Disparity among Asian Americans in transcatheter and surgical aortic valve replacement.

BACKGROUND: Racial disparities in transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) outcomes have been established, but research has predominantly focused on African Americans and Hispanics, leaving a gap in Asian Americans. This study aimed to investigate disparities in aortic valve replacement outcomes among Asian Americans. METHODS: Patients who underwent SAVR and TAVR were identified in National Inpatient Sample from the last quarter of 2015-2020. A 1:2 propensity score matching was applied to Asian Americans and Caucasians. In-hospital perioperative outcomes, length of stay, days from admission to operation, and total hospital charge, were compared. RESULTS: In TAVR, 51,394 (84.41 %) were Caucasians and 795 (1.31 %) were Asian Americans. In SAVR, there were 50,080 (78.52 %) Caucasians and 1233 (1.93 %) Asian Americans. No significant difference was found in post-TAVR complications. However, Asian Americans experienced longer waiting time until operation (p = 0.03) and higher costs (p < 0.01) in TAVR. In SAVR, Asian Americans had higher risks of in-hospital mortality (3.91 % vs 2.39 %, p = 0.01), cardiogenic shock (8.71 % vs 6.74 %, p = 0.03), respiratory complications (14.08 % vs 11.2 %, p = 0.01), mechanical ventilation (13.83 % vs 9.09 %, p < 0.01), acute kidney injury (25.47 % vs 20.13 %, p < 0.01), and hemorrhage/hematoma (72.01 % vs 62.95 %, p < 0.01). Additionally, Asian Americans underwent SAVR had longer lengths of stay (p < 0.01) and higher costs (p < 0.01). CONCLUSIONS: Asian Americans were underrepresented in aortic valve replacement. Asian Americans, while having similar post-TAVR outcomes to Caucasians, faced greater risks of post-SAVR mortality and surgical complications. These disparities among Asian Americans call for targeted actions to ensure equitable health outcomes.

Smoker's paradox in transcatheter aortic valve replacement: A National Inpatient Sample analysis from 2015 to 2020.

BACKGROUND: While smoking is recognized as a risk factor for multiple cardiovascular conditions, prior research has identified a smoker paradox, wherein smokers had better post-procedural outcomes following transcatheter aortic valve replacement (TAVR) in the initial years of its introduction among high-risk patients only. In recent years, TAVR has expanded to significant larger groups of low-risk patients and became the dominate approach for aortic valve replacement. Consequently, the study cohort from the previous research can no longer represent the current patient populations undergoing TAVR. This study aimed to examine the impact of smoking on TAVR outcomes in the later post-TAVR era. METHODS: Patients who underwent TAVR were identified in the National Inpatient Sample (NIS) database from the last quarter of 2015-2020 by ICD-10-PCS. Patients were stratified into two cohorts based on smoker status. Multivariable analysis was performed comparing in-hospital post-TAVR outcomes. Adjusted pre-procedural variables included sex, age, race, socioeconomic status, comorbidities, and hospital characteristics. RESULTS: A total number of 58,934 patients who underwent TAVR were identified including 23,683 smokers and 35,251 non-smokers. Compared to non-smokers, smokers had lower in-hospital mortality (aOR 0.589, p < 0.01), MACE (aOR 0.678, p < 0.01), MI (aOR 0.719, p < 0.01), stroke (aOR 0.599, p < 0.01), neurological complications (aOR 0.653, p < 0.01), pacemaker implantation (aOR 0.911, p < 0.01), cardiogenic shock (aOR 0.762, p < 0.01), respiratory complications (aOR 0.822, p < 0.01), mechanical ventilation (aOR 0.669, p < 0.01), AKI (aOR 0.745, p < 0.01), VTE (aOR 0.578, p < 0.01), hemorrhage/hematoma (aOR 0.921, p < 0.01), infection (aOR 0.625, p < 0.01), vascular complications (aOR 0.802, p < 0.01), reopen surgery (aOR 0.453), and transfer out to another facility (aOR 0.79, p < 0.01). In addition, cigarette smokers had shorter LOS (p < 0.01), and less hospital charge (p < 0.01). CONCLUSION: This study identified the smoker paradox in the later post-TAVR era with remarkably broad protection from many complications and lower mortality. The reasons underlying this apparent smoker paradox merit deeper investigation.

Reduced radiation exposure in the cardiac catheterization laboratory with a novel vertical radiation shield.

OBJECTIVES: Investigation of novel vertical radiation shield (VRS) in reducing operator radiation exposure. BACKGROUND: Radiation exposure to the operator remains an occupational health hazard in the cardiac catheterization laboratory (CCL). METHODS: A mannequin simulating an operator was placed near a computational phantom, simulating a patient. Measurement of dose equivalent and Air Kerma located the angle with the highest radiation, followed by a common magnification (8 in.) and comparison of horizontal radiation absorbing pads (HRAP) with or without VRS with two different: CCL, phantoms, and dosimeters. Physician exposure was subsequently measured prospectively with or without VRS during clinical procedures. RESULTS: Dose equivalent and Air Kerma to the mannequin was highest at left anterior oblique (LAO)-caudal angle (p < .005). Eight-inch magnification increased mGray by 86.5% and µSv/min by 12.2% compared to 10-in. (p < .005). Moving 40 cm from the access site lowered µSv/min by 30% (p < .005). With LAO-caudal angle and 8-in. magnification, VRS reduced µSv/min by 59%, (p < .005) in one CCL and µSv by 100% (p = .016) in second CCL in addition to HRAP. Prospective study of 177 procedures with HRAP, found VRS lowered µSv by 41.9% (µSv: 15.2 ± 13.4 vs. 26.2 ± 31.4, p = .001) with no difference in mGray. The difference was significant after multivariate adjustment for specified variables (p < .001). CONCLUSIONS: Operator radiation exposure is significantly reduced utilizing a novel VRS, HRAP, and distance from the X-ray tube, and consideration of lower magnification and avoiding LAO-caudal angles to lower radiation for both operator and patient.

Peripheral Venous Pressure Measurements in Patients With Acute Decompensated Heart Failure (PVP-HF).

BACKGROUND: Accurate assessment of volume status is essential in diagnosis and guidance of decongestive therapy in patients with acute heart failure. We sought to compare peripheral venous pressure (PVP) with central venous pressure (CVP), as well as other invasive hemodynamic measurements, in patients hospitalized with an acute heart failure syndrome. METHODS AND RESULTS: PVP-HF (Peripheral Venous Pressure Measurements in Patients With Acute Decompensated Heart Failure) was a single-center prospective study, which enrolled patients admitted with acute heart failure, regardless of ejection fraction or disease pathogenesis. PVP and intracardiac pressures were obtained by transducing a peripheral intravenous and pulmonary artery catheter, respectively, after zeroing at the phlebostatic axis. Data were compared using Pearson's correlation coefficient and Bland-Altman plots. A total of 30 patients (median age 64 years, 73% male, 30% ischemic pathogenesis) were enrolled. Mean ejection fraction was 31%, and 60% had moderate or greater right ventricular dysfunction. Median PVP was 9.5 (6-17) mm Hg, CVP was 8.5 (6-18) mm Hg, and pulmonary capillary wedge pressure was 18 (14-21) mm Hg. PVP and CVP were found to be highly correlated (r=0.947), while PVP and pulmonary capillary wedge pressure were found to be moderately correlated (r=0.565). The mean difference between PVP and CVP was 0.4 mm Hg and between PVP and pulmonary capillary wedge pressure was 7.5 mm Hg. CONCLUSIONS: In patients with acute heart failure syndromes, a simple assessment of PVP demonstrates a high correlation with CVP. These findings suggest that PVP may be useful in the standard bedside clinical assessment of volume status in these patients to help guide decongestive therapy.

Novel biomarkers in acute heart failure.

Heart failure goes beyond mechanical dysfunction and involves an interplay of multiple pathophysiologic mechanisms, including inflammation, tissue remodeling, neurohormonal and endocrine signaling, and interactions with the renal and nervous systems. This article highlights some novel biomarkers that may aid in diagnosis, treatment, and prognosis of acute heart failure, specifically focusing on ST2, endoglin, galectin-3, cystatin C, neutrophil gelatinase-associated lipocalin, midregional pro-adrenomedullin, chromogranin A, adiponectin, resistin, and leptin and their emerging clinical roles.