Sarah Verhemel

Background: Coronary computed tomography–derived valve calcification is becoming increasingly important in the multi‐modality assessment of valvular disease, especially in aortic and mitral valve disease. Separately, natural antibodies targeted against malondialdehyde‐modified low‐density lipoprotein (MDA‐LDL), an important subset of all oxidized LDLs, are related to fewer atherosclerosis and cardiovascular events. This study sought to investigate the association between the prevalence of aortic and mitral valve calcification with IgG and IgM anti‐MDA‐LDL antibodies. Methods: In a substudy of the multicenter randomized controlled SCOT‐HEART trial (Scottish computed tomography of the heart), blood biomarkers were measured using laboratory‐developed enzyme‐linked immunosorbent assays and assessed in tertiles, with adjustment for the ASSIGN cardiovascular risk score. Results: In 830 patients (53% male, 57.6±9.8 years) with a heavy burden of cardiovascular risk factors, the highest tertile of IgM anti‐MDA‐LDL was associated with a lower prevalence of aortic valve calcification (odds ratio, 0.59 [95% CI, 0.36–0.96], P =0.04) and mitral valve calcification (odds ratio, 0.26 [95% CI, 0.07–0.72], P =0.02). The highest tertile of IgG anti‐MDA‐LDL was associated with a lower prevalence of mitral valve calcification (odds ratio, 0.36 [95% CI, 0.10–0.99], P =0.05), but not aortic calcification. Conclusions: Anti‐MDA‐LDL antibody levels were associated with a lower prevalence of aortic and mitral valve calcification. Assessment of these novel biomarkers may be useful in screening patients for valve calcification, as well as providing novel insights into potential pathological relationships.

Background: Transcatheter aortic valve implantation (TAVI) procedures to treat severe aortic stenosis are rising, in line with aging populations and advancements in healthcare access. Economic development correlates with AS mortality rates. Socio-economic status (SES), defined by social and economic factors such as median household income, significantly influences cardiovascular outcomes. This study analyses the impact of SES on TAVI outcomes. Methods: Following PRISMA guidelines, a comprehensive search was conducted across PubMed, Medline, Embase, Cochrane, ClinicalTrials.gov and Google Scholar, including literature up to August 1, 2024. The search employed keywords related to SES and TAVI. Of 393 identified studies, 127 were selected for full-text review, with ten addressing SES effects post-TAVI. Most studies had a retrospective design. Results: The patient cohort comprised 319,557 individuals, (144,583 from low SES backgrounds and 174,974 from high SES backgrounds). The analysis revealed a higher burden of comorbidities in low SES patients. Post-TAVI, lower SES related to increased 30-day mortality, major adverse cardiovascular events and the need for pacemaker implantation, although it did not affect in-hospital mortality or 30-day readmission rates. Conclusion: These findings underscore the substantial socio-economic disparities in TAVI outcomes and highlight the need for specific interventions to improve care for patients from less advantaged backgrounds. Key Learning Points: A. What is already known: Lower SES negatively impacts cardiovascular outcomes due to disparities in healthcare access and comorbidities. TAVI is the standard treatment for severe aortic stenosis, especially in elderly patients. SES influences outcomes in cardiovascular procedures, but its impact on TAVI was unclear. B. What this study adds: Low SES increases 30-day mortality, MACE, and pacemaker implantation rates after TAVI. SES does not affect in-hospital mortality or 30-day readmissions. Highlights the need for standardized SES metrics in TAVI research.

Background: Trials comparing non‐vitamin K oral anticoagulant (NOAC) versus antiplatelet‐based strategies have shown a reduction of subclinical leaflet thrombosis at the cost of increased mortality and major‐bleedings. NOACs were often combined with antiplatelet therapy.Aims: The Rotterdam Edoxaban (REDOX) study aimed to evaluate the impact of edoxaban monotherapy on the incidence of hypo‐attenuated leaflet thickening (HALT) and reduced leaflet motion (RLM) and to evaluate safety in terms of mortality, thromboembolic events and major bleeding.Methods: The REDOX study is a single‐arm, open‐label trial including patients after successful transcatheter aortic valve implantation (TAVI) with no formal indication for oral anticoagulation or dual antiplatelet therapy. Patients received edoxaban monotherapy for 3 months, followed by multislice computed tomography (MSCT). The primary endpoint was the occurrence of HALT. Clinical follow‐up continued up to 1 year after TAVI.Results: We included 58 patients, of which 50 reached study completion including MSCT scanning and eight withdrew consent before end of study. At 3‐months follow‐up, HALT of any grade was detected in 12.0% (95% confidence interval (CI): 5.0%–23.1%) of patients. HALT grade ≥ 3 occurred in 4.0% (95% CI: 0.8%–12.2%) of patients. At 1 year follow‐up, all patients were alive and free of disabling strokes. Three patients had a non‐disabling stroke and one patient had a major bleeding.Conclusions: In the REDOX study, edoxaban monotherapy after TAVI was associated with a 12.0% incidence of any HALT and a 4.0% incidence of HALT grade ≥ 3. HALT was not associated with clinical events.

Background: Left ventricular assist devices (LVADs) are increasingly utilized in cardiogenic shock and high-risk percutaneous coronary interventions (PCIs). These devices aspirate and expel blood from the left ventricle (LV) into the aorta, consequently reducing left ventricular end-diastolic pressure (LVEDP). We report a case of unexpected LVEDP rise under LV-to-aorta LVAD in the context of transcatheter aortic valve implantation (TAVI) and concomitant multi-vessel PCI. Case summary: A patient with acute heart failure, severely depressed systolic LV function, severe aortic stenosis, and multi-vessel coronary artery disease underwent TAVI and concomitant PCI under pulsatile LVAD. Notably, the patient experienced unexpected shortness of breath and elevated LVEDP while under LVAD, which normalized immediately upon LVAD removal. Discussion: Pulsatile LVAD enhances cardiac output by providing pulsatile support through a percutaneous bi-directional flow catheter. Despite expectations of reduced LVEDP and improved myocardial oxygen supply under LVAD support, we observed high LVEDP and clinical complaints of shortness of breath following TAVI and multi-vessel PCI. This case illustrates that an LVAD across the aortic valve may immobilize aortic leaflets and generate acute aortic regurgitation.