Abstract:
Importance:Improvements in symptoms, functional capacity, and quality of life are among the key goals of edge-to-edge transcatheter mitral valve repair (TMVR) for mitral regurgitation. Objective:To examine health status outcomes among patients undergoing TMVR in clinical practice and the factors associated with improvement. Design, Setting, and Participants:This cohort study used the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry, which contains data on patients with severe mitral regurgitation treated with TMVR from 2013 through 2017 in 217 US hospitals. Main Outcomes and Measures:Change in disease-specific health status (Kansas City Cardiomyopathy Questionnaire-Overall Summary score [KCCQ-OS]; range 0-100 points, with higher scores indicating better health status) at 30 days and 1 year after TMVR. We also examined factors associated with health status at 30 days after TMVR, by means of multivariable linear regression using a generalized estimating equations approach to account for clustering of patients within sites. Results:The KCCQ data were available in 81.2% at baseline, 69.3% of survivors at 30 days, and 47.4% of survivors at 1 year. Among 4226 patients who underwent TMVR, survived 30 days, and completed the KCCQ at baseline and follow-up, the KCCQ-OS increased from 41.9 before TMVR to 66.7 at 30 days (mean change 24.8 [95% CI, 24.0-25.6] points; P < .001), representing a large clinical improvement. The KCCQ scores remained stable from 30 days to 1 year after TMVR, with no further significant increase or decline. On multivariable analysis, atrial fibrillation (-2.2 [95% CI, -3.7 to -0.6] points; P = .01), permanent pacemaker (-2.1 [95% CI, -3.7 to -0.4] points; P = .01), severe lung disease (-3.9 [95% CI, -6.2 to -1.5] points; P = .001), home oxygen (-2.7 [95% CI, -4.9 to -0.4] points; P = .02), and lower KCCQ scores at baseline (3.9 points for each 10-point increase [95% CI, 3.6-4.2]; P < .001) were independently associated with lower 30-day KCCQ-OS scores. In-hospital renal failure was uncommon but was also associated with significant reductions in 30-day KCCQ-OS scores (-7.3 [95% CI -13.3 to -1.2] points). In estimates calculated with inverse probability weighting, after 1 year after TMVR, 54.2% (95% CI 52.2%-56.1%) of patients were alive and well; 23.0% had died, 21.9% had persistently poor health status (KCCQ-OS <60 points), 5.5% had a health status decline from baseline, and 4.6% had both poor health status and health status decline. Conclusions and Relevance:In a national cohort of US patients undergoing edge-to-edge TMVR in clinical practice, health status was impaired prior to the procedure, improved within 30 days, and remained stable through 1 year among surviving patients with available data. While long-term mortality remains high, most surviving patients demonstrate improvements in symptoms, functional status, and quality of life, with only modest differences by patient-level factors.
journal_name
JAMA Cardioljournal_title
JAMA cardiologyauthors
Arnold SV,Li Z,Vemulapalli S,Baron SJ,Mack MJ,Kosinski AS,Reynolds MR,Hermiller JB,Rumsfeld JS,Cohen DJdoi
10.1001/jamacardio.2018.3359subject
Has Abstractpub_date
2018-12-01 00:00:00pages
1151-1159issue
12eissn
2380-6583issn
2380-6591pii
2715109journal_volume
3pub_type
杂志文章,多中心研究相关文献
JAMA Cardiology文献大全abstract:Importance:Cardiac resynchronization therapy (CRT) provides significant reduction in morbidity and mortality in select patients with left ventricular systolic dysfunction and specific parameters of electrocardiographic evidence of dyssynchrony. Relative to the 2012 American College of Cardiology/American Heart Associat...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2019.1755
更新日期:2019-08-01 00:00:00
abstract:Importance:Only 1 class of glucose-lowering agents-sodium-glucose cotransporter 2 (SGLT2) inhibitors-has been reported to decrease the risk of cardiovascular events primarily by reducing the risk of the development or progression of heart failure. In a landmark trial called Empagliflozin, Cardiovascular Outcomes, and M...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2017.2275
更新日期:2017-09-01 00:00:00
abstract:Importance:With improved survival, heart failure (HF) has become a major complication for individuals with human immunodeficiency virus (HIV) infection. It is unclear if this risk extends to different types of HF in the antiretroviral therapy (ART) era. Determining whether HIV infection is associated with HF with reduc...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2017.0264
更新日期:2017-05-01 00:00:00
abstract:Importance:Transcatheter aortic valve replacement (TAVR) is an established alternative to surgery for patients with severe symptomatic aortic stenosis. Adjunctive antithrombotic therapy used to mitigate thrombotic risks in patients undergoing TAVR must be balanced against bleeding complications, since both are associat...
journal_title:JAMA cardiology
pub_type: 杂志文章,评审
doi:10.1001/jamacardio.2019.4367
更新日期:2020-01-01 00:00:00
abstract:Importance:Acute mental stress can result in transient endothelial dysfunction, but the prognostic relevance of this phenomenon is unknown. Objective:To determine the association between mental stress-induced impairment in endothelium-dependent relaxation as assessed by brachial artery flow-mediated vasodilation and a...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2019.3252
更新日期:2019-10-01 00:00:00
abstract:Importance:Low-density lipoprotein cholesterol (LDL-C) is an important modifiable risk factor for atherosclerotic cardiovascular disease. It is unclear whether the percentage LDL-C lowering with pharmacotherapies differs on the basis of baseline LDL-C levels. Objective:To evaluate the association between baseline LDL-...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2020.6184
更新日期:2020-11-13 00:00:00
abstract:IMPORTANCE:Reduced rates of cardiac catheterization, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) are an unintended consequence of public reporting of cardiogenic shock outcomes in New York. OBJECTIVES:To evaluate whether the referral rates for cardiac catheterization, PCI, or CABG...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2016.0785
更新日期:2016-09-01 00:00:00
abstract:Importance:If we assume that women and men exhibit variations of the same fundamental vascular physiology, then conventional analyses of subclinical measures would suggest that women catch up to men by midlife in the extent of potentially important vascular disease. Alternatively, under the assumption that vascular phy...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2019.5306
更新日期:2020-03-01 00:00:00
abstract:Importance:Hutchinson-Gilford progeria syndrome (HGPS) is an ultrarare disorder associated with premature death due to cardiovascular events during the second decade of life. However, because of its rarity (107 identified living patients), the natural history of cardiac disease remains uncharacterized. Therefore, meani...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2017.5235
更新日期:2018-04-01 00:00:00
abstract:Importance:Hospitalizations for worsening heart failure (WHF) represent an enormous public health and financial burden, with physicians, health systems, and payers placing increasing emphasis on hospitalization prevention. In addition, maximizing time out of the hospital is an important patient-centered outcome. In thi...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2017.5250
更新日期:2018-03-01 00:00:00
abstract:Importance:As many as 10% of women experience natural menopause by the age of 45 years. If confirmed, an increased risk of cardiovascular disease (CVD) and all-cause mortality associated with premature and early-onset menopause could be an important factor affecting risk of disease and mortality among middle-aged and o...
journal_title:JAMA cardiology
pub_type: 杂志文章,meta分析,评审
doi:10.1001/jamacardio.2016.2415
更新日期:2016-10-01 00:00:00
abstract:Importance:The Department of Veterans Affairs (VA) operates a nationwide system of hospitals and hospital-affiliated clinics, providing health care to more than 2 million veterans with cardiovascular disease. While data permitting hospital comparisons of the outcomes of acute cardiovascular care (eg, myocardial infarct...
journal_title:JAMA cardiology
pub_type: 杂志文章,多中心研究
doi:10.1001/jamacardio.2018.1115
更新日期:2018-07-01 00:00:00
abstract:Importance:Bioresorbable scaffolds were designed to provide clinical benefits after their complete bioresorption. Prior studies demonstrated early risks with the Absorb polymeric bioresorbable vascular scaffold (BVS). Whether this risk profile changes over time during the course of its bioresorption is unknown. Object...
journal_title:JAMA cardiology
pub_type: 杂志文章,meta分析
doi:10.1001/jamacardio.2019.4101
更新日期:2019-12-01 00:00:00
abstract:Importance:Cardiac dysfunction is a leading cause of morbidity and mortality in Duchenne muscular dystrophy (DMD). This case highlights the importance of steroids in treating cardiac complications of DMD and the dangers of discontinuing or switching between steroid classes. Objective:To recognize the presentation of a...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2018.2695
更新日期:2018-10-01 00:00:00
abstract:Importance:Electronic health record (EHR) biobanks containing clinical and genomic data on large numbers of individuals have great potential to inform drug discovery. Individuals with interleukin 6 receptor (IL6R) single-nucleotide polymorphisms (SNPs) who are not receiving IL6R blocking therapy have biomarker profiles...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2018.2287
更新日期:2018-09-01 00:00:00
abstract:IMPORTANCE:Dyslipidemia in young adults in the United States during their childbearing years is common, and the consequences for the next generation are poorly understood. Further understanding of the harmful consequences of elevated low-density lipoprotein cholesterol (LDL-C) levels in young adults may help to inform ...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2015.0304
更新日期:2016-04-01 00:00:00
abstract:Importance:Volumetric measurements by transthoracic echocardiogram may better reflect left ventricular (LV) remodeling than conventional linear LV dimensions. However, the association of LV volumes with mortality in patients with chronic hemodynamically significant aortic regurgitation (AR) is unknown. Objective:To as...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2020.5268
更新日期:2020-11-04 00:00:00
abstract:Importance:Levels of proprotein convertase subtilisin kexin type 9 (PCSK9) vary markedly across the population and are influenced by genetic and nongenetic factors. Evolocumab is a fully human, monoclonal antibody against PCSK9 that reduces low-density lipoprotein cholesterol (LDL-C) levels by 55% to 75%. Whether the e...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2016.5395
更新日期:2017-05-01 00:00:00
abstract:Importance:Data sharing is as an expanding initiative for enhancing trust in the clinical research enterprise. Objective:To evaluate the feasibility, process, and outcomes of a reproduction analysis of the THERMOCOOL SMARTTOUCH Catheter for the Treatment of Symptomatic Paroxysmal Atrial Fibrillation (SMART-AF) trial u...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2017.3808
更新日期:2017-12-01 00:00:00
abstract:Importance:Cohort studies have reported increased incidence of cardiovascular disease (CVD) among individuals with low vitamin D status. To date, randomized clinical trials of vitamin D supplementation have not found an effect, possibly because of using too low a dose of vitamin D. Objective:To examine whether monthly...
journal_title:JAMA cardiology
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamacardio.2017.0175
更新日期:2017-06-01 00:00:00
abstract:Importance:Depression is increasingly recognized as a risk factor for adverse outcomes in cardiovascular disease. However, little is known about depression in older adults undergoing transcatheter (TAVR) or surgical (SAVR) aortic valve replacement. Objective:To determine the prevalence of depression and its associatio...
journal_title:JAMA cardiology
pub_type: 杂志文章,多中心研究
doi:10.1001/jamacardio.2017.5064
更新日期:2018-03-01 00:00:00
abstract:IMPORTANCE:The adverse outcomes associated with atrial fibrillation (AF) have been studied in predominantly white cohorts. Racial differences in outcomes associated with AF merit continued investigation. OBJECTIVE:To evaluate the race-specific associations of AF with stroke, heart failure, coronary heart disease (CHD)...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2016.1025
更新日期:2016-07-01 00:00:00
abstract:Importance:Limited evidence is available regarding the benefit and hazard of higher-intensity treatment to lower lipid levels among patients 75 years or older. As a result, guideline recommendations differ for this age group compared with younger patients. Objective:To determine the effect on outcomes and risks of com...
journal_title:JAMA cardiology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1001/jamacardio.2019.2306
更新日期:2019-09-01 00:00:00
abstract:Importance:It is unknown whether coronary revascularization, when added to optimal medical therapy, improves prognosis in patients with stable ischemic heart disease (SIHD) at increased risk of cardiovascular events owing to moderate or severe ischemia. Objective:To describe baseline characteristics of participants en...
journal_title:JAMA cardiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1001/jamacardio.2019.0014
更新日期:2019-03-01 00:00:00
abstract:Importance:Despite considerable improvements in heart failure care, mortality rates among patients in high-income countries have changed little since the early 2000s. Understanding the reasons underlying these trends may provide valuable clues for developing more targeted therapies and public health strategies. Object...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2019.3593
更新日期:2019-11-01 00:00:00
abstract:Importance:Use of transcatheter aortic valve replacement (TAVR) for severe aortic stenosis is growing rapidly. However, to our knowledge, the durability of these prostheses is incompletely defined. Objective:To determine the midterm hemodynamic performance of balloon-expandable transcatheter heart valves. Design, Set...
journal_title:JAMA cardiology
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamacardio.2017.3306
更新日期:2017-11-01 00:00:00
abstract:Importance:Observational studies have reported an association between low serum vitamin D levels and elevated risk of cardiovascular disease (CVD) events, but such studies cannot prove causation because of possible unmeasured confounding. Objective:We conducted a meta-analysis of randomized clinical trials that tested...
journal_title:JAMA cardiology
pub_type: 杂志文章,meta分析
doi:10.1001/jamacardio.2019.1870
更新日期:2019-08-01 00:00:00
abstract:Importance:The Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated the benefit of lowering systolic blood pressure (SBP) to 120 mm Hg, yet other trials, such as Heart Outcomes Prevention Evaluation-3 (HOPE-3), did not find consistent benefit. How to incorporate these results into the treatment of those wit...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2016.2861
更新日期:2016-11-01 00:00:00
abstract:Importance:Low-density lipoprotein cholesterol (LDL-C)-lowering therapies are a cornerstone of prevention in atherosclerotic cardiovascular disease. With the introduction of generic formulations and the release of new therapies, including proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, contemporary Me...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2020.3723
更新日期:2021-01-01 00:00:00
abstract:Importance:Accurate, real-time case identification is needed to target interventions to improve quality and outcomes for hospitalized patients with heart failure. Problem lists may be useful for case identification but are often inaccurate or incomplete. Machine-learning approaches may improve accuracy of identificatio...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2016.3236
更新日期:2016-12-01 00:00:00