Houston Methodist key Heart and Vascular Center

Houston, TX, United States

Houston Methodist key Heart and Vascular Center

Houston, TX, United States

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Maragiannis D.,401 General Army Hospital of Athens | Aggeli C.,National and Kapodistrian University of Athens | Nagueh S.F.,Houston Methodist key Heart and Vascular Center
Hellenic Journal of Cardiology | Year: 2016

This review focuses on the diagnostic value of novel echocardiographic techniques and the clinical application of recently described algorithms to assess tricuspid prosthetic valve function. © 2016 Hellenic Cardiological Society. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license.


Ibrahim H.,Houston Methodist key Heart and Vascular Center | Ibrahim H.,New York Medical College | Schutt R.C.,Houston Methodist key Heart and Vascular Center | Schutt R.C.,New York Medical College | And 7 more authors.
Journal of the American College of Cardiology | Year: 2014

BACKGROUND: Immature platelets are less responsive to the effects of antiplatelet drugs and contain messenger ribonucleic acid that is translationally active. They can be measured easily using an automated hematoanalyzer and reported as part of the complete blood count. OBJECTIVES: The purpose of this study was to determine the prognostic signifi cance of elevated immature platelet count (IPC) in patients with coronary artery disease (CAD). METHODS: In this prospective cohort study in patients with CAD, patients underwent IPC measurement and were then followed up for the composite endpoint of major adverse cardiovascular events (MACE), defined as a composite of all-cause mortality, myocardial infarction, unplanned revascularization, or hospitalization for angina. For the purposes of analysis, patients were stratified into tertiles of IPC. RESULTS: Eighty-nine patients were followed up for a median of 31 months. Stratification to the high IPC tertile was associated with higher rates of MACE compared with the intermediate and low tertiles (60% vs. 24% vs. 16%, respectively; p < 0.001). Time-dependent receiver-operating characteristic analysis revealed that an IPC level ≤7,632 platelets/μ l was 70.7% sensitive and 82.1% specific for MACE. After adjustment for age, admission diagnosis, index revascularization, heart failure, smoking, hematocrit, and baseline platelet count, patients with an IPC level ≤7,632 platelets/μl were more likely to experience a MACE (hazard ratio: 4.65; 95% confidence interval: 1.78 to 12.16; p < 0.002). CONCLUSIONS: IPC is a novel biomarker for MACE risk stratification in patients with CAD. Future studies should focus on the utilization of this marker for individualized antiplatelet therapy. © 2014 by the American College of Cardiology Foundation.


Reardon M.J.,Houston Methodist key Heart and Vascular Center | Adams D.H.,Mount Sinai Health System | Kleiman N.S.,Houston Methodist key Heart and Vascular Center | Yakubov S.J.,Riverside Methodist Hospital | And 23 more authors.
Journal of the American College of Cardiology | Year: 2015

Background The U.S. pivotal trial for the self-expanding valve found that among patients with severe aortic stenosis at increased risk for surgery, the 1-year survival rate was 4.9 percentage points higher in patients treated with a self-expanding transcatheter aortic valve bioprosthesis than in those treated with a surgical bioprosthesis. Objectives Longer-term clinical outcomes were examined to confirm if this mortality benefit is sustained. Methods Patients with severe aortic stenosis who were at increased surgical risk were recruited. Eligible patients were randomly assigned in a 1:1 ratio to transcatheter aortic valve replacement with the self-expanding transcatheter valve (transcatheter aortic valve replacement [TAVR] group) or to aortic valve replacement with a surgical bioprosthesis (surgical group). The 2-year clinical and echocardiographic outcomes were evaluated in these patients. Results A total of 797 patients underwent randomization at 45 centers in the United States. The rate of 2-year all-cause mortality was significantly lower in the TAVR group (22.2%) than in the surgical group (28.6%; log-rank test p < 0.05) in the as-treated cohort, with an absolute reduction in risk of 6.5 percentage points. Similar results were found in the intention-to-treat cohort (log-rank test p < 0.05). The rate of 2-year death or major stroke was significantly lower in the TAVR group (24.2%) than in the surgical group (32.5%; log-rank test p = 0.01). Conclusions In patients with severe aortic stenosis who are at increased surgical risk, the higher rate of survival with a self-expanding TAVR compared with surgery was sustained at 2 years. (Safety and Efficacy Study of the Medtronic CoreValve System in the Treatment of Symptomatic Severe Aortic Stenosis in High Risk and Very High Risk Subjects Who Need Aortic Valve Replacement; NCT01240902). © 2015 by the American College of Cardiology Foundation.


Adams D.H.,Mount Sinai Medical Center | Popma J.J.,Beth Israel Deaconess Medical Center | Reardon M.J.,Houston Methodist key Heart and Vascular Center | Yakubov S.J.,Riverside Methodist Hospital | And 20 more authors.
New England Journal of Medicine | Year: 2014

BACKGROUND: We compared transcatheter aortic-valve replacement (TAVR), using a self-expanding transcatheter aortic-valve bioprosthesis, with surgical aortic-valve replacement in patients with severe aortic stenosis and an increased risk of death during surgery. METHODS: We recruited patients with severe aortic stenosis who were at increased surgical risk as determined by the heart team at each study center. Risk assessment included the Society of Thoracic Surgeons Predictor Risk of Mortality estimate and consideration of other key risk factors. Eligible patients were randomly assigned in a 1:1 ratio to TAVR with the self-expanding transcatheter valve (TAVR group) or to surgical aortic-valve replacement (surgical group). The primary end point was the rate of death from any cause at 1 year, evaluated with the use of both noninferiority and superiority testing. RESULTS: A total of 795 patients underwent randomization at 45 centers in the United States. In the as-treated analysis, the rate of death from any cause at 1 year was significantly lower in the TAVR group than in the surgical group (14.2% vs. 19.1%), with an absolute reduction in risk of 4.9 percentage points (upper boundary of the 95% confidence interval, -0.4; P<0.001 for noninferiority; P = 0.04 for superiority). The results were similar in the intention-to-treat analysis. In a hierarchical testing procedure, TAVR was noninferior with respect to echocardiographic indexes of valve stenosis, functional status, and quality of life. Exploratory analyses suggested a reduction in the rate of major adverse cardiovascular and cerebrovascular events and no increase in the risk of stroke. CONCLUSIONS: In patients with severe aortic stenosis who are at increased surgical risk, TAVR with a self-expanding transcatheter aortic-valve bioprosthesis was associated with a significantly higher rate of survival at 1 year than surgical aortic-valve replacement. Copyright © 2014 Massachusetts Medical Society.


Ashrith G.,Houston Methodist key Heart and Vascular Center | Gupta D.,Sloan Kettering Cancer Center | Hanmer J.,University of Pittsburgh | Weiss R.M.,University of Iowa
Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance | Year: 2014

BACKGROUND: With recent advances in imaging methods, detection of LVNC is increasingly common. Concomitantly, the prognostic importance of LVNC is less clear.METHODS: We followed 42 patients (63% male, age 44 ± 15 years) with incident heart failure or suspected cardiomyopathy, in whom cardiovascular magnetic resonance (CMR) yielded a diagnosis of LVNC, for 27 ± 16 months.RESULTS: LVNC was preferentially distributed among posterolateral segments, with apical predominance. Patients with maximum non-compacted-to-compacted thickness ratio (NC:C) < 3 improved by 0.9 ± 0.7 NYHA Class, compared to 0.3 ± 0.8 for patients with NC:C > 3 (p = 0.001). In 29 patients with baseline LVEF < 0.40, there was an inverse correlation between NC:C ratio, and the change in LVEF during follow-up. Tachyarrhythmias were observed in 42% of patients with LGE, and in 0% of patients without LGE (p = 0.02). In multivariate analysis, arrhythmia incidence was significantly higher in patients with LGE, even when adjusted for LVEF and RVEF.CONCLUSIONS: CMR assessments of myocardial morphology provide important prognostic information for patients with LVNC who present with incident heart failure or suspected cardiomyopathy.


Hahn R.T.,Columbia University | Hahn R.T.,New York Presbyterian Hospital | Gillam L.D.,United Medical Systems | Little S.H.,Houston Methodist key Heart and Vascular Center
JACC: Cardiovascular Imaging | Year: 2015

Transcatheter aortic valve replacement (TAVR) with the use of the self-expandable Revalving system is an accepted alternative to surgical replacement for severe, symptomatic aortic stenosis in high-risk or inoperable patients. Intraprocedural imaging relies on fluoroscopic guidance, with echocardiographic imaging used as a supportive imaging modality. Intraprocedural transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) offer real-time imaging guidance throughout the procedure and may contribute to improving procedural results. Registries suggest that TAVR may be performed in lower-surgical-risk patients with equal outcomes to high-risk patients with ongoing randomized trials comparing these results with surgical outcomes. Understanding the utility of echocardiographic imaging in diagnosing or preventing complications may be particularly important as we move toward these lower-risk patient populations. This imaging compendium is intended to be a comprehensive compilation of intraprocedural complications imaged by intraprocedural echocardiography. © 2015 American College of Cardiology Foundation.


Hahn R.T.,Columbia University | Little S.H.,Houston Methodist key Heart and Vascular Center | Monaghan M.J.,King's College | Kodali S.K.,Columbia University | And 3 more authors.
JACC: Cardiovascular Imaging | Year: 2015

Recent multicenter trials have shown that transcatheter aortic valve replacement is an alternative to surgery in a high risk population of patients with severe, symptomatic aortic stenosis. Echocardiography and multislice computed tomographic imaging are accepted tools in the pre-procedural imaging of the aortic valve complex and vascular access. Transesophageal echocardiography can be valuable for intraprocedural confirmation of the landing zone morphology and measurements, positioning of the valve and post-procedural evaluation of complications. The current paper provides recommendations for pre-procedural and intraprocedural imaging used in assessing patients for transcatheter aortic valve replacement with either balloon-expandable or self-expanding transcatheter heart valves. © 2015 American College of Cardiology Foundation.


Kassi M.,Houston Methodist key Heart and Vascular Center | Estep J.D.,Houston Methodist key Heart and Vascular Center
Current Opinion in Cardiology | Year: 2016

Purpose of review The article provides an overview of recent advances in imaging patients with a left ventricular assist device (LVAD). Recent findings There is a growing population of patients with LVADs. LVADs improve survival in patients with end-stage heart failure, but are also associated with significant adverse outcomes. Imaging, particularly echocardiography, plays a critical role in patient selection and in predicting and detecting complications. Summary Recent studies have illustrated links between imaging parameters with adverse outcomes, such as pump thrombosis, right ventricular failure, and continuous aortic regurgitation. Novel parameters and imaging techniques have been developed. © 2016 Wolters Kluwer Health, Inc.


Barker C.M.,Houston Methodist key Heart and Vascular Center
Current Opinion in Cardiology | Year: 2016

Purpose of review: Clinical trials in transcatheter aortic valve replacement (TAVR) have been essential in establishing the effectiveness as well as the limitations of this exciting and disruptive technology. This review will focus on clinical trials related to TAVR that have been presented in the past year or are currently enrolling, as well as future trials that are in the planning stages. Recent findings: The currently available devices have gone through iterations to improve safety and outcomes, including lower profiles to reduce bleeding complications as well as adding a sealing skirt or allowing for repositioning in order to decrease para-valvular regurgitation and need for a permanent pacemaker. The intermediate-risk clinical trials will be finishing soon and will be followed by low-risk trials. Ancillary devices will likely continue to expand the access to this therapy. One of the main challenges moving forward will be the post-TAVR pharmacotherapy. Summary: Recently, improvements in first-generation devices have led to improved outcomes. Current trials evaluating novel TAVR platforms and lower risk patients as well as ancillary devices will likely continue to expand the access to this therapy. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.


Chang S.M.,Houston Methodist key Heart and Vascular Center | Nabi F.,Houston Methodist key Heart and Vascular Center | Xu J.,Methodist Hospital Research Institute | Pratt C.M.,Houston Methodist key Heart and Vascular Center | And 3 more authors.
JACC: Cardiovascular Imaging | Year: 2015

Objectives This prospective, observational study in 988 asymptomatic or symptomatic low-risk patients without prior coronary artery disease was conducted to define the relative value of coronary artery calcium score (CACS), exercise treadmill testing (ETT), and stress myocardial perfusion single-photon emission computed tomography (SPECT) variables in predicting long-term risk stratification. Background CACS, ETT, and stress myocardial perfusion SPECT results predict patients' outcome. There are currently no data comparing their relative value in long-term risk stratification. Methods Patients were stratified by Framingham risk score (FRS), with a median follow-up of 6.9 years. Cardiac events were defined as a composite of cardiac death, nonfatal myocardial infarction, and the need for coronary revascularization. Most patients (87%) were considered appropriate candidates for functional testing as defined by current appropriate use criteria. Results The long-term cardiac event rate was 11.2% (1.6% per year). Multivariate risk predictors in all patients and in the appropriate use cohort were abnormal SPECT (hazard ratio [HR]: 1.83 and 1.99), ETT ischemia (HR: 1.70 and 1.76), decreasing exercise capacity (HR: 1.11 and 1.17), decreasing Duke treadmill score (HR: 1.07 for both), and CACS severity (HR: 1.29 for both), respectively. Throughout the 10-year follow-up, CACS improved risk prediction, with event rates ranging from 0.6% per year (CACS ≤10) to 3.7% per year (CACS >400) (p < 0.0001). CACS also improved risk prediction in all patients, in the appropriate use cohort and among those with low-risk ETT and SPECT results (all, p < 0.001). Area under the receiver-operating characteristic curve was increased when CACS variables (from 0.63 to 0.70; p = 0.01) but not ETT variables (from 0.63 to 0.65) were added to FRS. Moreover, net reclassification improvement was significantly increased when CACS was added to FRS + functional variables in all patients and in the appropriate use cohort (both, p < 0.0001). Conclusions CACS significantly improved long-term risk stratification beyond FRS, ETT, and SPECT results across the spectrum of clinical risk and importantly even among those who are currently considered appropriate candidates for functional testing or have low-risk functional test results. Our findings support CACS as a first-line test over ETT or SPECT for accurately assessing long-term risk in such patients. © 2015 American College of Cardiology Foundation.

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