Publications by authors named "Jeremy Thaden"
Background: Mitral transcatheter edge-to-edge repair (TEER) is a minimally invasive therapy for severe mitral regurgitation (MR) in patients with high surgical risk. TEER results in a tissue bridge that decreases mitral valve area, potentially leading to elevated mean gradient. The clinical impact of elevated gradient on outcomes is unclear.
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- The study aimed to assess the prognostic value of right ventricle (RV) function and its coupling to pulmonary artery pressure in patients with tricuspid regurgitation (TR) to improve risk evaluation beyond an established clinical score.
- Researchers analyzed data from 417 patients with moderate TR and developed a new risk score by integrating RV function measures, finding significant correlations between these parameters and patient mortality during a median follow-up of nearly 4 years.
- Results showed that many patients initially categorized as low- or intermediate-risk were reclassified to higher risk when RV function metrics were included, indicating that incorporating these echocardiographic measures enhances mortality predictions in TR patients.
Eclipsed mitral regurgitation (MR) is a rare phenomenon of transient severe MR in patients with normal left ventricular function. This paper presents a case of a patient with recurrent heart failure exacerbations and transient, positional severe MR consistent with eclipsed MR, which improved after mitral transcatheter edge-to-edge repair.
View Article and Find Full Text PDFBackground: Mitral annular calcification (MAC) is a progressive degenerative process associated with comorbidities and increased mortality. A staging system that considers extramitral cardiac damage in MAC may help improve patient selection for mitral valve interventions.
Objectives: This study sought to develop a transthoracic echocardiogram (TTE)-based cardiac staging system in patients with MAC and significant mitral valve dysfunction and assess its prognostic utility.
Article Synopsis
- A study hypothesized that deep learning could detect moderate to severe left ventricular dysfunction from images taken during coronary angiography, aiming to estimate the left ventricular ejection fraction (LVEF) effectively.
- Researchers developed a combined model using 3D-convolutional neural networks (CNN) and transformers to analyze coronary angiograms, achieving high accuracy in classifying LVEF compared to traditional expert assessments.
- The model demonstrated impressive performance metrics (AUC 0.87, sensitivity 0.77, specificity 0.80) with a large dataset of over 18,000 angiograms and outperformed human experts, indicating its potential for clinical use.
Article Synopsis
- A study evaluated the safety and performance of the Intrepid transapical transcatheter mitral valve replacement (TMVR) system over two years in patients with symptomatic, moderate to severe mitral regurgitation (MR) who are at high surgical risk.
- 252 patients were analyzed, showing 13.1% all-cause mortality at 30 days, increasing to 36.2% by two years, along with significant heart failure rehospitalization rates.
- Despite early challenges, more than half of the patients showed improvement in functional status and mild MR at two years, indicating potential benefits from the TMVR system.
Background: Data on the prognostic factors after mitral valve (MV) transcatheter edge-to-edge repair (TEER; MV-TEER) are limited. Pulsed-wave Doppler interrogation of pulmonary vein flow (PVF) is a convenient method to assess the hemodynamic burden of residual mitral regurgitation (MR), which could be of utility as a predictor of outcomes.
Methods: Patients that underwent MV-TEER between May 2014 and December 2021 at our institution were evaluated.
Guidelines for the Evaluation of Prosthetic Valve Function With Cardiovascular Imaging: A Report From the American Society of Echocardiography Developed in Collaboration With the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography.
J Am Soc Echocardiogr
January 2024
In patients with significant cardiac valvular disease, intervention with either valve repair or valve replacement may be inevitable. Although valve repair is frequently performed, especially for mitral and tricuspid regurgitation, valve replacement remains common, particularly in adults. Diagnostic methods are often needed to assess the function of the prosthesis.
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- Exercise echocardiography helps identify non-coronary causes of dyspnea and evaluates the significance of elevated left ventricular (LV) filling pressures during physical activity.
- A study of 14,338 patients demonstrated that those with increased E/e' ratios (≥15) during exercise had significantly lower exercise capacity and higher rates of heart abnormalities and mortality compared to those with lower ratios.
- Elevated LV filling pressures indicate a greater risk for all-cause mortality, particularly in patients whose levels increased post-exercise, highlighting the need for further research in this area.
Background: High surgical risk may preclude mitral valve replacement in many patients. Transcatheter mitral valve replacement (TMVR) using transfemoral transseptal access is a novel technology for the treatment of mitral regurgitation (MR) in high-risk surgical patients.
Objectives: This analysis evaluates 30-day and 1-year outcomes of the Intrepid TMVR Early Feasibility Study in patients with ≥moderate-severe MR.
Objectives: Prior data indicate a very rare risk of serious adverse drug reaction (ADR) to ultrasound enhancement agents (UEAs). We sought to evaluate the frequency of ADR to UEA administration in contemporary practice.
Methods: We retrospectively reviewed 4 US health systems to characterize the frequency and severity of ADR to UEA.
Article Synopsis
- The MITRAL trial is a prospective study that assesses the safety and effectiveness of using transcatheter heart valves to replace failed surgical mitral valves in patients with severe mitral annular calcification.
- The study followed 91 high-risk patients over five years, focusing on three treatment types: mitral valve-in-valve (MViV), valve-in-ring (MViR), and valve-in-mitral annular calcification (ViMAC).
- Results showed that MViV patients had the lowest mortality rate (21.4%) and significant improvements in heart failure symptoms, while MViR and ViMAC groups had higher mortality rates (65.5% and 67.9%, respectively) despite stable heart function
Background: Atrial fibrillation (AF) portends poor prognosis in patients with aortic stenosis (AS).
Objectives: This study aimed to study the association of AF vs. sinus rhythm (SR) with outcomes in asymptomatic severe AS during routine clinical practice.
Patients with severe symptomatic tricuspid regurgitation face a significant dilemma in treatment options, as the yearly mortality with medical therapy and the surgical mortality for tricuspid repair or replacement are high. Transcatheter edge-to-edge repair (TEER) for the tricuspid valve is becoming a viable option in patients, although procedural success is dependent on high-quality imaging. While transesophageal echocardiography remains the standard for tricuspid TEER procedures, intracardiac echocardiography (ICE) with three-dimensional (3D) multiplanar reconstruction (MPR) has many theoretical and practical advantages.
View Article and Find Full Text PDFBackground Description of cerebral and retinal infarction in patients with bicuspid aortic valve (BAV) is limited to case reports. We aimed to characterize cerebral and retinal infarction and examine outcomes in patients with BAV. Methods and Results Consecutive patients from 1975 to 2015 with BAV (n=5401) were retrospectively identified from the institutional database; those with confirmed cerebral or retinal infarction were analyzed.
View Article and Find Full Text PDFAims: Aortic stenosis (AS) induces characteristic changes in left ventricular (LV) mechanics that can be reversed after aortic valve replacement (AVR). We aimed to comprehensively characterize LV mechanics before and after AVR in patients with severe AS and identify predictors of short-term functional recovery and long-term survival.
Methods And Results: We prospectively performed comprehensive strain analysis by 2D speckle-tracking echocardiography in 88 patients with severe AS and LV ejection fraction ≥50% (mean age 71 ± 12 years, 42% female) prior to and within 7 days after AVR.
The prevalence and impact of atrial fibrillation (AF) versus sinus rhythm (SR) on outcomes in very severe aortic stenosis (vsAS) of the native valve is unknown. The aim of the study was to determine the prognostic significance of AF in vsAS. A total of 563 patients with vsAS (transaortic valve peak velocity ≥5 m/s) and left ventricular ejection fraction ≥50% were identified retrospectively.
View Article and Find Full Text PDFBackground: The MITRAL (Mitral Implantation of Transcatheter Valves) trial is the first prospective study for valve-in-mitral annular calcification (ViMAC), mitral valve-in-ring (MViR), and mitral valve-in-valve (MViV) using balloon-expandable aortic transcatheter heart valves. Procedural outcomes beyond 1 year are not well described.
Objectives: This study evaluated 2-year outcomes in ViMAC, MViR, and MViV in the MITRAL trial.