Neil J Weissman

MedStar Health Research Institute, هایتسویل، مریلند, Maryland, United States

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Publications (359)3258.91 Total impact

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    ABSTRACT: OBJECTIVES The aim of this study was to assess the 1-year outcome after transcatheter aortic valve replacement (TAVR) of the Direct Flow Medical (DFM) valve in patients with severe symptomatic aortic stenosis who were contraindicated or high risk for surgery. BACKGROUND The DFM transcatheter heart valve is a new-generation, nonmetallic aortic valve with a pressurized support structure and conformable double-ring annular sealing delivered through an 18-F sheath. The device allows repositioning, retrieval, and assessment of valve performance before permanent implantation. METHODS A prospective multicenter European registry was set up to determine the safety and performance of the valve in 100 consecutive patients (10 centers). Echocardiographic and angiographic data were evaluated by an independent core laboratory, and adverse events were adjudicated by a clinical events committee using Valve Academic Research Consortium criteria. RESULTS Patients were 83.1 +/- 5.9 years of age and had a logistic EuroSCORE of 22.5 +/- 11.3% and a Society of Thoracic Surgeons score of 9.7 +/- 8.7%. Correct valve positioning was obtained in 99% of cases with a combined 30-day safety endpoint at 10%, including major stroke in 5.0%, major vascular complications in 2.0%, and death in 1%. At 12 months, 95% of patients were in New York Heart Association functional class I or II. Freedom from any death was 90%, and freedom from any death or major stroke was 85%. Echocardiography demonstrated none/trace to mild aortic regurgitation in 100% of patients and an unchanged mean aortic gradient of 12.2 +/- 6.6 mm Hg and effective orifice area of 1.6 +/- 0.4 cm(2). CONCLUSIONS At 1 year, the DFM transcatheter heart valve had durable hemodynamics. This study demonstrates that the low rate of early complications and the low risk of significant aortic regurgitation translated into m idterm clinical benefit. (J Am Coll Cardiol Intv 2016;9:68-75) (C) 2016 by the American College of Cardiology Foundation.
    Full-text · Article · Jan 2016 · JACC Cardiovascular Interventions
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    ABSTRACT: Chronic kidney disease (CKD) is strongly related to outcome in cardiovascular diseases. The relationship between treatment of mitral regurgitation (MR) and renal function is not well described. We sought to evaluate renal function before and after mitral valve repair by the MitraClip device. Patients with moderate-to-severe or severe (3+ or 4+, respectively) MR by core laboratory determination who underwent transcatheter mitral valve repair with the MitraClip device in multicenter, investigational trials were included in this study. Estimated glomerular filtration rate (eGFR) was evaluated before and at hospital discharge, 30 days, 6 months, and 1 year after mitral valve repair. Eight hundred fifty-four patients with baseline mean eGFR 61.5±23.1 mL/min/1.73 m(2) were studied, including 438 (51.3%) with eGFR ≥60 mL/min/1.73 m(2) (CKD stage 1 or 2), 371 (42.6%) with eGFR 30 to 59 mL/min/1.73 m(2) (CKD stage 3), and 52 (6.1%) with eGFR <30 mL/min/1.73 m(2) (CKD stage 4 or 5). Baseline renal dysfunction was more prevalent in older patients with a history of heart failure, coronary artery disease, cerebrovascular disease, diabetes mellitus, hypertension, and atrial fibrillation. Baseline eGFR was associated with 1-year survival (P<0.001) after MitraClip repair. At 1-year follow-up, the mean change in eGFR for the overall cohort was -1.0±15.1 mL/min/1.73 m(2); for patients with CKD stage 1 or 2, stage 3, or stage 4 or 5, mean change was -4.1±16.6, +2.6±12.4, and +4.8±9.5 mL/min/1.73 m(2), respectively. Linear mixed effect modeling demonstrated a strong association between MR and eGFR, and a statistically significant improvement in eGFR in patients with CKD stage 4 or 5 associated with MR reduction to ≤2+ (P=0.007). Renal dysfunction is associated with lower survival in patients with severe MR even after percutaneous mitral valve repair. Reduction in MR severity by the MitraClip device is associated with improvement in renal function at 1 year in patients with baseline renal dysfunction. Unique identifiers: NCT00209274, NCT01931956, NCT01940120. © 2015 American Heart Association, Inc.
    No preview · Article · Dec 2015 · Circulation Cardiovascular Interventions
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    ABSTRACT: Background A finding of reduced aortic-valve leaflet motion was noted on computed tomography (CT) in a patient who had a stroke after transcatheter aortic-valve replacement (TAVR) during an ongoing clinical trial. This finding raised a concern about possible subclinical leaflet thrombosis and prompted further investigation. Methods We analyzed data obtained from 55 patients in a clinical trial of TAVR and from two single-center registries that included 132 patients who were undergoing either TAVR or surgical aortic-valve bioprosthesis implantation. We obtained four-dimensional, volume-rendered CT scans along with data on anticoagulation and clinical outcomes (including strokes and transient ischemic attacks [TIAs]). Results Reduced leaflet motion was noted on CT in 22 of 55 patients (40%) in the clinical trial and in 17 of 132 patients (13%) in the two registries. Reduced leaflet motion was detected among patients with multiple bioprosthesis types, including transcatheter and surgical bioprostheses. Therapeutic anticoagulation with warfarin, as compared with dual antiplatelet therapy, was associated with a decreased incidence of reduced leaflet motion (0% and 55%, respectively, P=0.01 in the clinical trial; and 0% and 29%, respectively, P=0.04 in the pooled registries). In patients who were reevaluated with follow-up CT, restoration of leaflet motion was noted in all 11 patients who were receiving anticoagulation and in 1 of 10 patients who were not receiving anticoagulation (P<0.001). There was no significant difference in the incidence of stroke or TIA between patients with reduced leaflet motion and those with normal leaflet motion in the clinical trial (2 of 22 patients and 0 of 33 patients, respectively; P=0.16), although in the pooled registries, a significant difference was detected (3 of 17 patients and 1 of 115 patients, respectively; P=0.007). Conclusions Reduced aortic-valve leaflet motion was shown in patients with bioprosthetic aortic valves. The condition resolved with therapeutic anticoagulation. The effect of this finding on clinical outcomes including stroke needs further investigation. (Funded by St. Jude Medical and Cedars-Sinai Heart Institute; Portico-IDE number, NCT02000115 ; SAVORY registry, NCT02426307 ; and RESOLVE registry, NCT02318342 .).
    Full-text · Article · Oct 2015 · New England Journal of Medicine

  • No preview · Article · Oct 2015 · Journal of the American College of Cardiology
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    ABSTRACT: Background. Although saturated fatty acids (FAs) have been linked to cardiovascular mortality, it is not clear whether this outcome is attributable solely to their effects on low-density lipoprotein cholesterol (LDL-C) or whether other risk factors are also associated with FAs. The Western Alaskan Native population, with its rapidly changing lifestyles, shift in diet from unsaturated to saturated fatty acids and dramatic increase in cardiovascular disease (CVD), presents an opportunity to elucidate any associations between specific FAs and known CVD risk factors. Objective. We tested the hypothesis that the specific FAs previously identified as related to CVD mortality are also associated with individual CVD risk factors. Methods. In this community-based, cross-sectional study, relative proportions of FAs in plasma and red blood cell membranes were compared with CVD risk factors in a sample of 758 men and women aged ]35 years. Linear regression analyses were used to analyze relations between specific FAs and CVD risk factors (LDL-C, high-density lipoprotein cholesterol, triglycerides, C-reactive protein, systolic blood pressure, diastolic blood pressure, heart rate, body mass index, fasting glucose and fasting insulin, 2-hour glucose and 2-hour insulin). Results. The specific saturated FAs previously identified as related to CVD mortality, the palmitic and myristic acids, were adversely associated with most CVD risk factors, whereas unsaturated linoleic acid (18:2n-6) and the marine n-3 FAs were not associated or were beneficially associated with CVD risk factors. Conclusions. The results suggest that CVD risk factors are more extensively affected by individual FAs than hitherto recognized, and that risk for CVD, MI and stroke can be reduced by reducing the intake of palmitate, myristic acid and simple carbohydrates and improved by greater intake of linoleic acid and marine n-3 FAs.
    Full-text · Article · Aug 2015 · International journal of circumpolar health
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    ABSTRACT: Value-Based Healthcare: Summit 2014 clearly achieved the three goals set forth at the beginning of this document. First, the live event informed and educated attendees through a discussion of the evolving value-based healthcare environment, including a collaborative effort to define the important role of cardiovascular ultrasound in that environment. Second, publication of these Summit proceedings in the Journal of the American Society of Echocardiography will inform a wider audience of the important insights gathered. Third, moving forward, the ASE will continue to build a ‘‘living resource’’ on its website,, for clinicians, researchers, and administrators to use in advocating for the value of cardiovascular ultrasound in the new value-based healthcare environment. The ASE looks forward to incorporating many of the Summit recommendations as it works with its members, legislators, payers, hospital administrators, and researchers to demonstrate and increase the value of cardiovascular ultrasound. All Summit attendees shared in the infectious enthusiasm generated by this proactive approach to ensuring cardiovascular ultrasound’s place as ‘‘The Value Choice’’ in cardiac imaging.
    No preview · Article · Jul 2015 · Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography
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    ABSTRACT: Transcatheter aortic valve therapy has become an established procedure for patients at high risk for surgical valve replacement. The BIOVALVE-I study aims to assess the safety and performance of a novel self-expanding transcatheter heart valve. In this prospective, single-centre, first-in-human study, 13 patients with severe aortic stenosis suitable for transfemoral transcatheter aortic valve implantation were enrolled. Mean logistic EuroSCORE was 14.4±3.7% and mean STS PROM score was 4.3±1.6%. The primary endpoint, 30-day early safety composite per VARC-2, was observed in two patients (15.4%, one life-threatening bleeding and one valve-in-valve procedure). The implant was aborted in two patients due to unsuitable aortic anatomy. Overall, device success was obtained in nine patients (69.2%, two aborted implants, one valve-in-valve procedure and one patient with moderate aortic regurgitation). As determined by an independent core laboratory, all but one patient had less than moderate total aortic regurgitation at 30-day follow-up, mean aortic gradient was 6.7±2.3 mmHg and effective orifice area 1.8±0.3 cm². Pacemakers were implanted in three patients (23.1%), and no death, stroke, myocardial infarction or acute kidney failure was observed. In this first-in-human study, the feasibility of implantation of the BIOVALVE system and its re-sheathing functionality was demonstrated, and short-term safety data were encouraging. Larger studies are required to confirm the performance of the device.
    No preview · Article · May 2015 · EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
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    ABSTRACT: Paravalvular regurgitation (PVR) is a frequent complication of transcatheter aortic valve replacement that has been shown to be associated with increased mortality. The objective of this article is to review the most up-to-date information about the assessment and management of PVR and to propose a new more comprehensive and unifying scheme for grading PVR severity. A multimodality, multiparametric, integrative approach including Doppler echocardiography, cineangiography, hemodynamic assessment, and/or cardiac magnetic resonance is essential to accurately assess the severity of PVR and the underlying etiology. Corrective procedures such as balloon post-dilation, valve-in-valve, or leak closure may be considered, depending on the severity, location, and etiology of PVR. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Mar 2015 · JACC Cardiovascular Imaging

  • No preview · Article · Mar 2015 · Journal of the American College of Cardiology

  • No preview · Article · Mar 2015 · Journal of the American College of Cardiology
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    ABSTRACT: There is significant disparity in the reported incidence of moderate and severe paravalvular aortic regurgitation (PAR) between the Placement of Aortic Transcatheter Valves (PARTNER) I and PARTNER II trials, which may be related to the echocardiographic methodologies used by separate core laboratories. To further explore the variability in echocardiographic interpretation of PAR, agreement between the grading of PAR by the core laboratory of PARTNER IIB was compared with that by a consortium of echocardiography core laboratory directors. The PARTNER IIB core laboratory reevaluated patients using primarily the circumferential extent of the regurgitant jet for PAR. A consortium of echocardiography core laboratory directors was formed to evaluate the echocardiographic images and to grade PAR and central and total aortic regurgitation in a randomly chosen subset of the randomized patients in the PARTNER IIB trial using a multiwindow, multiparametric approach. Both a four-class scale (none or trace, mild, moderate, and severe) and a seven-class (none, trace, mild, mild to moderate, moderate, moderate to severe, and severe) scale were used. Levels of grading agreement between the consortium and original core laboratory in both scales were determined using weighted κ statistics. Only 87 patients assessed for PAR by the consortium could be paired with readings by the PARTNER IIB core laboratory. Using the four-class grading scheme the weighted κ statistic for PAR was 0.481 (95% confidence limits, 0.367, 0.595). Using the seven-class scale, the weighted κ statistic for PAR was 0.517 (95% confidence limits, 0.431, 0.607). For either grading scheme, 15.9% of patients graded by the PARTNER IIB core laboratory as having moderate PAR would have been graded as having mild PAR using the multiparametric approach. Similar results were seen for central and total aortic regurgitation assessments. Using primarily the circumferential extent criteria, the PARTNER IIB core laboratory overestimated the severity of PAR compared to the consortium using a multi-parametric approach. Although a more granular classification scheme for PAR may slightly improve concordance between core laboratories, differences in the incidence of moderate or severe PAR are likely related to differences in grading methodology. A multiparametric approach is advocated, and other echocardiographic methods for assessing PAR deserve further study. Copyright © 2015 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Feb 2015 · Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography

  • No preview · Article · Feb 2015 · JACC Cardiovascular Interventions
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    ABSTRACT: Background: Inoperable aortic stenosis may be treated with either transcatheter aortic valve replacement (TAVR) or medical management (MM) with or without balloon aortic valvuloplasty (BAV). The aim of this study was to compare the long-term echocardiographic findings among TAVR, MM, and BAV in patients with severe, inoperable aortic stenosis. Methods: A total of 358 inoperable patients in the Placement of Aortic Transcatheter Valves trial were randomized to MM or TAVR. Echocardiograms obtained at baseline, 30 days, and 1, 2, and 3 years were analyzed by a central core laboratory. Results: At baseline, TAVR and MM were similar, with more frequent Society of Thoracic Surgeons score > 10 (51.7% vs 65.0%, P = .03) and larger end-systolic volumes (54.5 ± 29.3 vs 69.1 ± 48.0 mL, P = .03) in MM. By 30 days after TAVR, mean aortic valve gradient had decreased (from 43.8 ± 14.7 to 10.0 ± 4.3 mm Hg, P < .001), ejection fraction had increased (from 53.2 ± 12.4% to 56.7 ± 10.0%, P < .001), and left ventricular (LV) mass index had decreased (from 144.7 ± 36.1 to 140.0 ± 37.9 gm/m(2), P < .05). After 1 year, aortic valve gradients and area were unchanged, while LV mass index had decreased by another 16 gm/m(2) (to 124 gm/m(2)). By 30 days after BAV, mean aortic valve gradient had decreased from 43.4 ± 15.0 to 31.9 ± 11.1 mm Hg, while ejection fraction and LV mass index were unchanged; gradient reverted to baseline at 1 year. No changes in gradients or mass were seen in MM patients. Conclusions: TAVR results in immediate and sustained relief in pressure overload and improved LV systolic function, with continued regression of hypertrophy over 3 years. Poor clinical results with BAV are explained by the modest and transient reductions in pressure overload with BAV, which were not accompanied by improved LV function or remodeling. TAVR is the preferred treatment in eligible inoperable patients ( identifier NCT00530894).
    Full-text · Article · Nov 2014 · Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography
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    ABSTRACT: Aim: The impact of paravalvular regurgitation (PVR) following transcatheter aortic valve replacement (TAVR) remains uncertain. In this analysis, we sought to evaluate the impact of varying degrees of PVR on both mortality and changes in ventricular geometry and function. Methods and results: Clinical and echocardiographic outcomes of patients who underwent TAVR from the randomized cohorts and continued access registries in the PARTNER trial were analysed after stratifying by severity of post-implant PVR, which was graded as none/trace in 52.9% (n = 1288), mild in 38.0% (n = 925), and moderate/severe in 9.1% (n = 221). There were significant differences in baseline clinical and echocardiographic characteristics. After TAVR, all the patients demonstrated increase in left ventricular (LV) function and reduction in the LV mass index, although the magnitude of mass regression was lower in the moderate/severe PVR group. The 30-day mortality (3.1 vs. 3.4 vs. 4.5%, P = 0.56) and stroke (3.4 vs. 3.7 vs. 2.3%, P = 0.59) were similar in all groups (none/trace, mild, and moderate/severe). At 1 year, there was increased all-cause mortality (15.9 vs. 22.2 vs. 35.1%, P < 0.0001), cardiac mortality (6.1 vs. 7.4% vs. 16.3%, P < 0.0001) and re-hospitalization (14.4 vs. 23.0 vs. 31.3%, P < 0.0001) with worsening PVR. A multivariable analysis indicated that the presence of moderate/severe PVR (HR: 2.18, 95% CI: 1.57-3.02, P < 0.0001) or mild PVR (HR: 1.37, 95% CI: 1.14-1.90, P = 0.012) was associated with higher late mortality. Conclusion: Differences in baseline characteristics in patients with increasing severities of PVR may increase the risk of this complication. Despite these differences, multivariable analysis demonstrated that both mild and moderate/severe PVR predicted higher 1-year mortality.
    No preview · Article · Oct 2014 · European Heart Journal
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    ABSTRACT: Aims: Non-uniform distribution of drug-eluting stent struts may cause uneven drug deposition associated with an adverse neointimal response and clinical events. This study assesses circumferential stent strut distribution in bare-metal (BMS) and paclitaxel-eluting (Taxus) stents post implantation and at 9-month follow-up, as well as its impact on intimal hyperplasia (IH). Methods and results: In the current analysis, intravascular ultrasound (IVUS) substudies of the Taxus IV, V, and VI trials were combined. Among them, 242 stents (117 BMS and 125 Taxus) had paired IVUS images post procedure and at 9-month follow-up that were reassessed at 1 mm intervals. Post implantation, the maximum interstrut angle (71.5 ± 17.7° vs 70.0 ± 19.6°; P=.53) and minimum number of stent struts (7.1 ± 1.0 vs 7.2 ± 0.8; P=.32) were similar in Taxus vs BMS subgroups, respectively. At 9-month follow-up, the maximum angle increased (92.8 ± 22.1° and 81.7 ± 20.6°) and stent strut numbers decreased (6.1 ± 0.9 and 6.5 ± 1.0) for both Taxus and BMS, respectively, as compared to immediately post implantation (all P<.001). The increased stent angle was more pronounced for Taxus compared with BMS (P<.01). Non-uniform strut distribution did not affect IH pattern or clinical outcomes in either stent population. No complete stent fractures were identified. Conclusion: Stent strut distribution changed from implantation to follow-up with an increased interstrut angle and fewer visible stent struts. These changes were more pronounced for Taxus as compared to BMS; however, non-uniform strut distribution was unrelated to increased IH or clinical outcomes.
    No preview · Article · Oct 2014 · The Journal of invasive cardiology
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    ABSTRACT: Background Little is known about the incidence of prosthesis-patient mismatch (PPM) and its impact on outcomes after transcatheter aortic valve replacement (TAVR). Objectives The objectives of this study were: 1) to compare the incidence of PPM in the TAVR and surgical aortic valve replacement (SAVR) randomized control trial (RCT) arms of the PARTNER (Placement of AoRTic TraNscathetER Valves) I Trial cohort A; and 2) to assess the impact of PPM on regression of left ventricular (LV) hypertrophy and mortality in these 2 arms and in the TAVR nonrandomized continued access (NRCA) registry cohort. Methods The PARTNER Trial cohort A randomized patients 1:1 to TAVR or bioprosthetic SAVR. Postoperative PPM was defined as absent if the indexed effective orifice area (EOA) was >0.85 cm2/m2, moderate if the indexed EOA was ≥0.65 but ≤0.85 cm2/m2, or severe if the indexed EOA was <0.65 cm2/m2. LV mass regression and mortality were analyzed using the SAVR-RCT (n = 270), TAVR-RCT (n = 304), and TAVR-NRCA (n = 1,637) cohorts. Results The incidence of PPM was 60.0% (severe: 28.1%) in the SAVR-RCT cohort versus 46.4% (severe: 19.7%) in the TAVR-RCT cohort (p < 0.001) and 43.8% (severe: 13.6%) in the TAVR-NRCA cohort. In patients with an aortic annulus diameter <20 mm, severe PPM developed in 33.7% undergoing SAVR compared with 19.0% undergoing TAVR (p = 0.002). PPM was an independent predictor of less LV mass regression at 1 year in the SAVR-RCT (p = 0.017) and TAVR-NRCA (p = 0.012) cohorts but not in the TAVR-RCT cohort (p = 0.35). Severe PPM was an independent predictor of 2-year mortality in the SAVR-RCT cohort (hazard ratio [HR]: 1.78; p = 0.041) but not in the TAVR-RCT cohort (HR: 0.58; p = 0.11). In the TAVR-NRCA cohort, severe PPM was not a predictor of 1-year mortality in all patients (HR: 1.05; p = 0.60) but did independently predict mortality in the subset of patients with no post-procedural aortic regurgitation (HR: 1.88; p = 0.02). Conclusions In patients with severe aortic stenosis and high surgical risk, PPM is more frequent and more often severe after SAVR than TAVR. Patients with PPM after SAVR have worse survival and less LV mass regression than those without PPM. Severe PPM also has a significant impact on survival after TAVR in the subset of patients with no post-procedural aortic regurgitation. TAVR may be preferable to SAVR in patients with a small aortic annulus who are susceptible to PPM to avoid its adverse impact on LV mass regression and survival. (The PARTNER Trial: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894)
    No preview · Article · Sep 2014 · Journal of the American College of Cardiology

  • No preview · Article · Sep 2014 · Journal of the American College of Cardiology
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    ABSTRACT: Objective: To investigate the difference in neointimal hyperplasia (NIH) between ST-segment elevation myocardial infarction (STEMI), stable angina pectoris (SAP), and unstable angina pectoris (UAP). Patients and methods: From formal core laboratory intravascular ultrasound substudies, we compared NIH after paclitaxel-eluting stents (PES) or bare metal stents (BMS) in STEMI lesions from HORIZONS-AMI trial with SAP and UAP lesions from TAXUS IV, V, and ATLAS studies. Results: At follow-up, %NIH at the minimum lumen area (MLA) site was less in STEMI (n=212) than in UAP (n=233) and SAP (n=440) lesions treated with PES (19.6 vs. 26.2 vs. 25.0%, P=0.002; all intravascular ultrasound data shown as least-square means in abstract) and less in STEMI (n=66) than in UAP (n=72) and SAP (n=143) lesions treated with BMS (34.0 vs. 26.7 vs. 45.5%, P=0.0003). As a result, MLA at follow-up was larger in STEMI than in UAP and SAP lesions treated with PES (5.9 vs. 5.2 vs. 5.0 mm, P<0.0001) or treated with BMS (5.1 vs. 4.3 vs. 4.0 mm, P=0.002). Net volume obstruction ([NIH/stent volume]×100) at follow-up was significantly less in STEMI than in UAP and SAP lesions treated with PES (7.8 vs. 13.4 vs. 13.4%, P<0.0001) or BMS (20.6 vs. 28.5 vs. 32.1%, P<0.0001). Multivariate linear regression analysis showed that STEMI was correlated independently and inversely with net volume obstruction compared with SAP (regression coefficient -6.99, P<0.0001) or UAP (regression coefficient -6.29, P<0.0001). Conclusion: Implantation of PES or BMS in STEMI compared with UAP and SAP was associated with less NIH.
    No preview · Article · Jun 2014 · Coronary Artery Disease
  • Neil J Weissman · Patrizio Lancellotti

    No preview · Article · Jun 2014 · JACC Cardiovascular Imaging
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    ABSTRACT: Objectives This study sought to examine the relationship between left ventricular mass (LVM) regression and clinical outcomes after transcatheter aortic valve replacement (TAVR). Background LVM regression after valve replacement for aortic stenosis is assumed to be a favorable effect of LV unloading, but its relationship to improved clinical outcomes is unclear. Methods Of 2,115 patients with symptomatic aortic stenosis at high surgical risk receiving TAVR in the PARTNER (Placement of Aortic Transcatheter Valves) randomized trial or continued access registry, 690 had both severe LV hypertrophy (left ventricular mass index [LVMi] 149 g/m2 men, 122 g/m2 women) at baseline and an LVMi measurement at 30-day post-TAVR follow-up. Clinical outcomes were compared for patients with greater than versus lesser than median percentage change in LVMi between baseline and 30 days using Cox proportional hazard models to evaluate event rates from 30 to 365 days. Results Compared with patients with lesser regression, patients with greater LVMi regression had a similar rate of all-cause mortality (14.1% vs. 14.3%, p = 0.99), but a lower rate of rehospitalization (9.5% vs. 18.5%, hazard ratio [HR]: 0.50, 95% confidence interval [CI]: 0.32 to 0.78; p = 0.002) and a lower rate of rehospitalization specifically for heart failure (7.3% vs. 13.6%, p = 0.01). The association with a lower rate of rehospitalization was consistent across subgroups and remained significant after multivariable adjustment (HR: 0.53, 95% CI: 0.34 to 0.84; p = 0.007). Patients with greater LVMi regression had lower B-type natriuretic peptide (p = 0.002) and a trend toward better quality of life (p = 0.06) at 1-year follow-up than did those with lesser regression. Conclusions In high-risk patients with severe aortic stenosis and severe LV hypertrophy undergoing TAVR, those with greater early LVM regression had one-half the rate of rehospitalization over the subsequent year compared to those with lesser regression.
    Full-text · Article · Jun 2014 · JACC Cardiovascular Interventions

Publication Stats

19k Citations
3,258.91 Total Impact Points


  • 2004-2015
    • MedStar Health Research Institute
      هایتسویل، مریلند, Maryland, United States
    • Brigham and Women's Hospital
      Boston, Massachusetts, United States
    • University of Maryland, Baltimore
      Baltimore, Maryland, United States
  • 2000-2015
    • Washington Hospital Center
      Washington, Washington, D.C., United States
    • Naval Medical Center Portsmouth
      Portsmouth, Virginia, United States
  • 1997-2015
    • Georgetown University
      • • Department of Medicine
      • • Division of Cardiology
      Washington, Washington, D.C., United States
    • Massachusetts Institute of Technology
      • Department of Electrical Engineering and Computer Science
      Cambridge, MA, United States
  • 2013
    • Durham University
      Durham, England, United Kingdom
    • New York Presbyterian Hospital
      • Department of Cardiology
      New York City, New York, United States
  • 2012
    • Lukaskrankenhaus Neuss
      Neuss, North Rhine-Westphalia, Germany
  • 2009
    • Chung-Ang University Hospital
      Sŏul, Seoul, South Korea
  • 2007-2009
    • Columbia University
      • Division of Cardiology
      New York, New York, United States
    • Baylor University
      Waco, Texas, United States
  • 2000-2009
    • Washington DC VA Medical Center
      Washington, Washington, D.C., United States
  • 2008
    • Duke University Medical Center
      Durham, North Carolina, United States
  • 1995-2008
    • University of Massachusetts Boston
      Boston, Massachusetts, United States
  • 2006
    • Vanderbilt University
      Нашвилл, Michigan, United States
  • 1995-2004
    • Massachusetts General Hospital
      • Department of Medicine
      Boston, Massachusetts, United States
  • 2003
    • University of Ulsan
      • Department of Medicine
      Urusan, Ulsan, South Korea
    • Asan Medical Center
      • Department of Cardiology
      Sŏul, Seoul, South Korea
  • 2002
    • William Penn University
      Filadelfia, Pennsylvania, United States
    • Rabin Medical Center
      Tell Afif, Tel Aviv, Israel
    • American Society of Echocardiography
      American Fork, Utah, United States
  • 2001-2002
    • Cardiovascular Research Foundation
      New York, New York, United States
  • 1996
    • Harvard Medical School
      • Department of Medicine
      Boston, Massachusetts, United States
  • 1995-1996
    • Harvard University
      Cambridge, Massachusetts, United States