Publications by authors named "David Fortuin"

Background: Tricuspid regurgitation (TR) and mitral regurgitation (MR) are common valvular conditions encountered in patients undergoing transcatheter aortic valve replacement (TAVR). This retrospective study investigates the impact of moderate or severe TR and MR on all-cause mortality in 1-year post-TAVR patients.

Methods: Consecutive patients who underwent TAVR at the 3 academic tertiary care centers in our health system between 2012 and 2018 were identified.

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Background: Anatomical factors may preclude transfemoral (TF) arterial access for transcatheter aortic valve implantation (TAVI). Transcaval (TCav) access has been utilized as an alternative access for these patients. We aimed to investigate the outcomes of TCav access in patients undergoing TAVI.

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While percutaneous closure of patent foramen ovale (PFO) and atrial septal defect (ASD) are generally well-tolerated procedures, the development of postprocedure fever has been observed at a higher frequency than reported in the initial device trials. We performed a retrospective analysis of 62 patients who underwent PFO or ASD closure from January 1, 2020, to December 31, 2022, at Mayo Clinic, Arizona. Eight patients out of 62 (12.

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Background: Despite optimal medical therapy and cardiac resynchronization therapy (CRT), significant functional mitral regurgitation (MR) persisted in 30% of the patients and labeled as CRT nonresponders.

Aims: We sought to study the impact of transcatheter edge-to-edge repair (TEER) in patients with symptomatic grade III and IV functional MR despite CRT.

Methods: A retrospective analysis was conducted of all patients who had prior CRT for at least 6 months and underwent TEER for significant residual functional MR (grade ≥3) and symptomatic heart failure (HF) at our institution.

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Conduction abnormality post-transcatheter aortic valve implantation (TAVI) remains clinically significant and usually requires chronic pacing. The effect of right ventricular (RV) pacing post-TAVI on clinical outcomes warrants further studies. We identified 147 consecutive patients who required chronic RV pacing after a successful TAVI procedure and propensity-matched these patients according to the Society of Thoracic Surgeons (STS) risk score to a control group of patients that did not require RV pacing post-TAVI.

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Background: Cardiovascular disease is a leading cause of morbidity and mortality, largely dominated by ischemic heart diseases (IHDs). Social determinants of health, including geographic, psychosocial, and socioeconomic factors, influence the development of IHD.

Objectives: This study aimed to evaluate yearly trends and disparities in IHD mortality and to assess the impact of social vulnerability.

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Background: Residual mitral regurgitation (MR) is frequent after transcatheter edge-to-edge repair (TEER). There is controversy regarding the clinical impact of residual MR and its quantitative assessment by transthoracic echocardiography (TTE), which is often challenging with multiple eccentric jets and artifact from the clip. The utility of the velocity time integral (VTI) ratio between the mitral valve (MV) and left ventricular outflow tract (LVOT), (VTI), a simple Doppler measurement that increases with MR, has not been assessed post TEER.

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Article Synopsis
  • The study looked at Lipoprotein(a) [Lp(a)] and its connection to a type of heart problem called in-stent restenosis (ISR) after a procedure called PCI.
  • Researchers tracked 1,209 adult patients who had their Lp(a) levels checked before the PCI and found more ISR in patients with high Lp(a) levels.
  • The study concluded that high Lp(a) levels are a strong predictor for developing ISR over time, so doctors should pay attention to Lp(a) when treating patients.
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  • The study focuses on cardiac amyloidosis (CA) in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), highlighting that CA commonly leads to poor outcomes for these patients.
  • The researchers analyzed data from 1,426 TAVR patients using an ECG AI model to predict CA risk, discovering that 24.4% had a high probability of CA, yet only 1.2% were clinically diagnosed.
  • Results showed that a high CA probability significantly correlated with increased all-cause mortality and rates of major adverse cardiovascular events, particularly heart failure hospitalizations, suggesting that these patients should undergo further diagnostic assessment for CA.
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Aims: Doppler mean gradient (MG) can underestimate aortic stenosis (AS) severity in patients with atrial fibrillation (AF) compared with patients with sinus rhythm (SR), potentially delaying intervention in AF. This study compared outcomes in patients with AF and SR following transcatheter aortic valve replacement (TAVR) and investigated delay in TAVR based on computed tomography aortic valve calcium score (AVCS).

Methods And Results: Patients who underwent TAVR from 2013 to 2017 for native valve severe AS were identified from an institutional database.

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Background: Percutaneous heart valve procedures have been increasingly performed over the past decade, yet real-world mortality data on valvular heart disease (VHD) in the United States remain limited.

Methods And Results: We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database among patients ≥15 years old from 1999 to 2020. VHD and its subtypes were listed as the underlying cause of death.

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  • High altitude can reduce oxygen levels, causing problems like shortness of breath and fatigue for some people.
  • A special test called Hypoxic Simulation Testing (HST) was used to see how the heart reacts to lower oxygen levels.
  • The study found that many patients had increased pressure in their heart, and some even had blood flow issues only noticed during low oxygen conditions, which could explain their breathing problems at high altitudes.
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Background: Atrial fibrillation (AF) is a known complication following patent foramen ovale (PFO) closure. AI-enabled ECG (AI-ECG) acquired during normal sinus rhythm has been shown to identify individuals with AF by noting high-risk ECG features invisible to the human eye. We sought to characterize the value of AI-ECG in predicting AF development following PFO closure and investigate key clinical and procedural characteristics possibly associated with post-procedural AF.

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Objective: To study the usefulness of a novel echocardiographic marker, augmented mean arterial pressure (AugMAP = [(mean aortic valve gradient + systolic blood pressure) + (2 × diastolic blood pressure)] / 3), in identifying high-risk patients with moderate aortic stenosis (AS).

Patients And Methods: Adults with moderate AS (aortic valve area, 1.0-1.

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Direct oral anticoagulants (DOACs) are a newer class of anticoagulants that inhibit factor Xa or factor IIa and include drugs such as rivaroxaban, apixaban, edoxaban, betrixaban, and dabigatran. Although vitamin K antagonists (VKAs) have been traditionally used to prevent thromboembolic events, DOACs have gained popularity because of their faster onset and offset of action and reduced need for monitoring. This study aimed to provide more data for anticoagulants in patients with atrial fibrillation with bioprosthetic heart valves by incorporating all available trials to date.

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Objectives: Lipoprotein(a) (Lp(a)) is associated with an increased incidence of native aortic stenosis, which shares similar pathological mechanisms with bioprosthetic aortic valve (bAV) degeneration. However, evidence regarding the role of Lp(a) concentrations in bAV degeneration is lacking. This study aims to evaluate the association between Lp(a) concentrations and bAV degeneration.

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Background: Post-transcatheter aortic valve replacement (TAVR) patient outcome is an important research topic. To accurately assess post-TAVR mortality, we examined a family of new echo parameters (augmented systolic blood pressure (AugSBP) and arterial mean pressure (AugMAP)) derived from blood pressure and aortic valve gradients.

Methods: Patients in the Mayo Clinic National Cardiovascular Diseases Registry-TAVR database who underwent TAVR between 1 January 2012 and 30 June 2017 were identified to retrieve baseline clinical, echocardiographic and mortality data.

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Background: Aortic stenosis (AS) is associated with myocardial ischemia through different mechanisms and may impair coronary arterial flow. However, data on the impact of moderate AS in patients with acute myocardial infarction (MI) is limited.

Aims: This study aimed to investigate the impact of moderate AS in patients presenting with acute myocardial infarction (MI).

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Background: Atrioventricular block requiring permanent pacemaker (PPM) implantation is an important complication of transcatheter aortic valve replacement (TAVR). Application of machine learning could potentially be used to predict pre-procedural risk for PPM.

Aim: To apply machine learning to be used to predict pre-procedural risk for PPM.

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Transcarotid access has emerged as the preferred access site for transcatheter aortic valve implantation (TAVI) in patients with prohibitive iliofemoral anatomy. This study aimed to compare outcomes with transcarotid with those of other accesses in patients who underwent TAVI. Cochrane, EMBASE, and MEDLINE databases were searched for all published studies that compared outcomes with transcarotid with those of other accesses (transfemoral, transaxillary/subclavian, transaortic, and transapical) in patients who underwent TAVI.

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Article Synopsis
  • This study investigates the occurrence and effects of persistent iatrogenic atrial septal defects (iASDs) after transcatheter edge-to-edge repair (TEER) procedures, which are used to treat heart conditions.
  • It involved 316 patients, revealing that 34.2% had persistent iASD, but there were no significant differences in mortality, heart failure, or stroke incidents between those with and without iASD.
  • Although patients with iASD exhibited higher right ventricular pressures, they experienced no adverse effects on heart function or prognosis, suggesting that leaving the defect may be safe and not require further intervention.
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  • Simulation technology can effectively enhance coronary angiographic (CA) image interpretation skills among medical trainees beyond traditional teaching methods, as shown in a randomized study.
  • The study involved 105 participants, including medical students, residents, and fellows, who were divided into two groups: one receiving simulation training alongside didactic teaching and the other receiving didactic teaching alone.
  • Results indicated that those in the simulation group had significantly higher improvement in test scores, particularly residents, emphasizing the need for integrating simulation training into cardiovascular fellowship programs.
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Background: Transcatheter aortic valve replacement (TAVR) is now an approved alternative to surgical aortic valve replacement for the treatment of severe aortic stenosis. As the clinical adoption of TAVR expands, it remains important to identify predictors of mortality after TAVR. We aimed to evaluate the impact of sex differences in aortic valve calcium score (AVCS) on long-term mortality following TAVR in a large patient sample.

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Article Synopsis
  • A rare case of external iliac vein stenosis in a young cyclist led to ischemic strokes caused by paradoxical embolism through a patent foramen ovale (PFO).
  • A detailed investigation revealed a significant blockage in the right external iliac vein, raising concerns about prior blood clots.
  • The patient chose to have his PFO closed to prevent future strokes so he could continue cycling, emphasizing the need for doctors to consider vein stenosis when diagnosing strokes in young athletes.
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Article Synopsis
  • * Success in delivery was monitored through echocardiography, showing signs of local myocardial necrosis and changes in heart wall motion.
  • * The researchers tested a new injection catheter that uses Doppler ultrasound for guidance, which showed promise but requires further refinement to prevent unwanted spread of the injected substance throughout the body.
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