TAVR patients at low surgical risk still ahead vs. SAVR, but thrombosis a concern
The use of transcatheter aortic valve replacement (TAVR) devices in patients at low risk of poor outcomes was not looked upon fondly in the early days of this category of devices, but the numbers for TAVR have been trending well against surgical AVR for several years. A recent study suggests that TAVR in these relatively healthy patients numerically outperforms SAVR devices for death, stroke and rehospitalization, but device thrombosis was higher in TAVR, suggesting a need for more antithrombotic therapy in this patient population. As part of the Partner 3 trial, the investigators randomly assigned 1,000 patients at a 1:1 ratio to transfemoral TAVR with the Sapien 3 valve by Edwards Lifesciences Corp., of Irvine, Calif., and SAVR, with an eye toward two-year rates for death from any cause and all stroke or rehospitalization at one year. The secondary endpoints included new pacemaker implant and new left bundle branch block, along with valve thrombosis. Mean age of enrollees was 73 years, and follow-up consisted of clinical appointments and echocardiography at 30 days and at one and two years. The two-year primary endpoint occurred in 11.5% of those treated with TAVR devices compared to 17.4% of those receiving a SAVR device after surgery, a difference that reached statistical significance (p score of 0.007). Those differences diminished sufficiently over time, and although the differences failed to meet statistical significance by the end of the second year, they continued to favor TAVR. For instance, death at two years in the TAVR arm was 2.4% vs. 3.2% of the subjects in the SAVR arm. Rates of valve thrombosis at one year were 1% for TAVR and 0.2% for SAVR, but this difference failed to reach statistical significance. By the end of year two, that difference had expanded to 2.6% for TAVR and 0.7% for SAVR for a p score of 0.02. These results are reported in the March issue of the Journal of the American College of Cardiology.
Heart failure numbers nearly doubled between 1990 and 2017
The world’s growing population, and the rapid rise in populations that are vulnerable to heart failure, has led to a near doubling of diagnoses of heart failure between 1990 and 2017, but the age-adjusted standardized rate is actually down over that term. Still, the numbers serve as a clarion call for public health officials to act, according to the authors of a new study. In 1990, roughly 33.5 million were known to suffer from heart failure, which spiked to more than 64 million in 2017, according to data from the Global Burden of Disease Study. That study encompassed data from 195 nations and territories, and the numbers suggest that heart failure rates dropped by roughly 20% in more advanced economies. The increasing prevalence of heart failure in other nations was driven by the well-known risk factors, such as hypertension, diabetes mellitus, obesity, and smoking, and China saw a 29.9% increase in diagnoses over the surveyed period. For India, the increase was in excess of 16%, and air pollution is seen as a plausible additional factor in the rise in these two and several other nations. The authors recommended the deployment of “more geo-specific strategies” to both prevent and treat heart failure. Their results are depicted in the Feb. 12 online issue of the European Journal of Preventive Cardiology.
COVID exerting large effect on heart health
Those infected with the SARS-CoV-2 virus are known to suffer from acute respiratory distress syndrome, but the impact of the virus on cardiovascular health is still an emerging science. Researchers in Germany and Russia have taken a closer look at the predicament and their data indicate that 6 of 10 patients may experience ongoing cardiac inflammation independently of any pre-existing conditions. This observational study drew on blood tests and cardiac MR images for 100 COVID-19 patients whose median age was 49 years. These data were matched with evaluations of an approximately even number of healthy controls, and the median time between diagnosis of the COVID patients and the performance of the MR imaging procedure was 71 days. Compared with healthy controls and risk factor–matched controls, patients who had recently recovered from COVID-19 exhibited lower left ventricular ejection fraction and higher left ventricle volumes. Each of 78 who had recently recovered from COVID-19 had abnormal findings for MRI, such as raised myocardial native T1 and T2 returns, while 22 demonstrated pericardial enhancement on imaging. None of the measures used in the study seemed to correlate with elapsed time from diagnosis, and acute lymphocyte inflammation was seen in patients who underwent biopsy. Sixty of the 100 COVID patients exhibited “ongoing myocardial inflammation,” a problem that seemed to run independently of overall course of acute illness and time from original diagnosis. “These findings indicate the need for ongoing investigation of the long-term cardiovascular consequences of COVID-19,” the authors said. Their results appear in JAMA Cardiology.