ping Ping Goh, and Lee Fong Ling
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LEFT heart ventricle ,RESEARCH ,RESEARCH methodology ,AORTIC stenosis ,PROTEIN precursors ,PROGNOSIS ,EVALUATION research ,ATRIAL natriuretic peptides ,COMPARATIVE studies ,STROKE volume (Cardiac output) ,PEPTIDE hormones ,HEART physiology ,HEART failure ,PEPTIDES - Abstract
Objective: We investigated the prognostic significance of selected known and novel circulating biomarkers in aortic stenosis (AS).Methods: N-terminal pro-BNP (NT-proBNP), high-sensitivity troponin-T (hsTnT), growth differentiation factor-15 (GDF-15), suppression of tumorigenicity-2 (ST2), mid-regional proadrenomedullin (MR-proADM) and mid-regional proatrial natriuretic peptide (MR-proANP) were measured in patients with moderate to severe AS, New York Heart Association (NYHA) class I-II and left ventricular ejection fraction ≥50%, recruited consecutively across five centres from 2011 to 2018. Their ability to predict both primary (all-cause mortality, heart failure hospitalisation or progression to NYHA class III-IV) and secondary (additionally incorporating syncope and acute coronary syndrome) outcomes was determined by competing risk analyses.Results: Among 173 patients with AS (age 69±11 years, 55% male, peak transaortic velocity (Vmax) 4.0±0.8 m/s), the primary and secondary outcomes occurred in 59 (34%) and 66 (38%), respectively. With aortic valve replacement as a competing risk, the primary outcome was determined consistently by the comorbidity index and each selected biomarker except ST2 (p<0.05), independent of NYHA class, Vmax, LV-global longitudinal strain and serum creatinine. MR-proADM had the highest discriminative value for both primary (subdistribution HR (SHR) 11.3, 95% CI 3.9 to 32.7) and secondary outcomes (SHR 12.6, 95% CI 4.7 to 33.5). Prognostic assessment of dual-biomarker combinations identified MR-proADM plus either hsTnT or NT-proBNP as the best predictive model for both clinical outcomes. Paired biomarker models were not superior to those including MR-proADM as the sole circulating biomarker.Conclusion: MR-proADM most powerfully portended worse prognosis and should be further assessed as possibly the biomarker of choice for risk stratification in AS. [ABSTRACT FROM AUTHOR]- Published
- 2022
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5. Validation of aortic valve calcium quantification thresholds measured by computed tomography in Asian patients with calcific aortic stenosis.
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Guzzetti, Ezequiel, Oh, Jin Kyung, Shen, Mylène, Dweck, Marc R, Poh, Kian Keong, Abbas, Amr E, Mando, Ramy, Pressman, Gregg S, Brito, Daniel, Tastet, Lionel, Pawade, Tania, Falconi, Mariano Luis, Arenaza, Diego Perez de, Kong, William, Tay, Edgar, Pibarot, Philippe, Song, Jae-Kwan, and Clavel, Marie-Annick
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REFERENCE values ,AORTIC stenosis ,CALCINOSIS ,DESCRIPTIVE statistics ,COMPUTED tomography ,HEMODYNAMICS ,ETHNIC groups ,AORTIC valve - Abstract
Aims Sex-specific thresholds of aortic valve calcification (AVC) have been proposed and validated in Caucasians. Thus, we aimed to validate their accuracy in Asians. Methods and results Patients with calcific aortic stenosis (AS) from seven international centres were included. Exclusion criteria were ≥moderate aortic/mitral regurgitation and bicuspid valve. Optimal AVC and AVC-density sex-specific thresholds for severe AS were obtained in concordant grading and normal flow patients (CG/NF). We included 1263 patients [728 (57%) Asians, 573 (45%) women, 837 (66%) with CG/NF]. Mean gradient was 48 (26–64) mmHg and peak aortic velocity 4.5 (3.4–5.1) m/s. Optimal AVC thresholds were: 2145 Agatston Units (AU) in men and 1301 AU in women for Asians; and 1885 AU in men and 1129 AU in women for Caucasians. Overall, accuracy (% correctly classified) was high and comparable either using optimal or guidelines' thresholds (2000 AU in men, 1200 AU in women). However, accuracy was lower in Asian women vs. Caucasian women (76–78% vs. 94–95%; P < 0.001). Accuracy of AVC-density (476 AU/cm
2 in men and 292 AU/cm2 in women) was comparable to absolute AVC in Caucasians (91% vs. 91%, respectively, P = 0.74), but higher than absolute AVC in Asians (87% vs. 81%, P < 0.001). There was no interaction between AVC/AVC-density and ethnicity (all P > 0.41) with regards to AS haemodynamic severity. Conclusion AVC thresholds defining severe AS are comparable in Asian and Caucasian populations, and similar to those proposed in the guidelines. However, accuracy of AVC to identify severe AS in Asians (especially women) is sub-optimal. Therefore, the use of AVC-density is preferable in Asians. [ABSTRACT FROM AUTHOR]- Published
- 2022
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6. Outcomes in transcatheter aortic valve replacement for bicuspid versus tricuspid aortic valve stenosis
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Yoon, Sung-Han, Bleiziffer, Sabine, De Backer, Ole, Delgado, Victoria, Arai, Takahide, Ziegelmueller, Johannes, Barbanti, Marco, Sharma, Rahul, Perlman, Gidon Y, Khalique, Omar K, Holy, Erik W, Saraf, Smriti, Deuschl, Florian, Fujita, Buntaro, Ruile, Philipp, Neumann, Franz-Josef, Pache, Gregor, Takahashi, Masao, Kaneko, Hidehiro, Schmidt, Tobias, Ohno, Yohei, Schofer, Niklas, Kong, William K F, Tay, Edgar, Sugiyama, Daisuke, Kawamori, Hiroyuki, Maeno, Yoshio, Abramowitz, Yigal, Chakravarty, Tarun, Kuwata, Shingo, et al, University of Zurich, and Yoon, Sung-Han
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congenital, hereditary, and neonatal diseases and abnormalities ,aortic Stenosis ,bicuspid aortic valve ,cardiovascular system ,10209 Clinic for Cardiology ,610 Medicine & health ,cardiovascular diseases ,2705 Cardiology and Cardiovascular Medicine ,transcatheter aortic valve implantation ,10020 Clinic for Cardiac Surgery - Published
- 2017
7. Transcatheter aortic valve implantation during the COVID-19 pandemic: Clinical expert opinion and consensus statement for Asia.
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Tay, Edgar L., Hayashida, Kentaro, Chen, Mao, Yin, Wei‐Hsien, Park, Duk‐Woo, Seth, Ashok, Kao, Hsien‐Li, Lin, Mao‐Shin, Ho, Kay‐Woon, Buddhari, Wacin, Chandavimol, Mann, Posas, Fabio‐Enriques, Nguyen, Quang N., Kong, William, Rosli, M. A., Hon, Jimmy, Firman, Doni, Lee, Michael, Yin, Wei-Hsien, and Park, Duk-Woo
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COVID-19 pandemic , *HEART valve prosthesis implantation , *AORTIC stenosis , *COVID-19 , *TREND setters - Abstract
Objectives: The impact of the COVID-19 pandemic on the treatment of patient with aortic valve stenosis is unknown and there is uncertainty on the optimal strategies in managing these patients.Methods: This study is supported and endorsed by the Asia Pacific Society of Interventional Cardiology. Due to the inability to have face to face discussions during the pandemic, an online survey was performed by inviting key opinion leaders (cardiac surgeon/interventional cardiologist/echocardiologist) in the field of transcatheter aortic valve implantation (TAVI) in Asia to participate. The answers to a series of questions pertaining to the impact of COVID-19 on TAVI were collected and analyzed. These led subsequently to an expert consensus recommendation on the conduct of TAVI during the pandemic.Results: The COVID-19 pandemic had resulted in a 25% (10-80) reduction of case volume and 53% of operators required triaging to manage their patients with severe aortic stenosis. The two most important parameters used to triage were symptoms and valve area. Periprocedural changes included the introduction of teleconsultation, preprocedure COVID-19 testing, optimization of protests, and catheterization laboratory set up. In addition, length of stay was reduced from a mean of 4.4 to 4 days.Conclusion: The COVID-19 pandemic has impacted on the delivery of TAVI services to patients in Asia. This expert recommendation on best practices may be a useful guide to help TAVI teams during this period until a COVID-19 vaccine becomes widely available. [ABSTRACT FROM AUTHOR]- Published
- 2020
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8. Echocardiographic discrepancies in severity grading of aortic valve stenosis with left ventricular outflow tract (LVOT) cut-off values in an Asian population.
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Chew, Nicholas W. S., Ngiam, Jinghao Nicholas, Tan, Benjamin Yong-Qiang, Sia, Ching-Hui, Sim, Hui Wen, Kuntjoro, Ivandito, Kong, William K. F., Tay, Edgar L. W., Yeo, Tiong-Cheng, and Poh, Kian Keong
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Inconsistencies in grading of aortic stenosis (AS) severity have been reported. However, it remains to be studied in an Asian population. We investigated consistency of grading AS severity at various left ventricular outflow tract diameter (LVOTd) categories, and postulated alternative cut-offs for more consistent grading of AS severity. Consecutive Asian patients (n = 350) with index echocardiographic diagnosis of severe AS were divided them into three groups based on LVOTd: 'small' (< 20 mm), 'average' (20-22 mm) and 'large' (> 22 mm). In each group, the consistency of flow-dependent (transaortic mean pressure gradient (MG)) and flow-independent parameters (AVA) were used for classification of AS severity. Of 350 patients, 51.7% had small LVOTd, while 30.8% and 17.5% had average and large LVOTd respectively. Consistent grading by LVOTd based on AVA and MG, was seen in 33.7% of patients with small, 47.6% with average, 57.7% with large LVOTd. When an AVA cut-off of 0.9 cm2 was used, consistent grading improved to 38.0% in small, 56.5% in average and 70.0% in large LVOTd. At an AVA cut-off of 0.8 cm2, there was further incremental improvement in the small LVOTd group to 54.1% (p < 0.05). In conclusion, current severe AS guidelines are most inconsistent with those in the small LVOTd group. With majority of the study's Asian population having small LVOTd, this raises concerns that current AS guidelines may overestimate the severity of AS in the Asian cohort. Improved consistency in echocardiographic grading may be attained with a lower AVA cut-off in this Asian cohort. [ABSTRACT FROM AUTHOR]
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- 2020
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9. Mid-term study of transcatheter aortic valve implantation in an Asian population with severe aortic stenosis: two-year Valve Academic Research Consortium-2 outcomes.
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Chew, Nicholas, Kim Fatt, Jimmy, Wei Luen James Yip, Siew Pang Chan, Kian-Keong Poh, Kok-Fai Kong, William, Leok Kheng Teoh, Kristine, Tiong Cheng Yeo, Huay Cheem Tan, Lik Wui Tay, Edgar, Hon, Jimmy Kim Fatt, Yip, Wei Luen James, Chan, Siew Pang, Poh, Kian-Keong, Kong, William Kok-Fai, Teoh, Kristine Leok Kheng, Yeo, Tiong Cheng, Tan, Huay Cheem, and Tay, Edgar Lik Wui
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AORTIC valve transplantation ,AORTIC stenosis ,PATIENT readmissions ,SYMPTOMS ,ASIANS ,PATIENTS - Abstract
Introduction: Transcatheter aortic valve implantation (TAVI) is an effective treatment for high-risk or inoperative patients with severe aortic stenosis. Given the unique characteristics of Asian populations, questions regarding mid-term outcomes in Asians undergoing TAVI have yet to be addressed. We evaluated the two-year clinical outcomes of TAVI in an Asian population using Valve Academic Research Consortium-2 definitions.Methods: This prospective study recruited 59 patients from a major academic medical centre in Singapore. The main outcomes were two-year survival rates, peri-procedural complications, symptom improvement, valvular function and assessment of learning curve.Results: Mean age was 76.8 years (61.0% male), mean body surface area 1.6 m2 and mean logistic EuroSCORE 18.7%. Survival was 93.2%, 86.0% and 79.1% at 30 days, one year and two years, respectively. At 30 days post TAVI, the rate of stroke was 1.7%, life-threatening bleeding 5.1%, acute kidney injury 25.0%, major vascular complication 5.1%, and new permanent pacemaker implantation 6.8%. 29.3% of TAVI patients were rehospitalised (47.1% cardiovascular-related) within one year. These composite outcomes were measured: device success (93.2%); early safety (79.7%); clinical efficacy (66.1%); and time-related valve safety (84.7%). Univariate analysis found these predictors of two-year all-cause mortality: logistic EuroSCORE (hazard ratio [HR] 1.07; p < 0.001); baseline estimated glomerular filtration rate (HR 0.97; p = 0.048); and acute kidney injury (HR 5.33; p = 0.022). Multivariate analysis identified non-transfemoral TAVI as a predictor of cardiovascular-related two-year mortality (HR 14.64; p = 0.008).Conclusion: Despite the unique clinical differences in Asian populations, this registry demonstrated favourable mid-term clinical and safety outcomes in Asians undergoing TAVI. [ABSTRACT FROM AUTHOR]- Published
- 2017
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10. Clinical Outcomes Following Transcatheter Aortic Valve Replacement in Asian Population.
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Yoon, Sung-Han, Ahn, Jung-Min, Hayashida, Kentaro, Watanabe, Yusuke, Shirai, Shinichi, Kao, Hsien-Li, Yin, Wei-Hsian, Lee, Michael Kang-yin, Tay, Edgar, Araki, Motoharu, Yamanaka, Futoshi, Arai, Takahide, Lin, Mao-Shin, Park, Jun-Bean, Park, Duk-Woo, Kang, Soo-Jin, Lee, Seung-Whan, Kim, Young-Hak, Lee, Cheol Whan, and Park, Seong-Wook
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Objectives This study describes the characteristics of a real-world Asian patient population treated with transcatheter aortic valve replacement (TAVR) and evaluates their clinical outcomes. Background No previously reported randomized or observational studies adequately assess the safety and efficacy of TAVR in an Asian population. Methods The Asian TAVR registry is an international multicenter study that enrolled patients with aortic stenosis who underwent TAVR in Asian countries. Results In total, 848 patients with mean STS score of 5.2 ± 3.8% were enrolled between March 2010 and September 2014 at 11 centers in 5 countries. The Edwards Sapien or Medtronic CoreValve was implanted in 64.7% and 35.3% of patients, respectively. The procedural success rate was 97.5%. The 30-day and 1-year mortality rates were 2.5% and 10.8%, respectively. There was no difference in 1-year mortality between devices (Sapien: 9.4%; CoreValve: 12.2%; log-rank p = 0.40). The rates of stroke, life-threatening bleeding, major vascular complications and acute kidney injury (stage 2 to 3) were 3.8%, 6.4%, 5.0% and 3.3%, respectively. Moderate or severe paravalvular leakage was significantly more common with the CoreValve than Sapien (14.4% vs. 7.3%; p = 0.001). According to the multivariate model, a higher STS score, lower body mass index, New York Heart Association functional class III–IV symptoms, diabetes mellitus, prior cerebrovascular accident, low mean gradient at baseline, and moderate or severe paravalvular leakage were significantly associated with reduced survival. Conclusions Despite anatomical features of concern, the clinical outcomes of TAVR in our Asian population were favorable in comparison with those of previously published trials and observational studies. (The Asian Transcatheter Aortic Valve Replacement Registry [Asian TAVR]; NCT02308150 ) [ABSTRACT FROM AUTHOR]
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- 2016
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11. Management of severe aortic stenosis: the Singapore and Asian perspective.
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Edgar Lik Wui Tay, Ngiam, Jinghao Nicholas, Kong, William K. F., Kian-Keong Poh, Tay, Edgar Lik Wui, Kong, William Kf, and Poh, Kian-Keong
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AORTIC stenosis treatment ,AORTIC valve ,AORTIC stenosis ,ASIANS ,CARDIOLOGY ,CARDIOVASCULAR surgery ,RELATIVE medical risk ,SEVERITY of illness index - Abstract
An editorial is presented which discusses the management of aortic valve stenosis (AS). Mentioned is the decision of the American College of Cardiology on updating guidelines on the management of valvular heart diseases. Tackled is the statistics conducted by the World Health Organization on the treatment of AS.
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- 2018
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12. Multislice Computed Tomography for Prediction of Optimal Angiographic Deployment Projections During Transcatheter Aortic Valve Implantation.
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Gurvitch, Ronen, Wood, David A., Leipsic, Jonathon, Tay, Edgar, Johnson, Mark, Ye, Jian, Nietlispach, Fabian, Wijesinghe, Namal, Cheung, Anson, and Webb, John G.
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AORTIC stenosis ,TOMOGRAPHY ,ARTERIAL catheters ,ARTIFICIAL implants ,AORTIC valve surgery ,ANGIOGRAPHY - Abstract
Objectives: This study assessed whether multislice computed tomography (MSCT) could predict optimal angiographic projections for visualizing the plane of the native valve and facilitate accurate positioning during transcatheter aortic valve implantation (TAVI). Background: Accurate device positioning during TAVI depends on valve deployment in angiographic projections perpendicular to the native valve plane, but these may be difficult to determine. Methods: Twenty patients underwent MSCT before TAVI. Using a novel technique, multiple angiographic projections accurately representing the native valve plane in multiple axes were determined. The accuracy of all predicted projections was determined post-procedure using angiography according to new criteria, based on valve perpendicularity and the degree of strut overlap (defined as excellent, satisfactory, or poor). The accuracy of valve deployment using MSCT was compared with the results of 20 consecutive patients undergoing TAVI without such MSCT angle prediction. Results: Correct final deployment projections were more frequent in the MSCT-guided compared with non–MSCT-guided group: excellent or satisfactory projections (90% vs. 65%, p = 0.06). The MSCT angle prediction was accurate but dependent on optimal images (optimal images: 93% of predicted angles were excellent or satisfactory, suboptimal images: 73% of predicted angles were poor). A “line of perpendicularity” could be generated with optimal projections across the right-to-left anterior oblique plane by adding the correct cranial or caudal angulation. Conclusions: Pre-procedural MSCT can predict optimal angiographic deployment projections for implantation of transcatheter valves. An ideal deployment angle curve or “line of perpendicularity” can be generated. Understanding and applying these principles improves the accuracy of valve deployment and may improve outcomes. [ABSTRACT FROM AUTHOR]
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- 2010
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13. Transcatheter Aortic Valve Implantation in Patients With Bicuspid Aortic Valve Stenosis.
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Wijesinghe, Namal, Ye, Jian, Rodés-Cabau, Josep, Cheung, Anson, Velianou, James L., Natarajan, Madhu K., Dumont, Eric, Nietlispach, Fabian, Gurvitch, Ronen, Wood, David A., Tay, Edgar, and Webb, John G.
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MITRAL valve ,AORTIC stenosis ,TRANSESOPHAGEAL echocardiography ,THORACIC surgeons ,AORTIC valve surgery ,ARTIFICIAL implants ,FEMORAL artery ,HEMODYNAMICS ,SURGERY ,SOCIETIES - Abstract
Objectives: We evaluated transcatheter aortic valve implantation (TAVI) in high-risk patients with bicuspid aortic valve (BAV) stenosis. Background: TAVI shows promise in the treatment of severe stenosis of triscupid aortic valves, especially in high-risk patients. However, BAV stenosis has been considered a contraindication to TAVI. Methods: Eleven patients (age 52 to 90 years) with symptomatic severe BAV stenosis underwent TAVI at 3 Canadian tertiary hospitals between May 2006 and April 2010. All patients were considered high risk for surgical aortic valve replacement. Edwards-SAPIEN transcatheter heart valves (Edwards Lifesciences, Inc., Irvine, California) were used. Transfemoral or transapical access was selected, depending on the adequacy of femoral access. Results: Access was transfemoral in 7 patients and transapical in 4 patients. There were no intraprocedural complications. Significant symptomatic and hemodynamic improvement was observed in 10 of 11 patients. Baseline aortic valve area of 0.65 ± 0.17 cm
2 and mean transaortic pressure gradient of 41 ± 22.4 mm Hg were improved to 1.45 ± 0.3 cm2 and 13.4 ± 5.7 mm Hg, respectively. Two patients had moderate perivalvular leaks. At the 30-day follow-up there were 2 deaths due to multisystem failure in 2 transapical patients. In 1 patient an undersized, suboptimally positioned, unstable valve required late conversion to open surgery. Conclusions: TAVI in selected high-risk patients with severe BAV stenosis can be successfully performed with acceptable clinical outcomes but will require further evaluation. [ABSTRACT FROM AUTHOR]- Published
- 2010
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14. Impact of Left Ventricular Ejection Fraction on Clinical Outcomes in Bicuspid Aortic Valve Disease.
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Hecht, Sébastien, Butcher, Steele C., Pio, Stephan M., Kong, William K.F., Singh, Gurpreet K., Ng, Arnold C.T., Perry, Rebecca, Poh, Kian Keong, Almeida, Ana G., González, Ariana, Shen, Mylène, Yeo, Tiong Cheng, Shanks, Miriam, Popescu, Bogdan A., Gay, Laura Galian, Fijałkowski, Marcin, Liang, Michael, Tay, Edgar, Marsan, Nina Ajmone, and Selvanayagam, Joseph
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AORTIC valve diseases , *MITRAL valve , *VENTRICULAR ejection fraction , *AORTIC valve , *TREATMENT effectiveness , *AORTIC valve insufficiency , *HEART failure - Abstract
Background: The prognostic impact of left ventricular ejection fraction (LVEF) in patients with bicuspid aortic valve (BAV) disease has not been previously studied.Objectives: The purpose of this study was to determine the prognostic impact of LVEF in BAV patients according to the type of aortic valve dysfunction.Methods: We retrospectively analyzed the data collected in 2,672 patients included in an international registry of patients with BAV. Patients were classified according to the type of aortic valve dysfunction: isolated aortic stenosis (AS) (n = 749), isolated aortic regurgitation (AR) (n = 554), mixed aortic valve disease (MAVD) (n = 190), or no significant aortic valve dysfunction (n = 1,179; excluded from this analysis). The study population was divided according to LVEF strata to investigate its impact on clinical outcomes.Results: The risk of all-cause mortality and the composite endpoint of aortic valve replacement or repair (AVR) and all-cause mortality increased when LVEF was <60% in the whole cohort as well as in the AS and AR groups, and when LVEF was <55% in MAVD group. In multivariable analysis, LVEF strata were significantly associated with increased rate of mortality (LVEF 50%-59%: HR: 1.83 [95% CI: 1.09-3.07]; P = 0.022; LVEF 30%-49%: HR: 1.97 [95% CI: 1.13-3.41]; P = 0.016; LVEF <30%: HR: 4.20 [95% CI: 2.01-8.75]; P < 0.001; vs LVEF 60%-70%, reference group).Conclusions: In BAV patients, the risk of adverse clinical outcomes increases significantly when the LVEF is <60%. These findings suggest that LVEF cutoff values proposed in the guidelines to indicate intervention should be raised from 50% to 60% in AS or AR and 55% in MAVD. [ABSTRACT FROM AUTHOR]- Published
- 2022
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15. Assessing the Impact of Transcatheter Aortic Valve Implantation on Cardiac Catheterisation: A Multicentric Study.
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Lim, Yinghao, Gochuico, Carlo Francisco Santos, D'Ascenzo, Fabrizio, Ho, Kay Woon, Lin, Mao-Shin, Gil, Iván J. Núñez, Ielasi, Alfonso, Tespili, Maurizio, Mejía, Alex Castro, DePaoli, Alessandro, Yap, Jonathan, Kao, Hsien-Li, Lee, Michael Kang-Yin, and Tay, Edgar
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HEART valve prosthesis implantation , *HEART valves , *CORONARY angiography , *THORACIC surgery , *CREDIT ratings , *CARDIAC catheterization , *PROSTHETICS , *RESEARCH , *RESEARCH methodology , *AORTIC stenosis , *RETROSPECTIVE studies , *MEDICAL cooperation , *EVALUATION research , *TREATMENT effectiveness , *COMPARATIVE studies , *PROSTHETIC heart valves , *AORTIC valve ,AORTIC valve surgery - Abstract
Background: The success rate of coronary angiography (CA) after transcatheter aortic valve implantation (TAVI) is variable. Our aim was to investigate CA difficulty, outcomes, and predictors of difficult CA after TAVI.Method: This was an international multicentric retrospective cohort study that included patients with TAVI and subsequent CA between January 2010 and December 2019. Difficulty with CA was graded as 1 (normal), 2 (partial engagement, complete vessel opacification), 3 (partial engagement, incomplete vessel opacification), and 4 (unsuccessful angiography). Patients were grouped as (a) "easy" (grade 1 for left and right) or (b) "difficult" (grade >1 for either). We compared baseline characteristics and outcomes, and performed multivariate logistic regression for predictors of difficult CA.Results: Of 96 patients included (mean age 77.4±8.7 years, 48 [50%] male), 88 (92%) had successful CA. Right CA was successful in 80 (83%) patients and left CA in 91 (95%) (p<0.0001). The "difficult" group (n=41 [43%]) had higher Society of Thoracic Surgery (STS) scores (7.6±4.9 vs 5.4±4.0; p=0.022), smaller annulus perimeters (72.4±5.4 mm vs 76.2±9.4 mm; p=0.049), greater use of self-expanding valves (83% vs 18%; p<0.0001), increased valve size (26.8±2.1 mm vs 25.6±3.0 mm; p=0.032), and increased oversizing for area (44.3%±17.4% vs 23.6%±22.0%; p=0.0002) and perimeter (17.5%±8.2% vs 7.1%±10.8%; p<0.0001). There was no difference in outcomes except for increased major bleeding (7.3% vs 0.0%; p=0.042). The strongest predictor for "difficult" CA was self-expanding valves when compared to balloon-expandable valves (adjusted odds ratio [aOR], 15.23; 95% confidence interval [CI], 2.27-102.40). Society of Thoracic Surgery score was borderline predictive (aOR, 1.26; 95% CI, 1.04-1.52).Conclusions: Our results show that after TAVI, CA success rate is high, right CA is more difficult than left, self-expanding valves predispose to difficult CA, and STS score weakly predicts difficult CA. This study is hypothesis-generating and more research is required to confirm these findings. [ABSTRACT FROM AUTHOR]- Published
- 2021
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16. An Asian Perspective on Gender Differences in Clinical Outcomes and Echocardiographic Profiles of Patients With Medically Managed Severe Aortic Stenosis.
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Ngiam, Jinghao Nicholas, Chew, Nicholas, Tan, Yong-Qiang Benjamin, Sim, Hui-Wen, Sia, Ching-Hui, Low, Ting-Ting, Kong, William K.F., Tay, Edgar L., Kang, Giap Swee, Yeo, Tiong-Cheng, and Poh, Kian Keong
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AORTIC stenosis , *HEART valve diseases , *BODY surface area , *DIABETES in women , *AORTIC valve , *AORTIC stenosis treatment , *LEFT heart ventricle , *ECHOCARDIOGRAPHY , *RETROSPECTIVE studies , *DISEASE incidence , *PROGNOSIS , *SEVERITY of illness index , *SEX distribution , *HEART physiology , *STROKE volume (Cardiac output) , *DIASTOLE (Cardiac cycle) , *DISEASE management , *LONGITUDINAL method ,AORTIC valve surgery - Abstract
Background: Gender differences in valvular heart disease are increasingly recognised. A prior study has suggested better surgical outcomes in women with symptomatic aortic stenosis (AS). We investigate gender differences in medically managed severe AS.Method: We studied 347 patients with severe AS (aortic valve area index <0.6 cm2/m2) in terms of baseline clinical background, echocardiographic characteristics, and clinical outcomes. Appropriate univariate and multivariate models were employed, while Kaplan-Meier curves were constructed to compare mortality outcomes.Results: In total, 205 (59%) patients were women. Despite higher incidences of hypertension (75.6% vs 47.3%) and diabetes mellitus (46.5% vs 29.5%) in women, women had improved survival (Kaplan-Meier log-rank = 6.24, p = 0.012). After adjusting for age (hazard ratio [HR], 1.034; 95% confidence interval [CI], 1.014-1.054), hypertension (HR, 1.469; 95% CI, 0.807-2.673), diabetes (HR, 1.219; 95% CI, 0.693-2.145), and indexed aortic valve area (HR 0.145, 95% CI 0.031-0.684) on multivariate analyses, female gender remained independently associated with lower mortality (HR, 0.561; 95%, CI 0.332-0.947). Women tended to have smaller body surface area (BSA), left ventricular (LV) internal diastolic diameter, and smaller LV outflow tract diameter but were similar to men in terms of LV ejection fraction, AS severity, and patterns of LV remodelling.Conclusions: Women appeared to have better outcomes compared to men in medically managed severe AS. These gender differences warrant further study and may affect prognosis, follow-up, and timing of valve surgery. [ABSTRACT FROM AUTHOR]- Published
- 2021
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17. Differences in Clinical and Echocardiographic Profiles and Outcomes of Patients With Atrial Fibrillation Versus Sinus Rhythm in Medically Managed Severe Aortic Stenosis and Preserved Left Ventricular Ejection Fraction.
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Chew, Nicholas W.S., Ngiam, Jinghao Nicholas, Tan, Benjamin Yong-Qiang, Sia, Ching-Hui, Sim, Hui-Wen, Kong, William K.F., Tay, Edgar L.W., Yeo, Tiong Cheng, and Poh, Kian Keong
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ATRIAL fibrillation , *VENTRICULAR ejection fraction , *AORTIC stenosis , *LEFT ventricular hypertrophy , *HEART failure , *BODY mass index - Abstract
Background: Atrial fibrillation (AF) results in the loss of atrial booster pump function and portends poorer outcome in aortic valve stenosis (AS). However, its characteristics and impact on medically managed AS remained under-recognised. We compared these patients with AF to sinus rhythm (SR).Method: In total, 347 consecutive patients with medically managed severe AS (aortic valve area <1 cm2) and preserved left ventricular ejection fraction (>50%) were studied, in terms of echocardiographic characteristics and clinical outcomes. Appropriate univariate and multivariate models were used, while Kaplan-Meier curves and Cox regression models were constructed to compare clinical outcomes (mortality, admissions for congestive cardiac failure, and stroke).Results: Ninety (90) (25.9%) patients had AF. Patients with AF had lower body mass index (BMI 18.5±10.4 vs 23.8±6.2 g/m2; p<0.001), larger left ventricular mass index (LVMI 127.9±39.0 vs 116.7±36.5; p=0.017), and left atrial volume index (53.2±20.0 vs 31.0±9.2 mL/m2; p=0.004). Atrial fibrillation was associated with higher mortality (52.2% vs 37.4%; Kaplan-Meier log-rank 7.18; p=0.007), admissions for congestive cardiac failure (log-rank 6.42; p=0.011), and poorer composite outcomes (log-rank 6.29; p=0.012). The incidence of stroke in both groups were similar on follow-up (log-rank 0.08; p=0.776). After adjusting for age, BMI, LVMI, and left atrial volume index on Cox regression, AF remained independently associated with poorer composite clinical outcomes (hazard ratio, 1.66; 95% confidence interval 1.07-2.58).Conclusions: Atrial fibrillation remained an important comorbidity affecting a quarter of patients with medically managed severe AS. It was independently associated with poorer clinical outcomes and may thus aid in prognostication and management. [ABSTRACT FROM AUTHOR]- Published
- 2020
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18. Transcatheter Aortic Valve Replacement With Early- and New-Generation Devices in Bicuspid Aortic Valve Stenosis.
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Yoon, Sung-Han, Lefèvre, Thierry, Ahn, Jung-Ming, Perlman, Gidon Y., Dvir, Danny, Latib, Azeem, Barbanti, Marco, Deuschl, Florian, De Backer, Ole, Blanke, Philipp, Modine, Thomas, Pache, Gregor, Neumann, Franz-Josef, Ruile, Philipp, Arai, Takahide, Ohno, Yohei, Kaneko, Hidehiro, Tay, Edgar, Schofer, Niklas, and Holy, Erik W.
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ARTERIAL stenosis treatment , *ARTERIAL stenosis , *AORTIC valve transplantation , *BICUSPIDS , *HEALTH outcome assessment , *PATIENTS , *SURGERY , *AORTIC valve abnormalities , *PROSTHETIC heart valves , *AORTIC stenosis , *COMPARATIVE studies , *HEART valve diseases , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH , *PRODUCT design , *EVALUATION research , *DISEASE complications , *EQUIPMENT & supplies ,AORTIC valve surgery - Abstract
Background: Few studies have evaluated the clinical outcomes of transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve stenosis (AS). Particularly, limited data exist comparing the results of TAVR with new-generation devices versus early-generation devices.Objectives: This study sought to evaluate the clinical outcomes of TAVR for bicuspid AS with early- and new-generation devices.Methods: The Bicuspid TAVR Registry is an international multicenter study enrolling consecutive patients with bicuspid AS undergoing TAVR between April 2005 and May 2015.Results: Of 301 patients, 199 patients (71.1%) were treated with early-generation devices (Sapien XT [Edwards Lifesciences Corporation, Irvine, California]: n = 87; CoreValve [Medtronic, Minneapolis, Minnesota]: n = 112) and 102 with new-generation devices (Sapien 3 [Edwards Lifesciences Corporation]: n = 91; Lotus [Boston Scientific Corporation, Marlborough, Massachusetts]: n = 11). The mean Society of Thoracic Surgeons score was 4.7 ± 5.2 without significant differences between groups (4.6 ± 5.1 vs. 4.9 ± 5.4; p = 0.57). Overall, all-cause mortality rates were 4.3% at 30 days and 14.4% at 1 year. Moderate or severe paravalvular leak was absent and significantly less frequent with new-generation compared to early-generation devices (0.0% vs. 8.5%; p = 0.002), which resulted in a higher device success rate (92.2% vs. 80.9%; p = 0.01). There were no differences between early- and new-generation devices in stroke (2.5% vs. 2.0%; p > 0.99), life-threatening bleeding (3.5% vs. 2.9%; p > 0.99), major vascular complication (4.5% vs. 2.9%; p = 0.76), stage 2 to 3 acute kidney injury (2.5% vs. 2.9%; p > 0.99), early safety endpoints (15.1% vs. 10.8%; p = 0.30), and 30-day all-cause mortality (4.5% vs. 3.9%; p > 0.99).Conclusions: The clinical outcomes of TAVR in patients with bicuspid AS were favorable. New-generation devices were associated with less paravalvular leak and, hence, a higher device success rate than early-generation devices. (The Bicuspid Aortic Stenosis Following Transcatheter Aortic Valve Replacement Registry [Bicuspid TAVR]; NCT02394184). [ABSTRACT FROM AUTHOR]- Published
- 2016
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19. THE ETHNIC GAP IN CLINICAL OUTCOMES OF SIGNIFICANT AORTIC STENOSIS IN THE ASIAN POPULATION.
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Chew, Nicholas, Ngiam, Nicholas, Cheong, Clare, Kong, Gwyneth, Sia, Ching Hui, Kuntjoro, Ivandito, Wen, Ruan, Kong, William, Tay, Edgar, Yeo, Tiong Cheng, and Poh, Kian Keong
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AORTIC stenosis , *TREATMENT effectiveness , *ASIANS - Published
- 2021
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20. THE ASIAN PERSPECTIVE OF DIMENSIONLESS INDEX IN PATIENTS WITH LOW-GRADIENT SEVERE AORTIC STENOSIS WITH PRESERVED EJECTION FRACTION.
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Chew, Nicholas, Kong, Gwyneth, Ngiam, Nicholas, Cheong, Clare, Sia, Ching Hui, Kuntjoro, Ivandito, Wen, Ruan, Kong, William, Tay, Edgar, Yeo, Tiong Cheng, and Poh, Kian Keong
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AORTIC stenosis - Published
- 2021
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21. Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis
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Jeroen J. Bax, Yigal Abramowitz, Hidehiro Kaneko, Fabian Nietlispach, Niklas Schofer, Thomas Modine, Omar K. Khalique, Tarun Chakravarty, Masao Takahashi, S. Chiu Wong, Ulrich Schaefer, Thierry Lefèvre, Erik W. Holy, Brian Whisenant, Seung-Jung Park, Smriti Saraf, Florian Deuschl, Emmanuel Teiger, Gidon Y. Perlman, Ole De Backer, Yohei Ohno, Christian Butter, Marco Barbanti, Rahul Sharma, Mohamed Abdel-Wahab, Franz-Josef Neumann, Philipp Blanke, Gerald Yong, Antonio Colombo, Hiroyuki Kawamori, Bernard Chevalier, Mamoo Nakamura, Hyo-Soo Kim, Johannes Ziegelmueller, William K.F. Kong, Susheel Kodali, Michael S. Lee, Shingo Kuwata, Sung Han Yoon, Buntaro Fujita, Luca Testa, Edgar Tay, Stephan Ensminger, Daisuke Sugiyama, Corrado Tamburino, Jonathon Leipsic, Hsien-Li Kao, Yoshio Maeno, John G. Webb, Victoria Delgado, David Hildick-Smith, Lars Søndergaard, Takahide Arai, Raj Makkar, Tobias Schmidt, Danny Dvir, Francesco Bedgoni, Azeem Latib, Philipp Ruile, Sabine Bleiziffer, Martin B. Leon, Gregor Pache, Yoon, Sung han, Bleiziffer, Sabine, De Backer, Ole, Delgado, Victoria, Arai, Takahide, Ziegelmueller, Johanne, Barbanti, Marco, Sharma, Rahul, Perlman, Gidon Y., Khalique, Omar K., Holy, Erik W., Saraf, Smriti, Deuschl, Florian, Fujita, Buntaro, Ruile, Philipp, Neumann, Franz josef, Pache, Gregor, Takahashi, Masao, Kaneko, Hidehiro, Schmidt, Tobia, Ohno, Yohei, Schofer, Nikla, Kong, William K. F., Tay, Edgar, Sugiyama, Daisuke, Kawamori, Hiroyuki, Maeno, Yoshio, Abramowitz, Yigal, Chakravarty, Tarun, Nakamura, Mamoo, Kuwata, Shingo, Yong, Gerald, Kao, Hsien li, Lee, Michael, Kim, Hyo soo, Modine, Thoma, Wong, S. Chiu, Bedgoni, Francesco, Testa, Luca, Teiger, Emmanuel, Butter, Christian, Ensminger, Stephan M., Schaefer, Ulrich, Dvir, Danny, Blanke, Philipp, Leipsic, Jonathon, Nietlispach, Fabian, Abdel wahab, Mohamed, Chevalier, Bernard, Tamburino, Corrado, Hildick smith, David, Whisenant, Brian K., Park, Seung jung, Colombo, Antonio, Latib, Azeem, Kodali, Susheel K., Bax, Jeroen J., Sã¸ndergaard, Lar, Webb, John G., Lefãvre, Thierry, Leon, Martin B., and Makkar, Raj
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Aortic valve ,Male ,medicine.medical_treatment ,Heart Valve Diseases ,030204 cardiovascular system & hematology ,Global Health ,aortic stenosis ,bicuspid aortic valve ,transcatheter aortic valve implantation ,Aged ,Aortic Valve ,Aortic Valve Stenosis ,Female ,Humans ,Retrospective Studies ,Survival Rate ,Transcatheter Aortic Valve Replacement ,Treatment Outcome ,Tricuspid Valve ,Heart Valve Prosthesis ,Cardiology and Cardiovascular Medicine ,0302 clinical medicine ,Bicuspid aortic valve ,Bicuspid Aortic Valve Disease ,Valve replacement ,Retrospective Studie ,Heart Valve Diseases/surgery ,030212 general & internal medicine ,Survival Rate/trends ,Tricuspid valve ,Heart Valve Disease ,medicine.anatomical_structure ,Aortic valve stenosis ,Cardiology ,cardiovascular system ,Human ,Transcatheter Aortic Valve Replacement/methods ,medicine.medical_specialty ,congenital, hereditary, and neonatal diseases and abnormalities ,Aortic Valve Stenosis/mortality ,Tricuspid Valve/abnormalities ,03 medical and health sciences ,Internal medicine ,medicine ,cardiovascular diseases ,Survival rate ,business.industry ,Aortic Valve/abnormalities ,Retrospective cohort study ,aortic stenosi ,medicine.disease ,Aortic Valve Stenosi ,Stenosis ,Heart Valve Prosthesi ,business - Abstract
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is being increasingly performed in patients with bicuspid aortic valve stenosis (AS).OBJECTIVES: This study sought to compare the procedural and clinical outcomes in patients with bicuspid versus tricuspid AS from the Bicuspid AS TAVR multicenter registry.METHODS: Outcomes of 561 patients with bicuspid AS and 4,546 patients with tricuspid AS were compared after propensity score matching, assembling 546 pairs of patients with similar baseline characteristics. Procedural and clinical outcomes were recorded according to Valve Academic Research Consortium-2 criteria.RESULTS: Compared with patients with tricuspid AS, patients with bicuspid AS had more frequent conversion to surgery (2.0% vs. 0.2%; p = 0.006) and a significantly lower device success rate (85.3% vs. 91.4%; p = 0.002). Early-generation devices were implanted in 320 patients with bicuspid and 321 patients with tricuspid AS, whereas new-generation devices were implanted in 226 and 225 patients with bicuspid and tricuspid AS, respectively. Within the group receiving early-generation devices, bicuspid AS had more frequent aortic root injury (4.5% vs. 0.0%; p = 0.015) when receiving the balloon-expanding device, and moderate-to-severe paravalvular leak (19.4% vs. 10.5%; p = 0.02) when receiving the self-expanding device. Among patients with new-generation devices, however, procedural results were comparable across different prostheses. The cumulative all-cause mortality rates at 2 years were comparable between bicuspid and tricuspid AS (17.2% vs. 19.4%; p = 0.28).CONCLUSIONS: Compared with tricuspid AS, TAVR in bicuspid AS was associated with a similar prognosis, but lower device success rate. Procedural differences were observed in patients treated with the early-generation devices, whereas no differences were observed with the new-generation devices.
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- 2017
22. ETHNIC DIFFERENCES IN COMPUTED TOMOGRAPHY AORTIC VALVE CALCIUM QUANTIFICATION IN PATIENTS WITH AORTIC STENOSIS.
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Guzzetti, Ezequiel, Oh, Jin Kyung, Shen, Mylène, Dweck, Marc, Poh, Kian Keong, Abbas, Amr E., Mando, Ramy, Pressman, Gregg S., Brito, Daniel, Tastet, Lionel Lloyd, Pawade, Tania, Falconi, Mariano, de Arenaza, Diego Perez, Kong, William, Tay, Edgar, Pibarot, Philippe, Song, Jae-Kwan, and Clavel, Marie-Annick
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ETHNIC differences , *AORTIC valve , *AORTIC stenosis , *ASIANS , *CALCIUM - Published
- 2020
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23. INADEQUATELY LOW LEFT VENTRICULAR MASS IN PATIENTS WITH AORTIC VALVE STENOSIS: IMPROVED LEFT VENTRICULAR CONTRACTILITY AND CLINICAL OUTCOMES?
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Chew, Nicholas, Ngiam, Nicholas, Tan, Benjamin, Sia, Ching Hui, Sim, Hui-Wen, Kong, William, Tay, Edgar, Yeo, Tiong Cheng, and Poh, Kian Keong
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AORTIC stenosis , *LEFT ventricular hypertrophy - Published
- 2020
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