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Background:Acute respiratory distress syndrome (ARDS) occurs commonly in intensive care units. The reported mortality rates in studies evaluating ARDS are highly variable.

Cardiac amyloidosis wild type (ATTR-CAwt) is often the underdiagnosed cause of heart failure with preserved ejection fraction (HFpEF) and has a high mortality rate. There is usually a long delay between the appearance of clinical signs and the diagnosis of ATTR-CAwt but a short duration between diagnosis and death. ATTR-CAwt was associated with significant clinical arrhythmias. We report a case of ATTR-CAwt, the process of its diagnosis, and the associated clinical arrhythmias and their management. We also reviewed the literature of this underdiagnosed and potentially fatal condition and the current existing therapies.

Transabdominal duplex ultrasound, intravascular ultrasound (IVUS), and fluoroscopy have been used to assist with inferior vena cava filter (IVCF) placement since the late 1990s. We sought to compare the technical success and procedural complications of bedside placement of IVCF by the three commonly used modalities, namely, duplex ultrasound, IVUS, and combined IVUS and fluoroscopy.

ABSTRACTBackground: The purpose of this study was to perform a systematic review and pooled analysis to evaluate 30-day and 1-year outcomes of transcatheter mitral valve-in-valve (VIV) and valve-in-ring (VIR) procedures. Data from the Valve-in-Valve Data Registry revealed that there were several safety and efficacy concerns, although procedural success was achieved in most cases.Methods: Studies reporting data on either mitral VIV and/or VIR with at least five patients were pooled using weighted proportional analysis.Results: The 30-day pooled estimate of all-cause mortality in the mitral VIV group was 7%, valve embolization, 5%, stroke, 3%, and major bleeding, 9%. At 1 year the all-cause mortality was 11%, valve thrombosis, 10%, stroke, 6%, and major bleeding, 16%. In the mitral VIR group, the 30-day pooled estimate for all-cause mortality was 8%, renal failure, 11%, valve embolization, 3%, and left ventricular outflow tract obstruction, 10% and at 1 year the all-cause mortality was about 22%.Conclusions: Mitral VIV and VIR procedures are safe and feasible in high risk surgical candidates. The long-term safety and efficacy data beyond 1 year for both mitral VIV and VIR need to be established.

ABSTRACTBackground:The transapical (TA) route for mitral valve-in-valve (MVIV) and mitral valve-in-ring (MVIR) techniques has been predominantly used. Currently, there is an increasing trend towards the transseptal (TS) route. The purpose of the study was to assess the outcomes of TA and TS access for percutaneous MVIV and MVIR techniques in terms of procedural success, 30-day mortality, major bleeding events and valve embolization.Methods:A comprehensive literature search of EMBASE, PubMed, and the Cochrane CENTRAL was completed. We identified and pooled all studies reporting either the TS or TA approach for MVIV or MVIR with at least five patients using weighted proportional analysis. For analysis we used studies reporting the outcomes of percutaneous MVIV or MVIR based on the TS/TA approach.Results:From the initial 1,993 abstracts, 15 studies reporting on 236 patients were analyzed to find the pooled estimate of the endpoints. In the TA arm, 11 studies were included, and in the TS arm, 8 studies were included. Of these, 5 studies reported data for both the TA and TS arms. There was no difference between the groups in terms of technical success, 30-day all-cause mortality, major bleeding events, and valve embolization.Conclusion:Although the TA approach has been used in most of the published studies, the TS approach appears to be equally effective at 30 days. Long-term studies are needed to establish the relative efficacy of one approach over the other.

Introduction:Patients with chronic kidney disease (CKD) often have cardiovascular calcification with a higher prevalence of AV disease. Aortic valve calcium (AVC) scores are often used to assess the severity of aortic stenosis (AS).Methods:We retrospectively studied 361 patients with AS who underwent a CTA at our institute from Nov 2018 to Mar 2022. GFR values closest to the CTA, but at most three months prior, along with the occurrence of the following outcomes: TAVR, SAVR, and all-cause mortality were recorded. An AVC score > 2000 for men and 1200 for women was defined as severe AS. Also, GFR values were split into 3 groups: >=60 (Group 1), 30-59 (Group 2), and <30 (Group 3). An interaction term (CKD x AS) was also used to evaluate the differential impact of severe AS on outcomes within the CKD groups.Results:There was no significant difference in AVC scores among the CKD groups (p = 0.21) using a Kruskal-Wallis test. However, severe AS was associated with a higher occurrence of outcomes (OR = 6.84 [1.67 - 27.96], p = 0.008*), along with a non-significant interaction term (OR = 0.63 [0.26 - 1.52], p = 0.3) using a logistic regression with severe AS, CKD groups, and the interaction term as independent variables. Moreover, using a cox proportional-hazards model with the same variables, severe AS had a significant association with the outcomes (HR = 2.51, p = 0.009*), with a non-significant interaction term (HR = 0.85, p = 0.43).Conclusions:There was no significant difference in AVC scores among the CKD groups. But irrespective of kidney function, severe AS was associated with worse outcomes. Therefore, similar thresholds of AVC scores can be used to define severe AS in patients with and without CKD.

Introduction:AVA can be estimated by either TTE or CTA however there is only limited literature assessing the concordance between these two modalities. AVA of 1.2 has been proposed as an indicator for severe AS by cardiac CTA in previous literature.Hypothesis:In our single center experience, we are hypothesizing that if use CTA AVA cut off of 1.2 cm^2, it will have high sensitivity in identifying all severe AS patients rather than using 1 cm^2 in CTA.Methods:We retrospectively studied 255 patients with severe AS who underwent both CTA and TTE at our institute from 11/2018 to 08/2021. Aortic valve area was obtained by CTA planimetry and categorized the subjects into three groups (AVA < 1 cm^2; AVA 1-1.2 cm^2; AVA > 1.2cm^2). Aortic valve area from TTE was calculated by continuity equation. The subjects were further categorized into patients with high gradient severe AS (mean gradient >40 mmhg) and low gradient severe AS.Results:Among 116 patients with low gradient severe AS (TTE AVA <1cm^2), 45 patients had CTA AVA <1 cm^2 and 39 patients had CTA AVA 1-1.2 cm^2 and 32 patients had CTA AVA >1.2 cm^2. And among 129 patients with high gradient severe AS (TTE AVA <1cm^22), 55 patients had CTA AVA <1 cm^2, 42 patients had CTA AVA 1-1.2 cm^2 and 32 patients had CTA AVA >1.2 cm^2. Overall when we use CTA AVA <1.2 cm^2 in low gradient severe AS cohort, we were able to identify 72% of severe AS patients and in high gradient severe AS cohort, we were able to identify 75.2% of severe AS patients.Conclusions:From our single center retrospective study, we are observing that for both high gradient and low gradient AS, there is high level of correlation between CTA and TTE when the AVA is either less than 1 cm^2 or when it is between 1-1.2 cm^2. However, for the AVA greater than 1.2 cm^2 there is lesser degree of correlation between the modalities especially in low gradient cohort. Overall, we suggest that using the cut off AVA 1.2 cm^2 by Cardiac CTA would achieve higher sensitivity for identifying the severe AS patients.

Introduction:With the approval of transcatheter mitral valve edge-edge repair (TEER) for secondary mitral regurgitation, there has been a significant increase in the volume of TEER. Prior investigators have explored gender differences in outcomes of Mitraclip (the only approved TEER) with mixed results. In this study, we systematically reviewed impact of gender on Mitraclip outcomes and performed a meta-analysis to examine short-term and long-term outcomes in women versus men.Hypothesis:Females undergoing TEER with Mitraclip will have higher mortality, major adverse events and less functional improvement compared to men.Methods:Pubmed, Google scholar, Cochrane database etc were searched through 31 May 2021 for published studies reporting outcomes with Mitraclip in women versus men. Meta-analysis was performed using comprehensive meta-analysis software using random effects model.Results:Ten studies (8 manuscripts and 2 abstracts) with total of 2924 males and 1816 females were analysed. The risk of death at discharge (p=0.71), at 30 days (p=0.32) and beyond 6-12 months (p=0.97) was similar. Acute procedural success (defined by mitral regurgitation grade ≤2 at 30 days), major adverse events at 1 month (p=0.064) and at 1 year (p= 0.98), risk of renal failure (p=0.15), stroke (p=0.71) and 1 year readmission rate (p=0.42) were all similar. Females received more blood transfusion than males (RR: 1.37, CI: 1.03-1.80, p=0.02). Prevalence of NYHA 3/4 class at 1 year post-procedure (RR: 1.36, CI: 1.19-1.56, p<0.01) and MLHFQ scores (RR: 1.91, CI: 1.47-2.48, p=0.01) were higher in females compared to males.Conclusions:Females have similar early and intermediate term mortality, major adverse events and rehospitalization rates compared to men following TEER with Mitraclip. However, females have less symptoms improvement as evidenced by greater frequency of NYHA class 3/4 symptoms and higher MLHFQ scores at 6-12 months after Mitraclip implantation compared to males.