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Cited by 3 publications
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Outcomes of Balloon-Expandable Transcatheter Aortic Valve Replacement in Younger Patients in the Low-Risk Era
ImportanceGuidelines advise heart team assessment for all patients with aortic stenosis, with surgical aortic valve replacement recommended for patients younger than 65 years or with a life expectancy greater than 20 years. If bioprosthetic valves are selected, repeat procedures may be needed given limited durability of tissue valves; however, younger patients with aortic stenosis may have major comorbidities that can limit life expectancy, impacting decision-making.ObjectiveTo characterize patients younger than 65 years who received transcatheter aortic valve replacement (TAVR) and compare their outcomes with patients aged 65 to 80 years.Design, Setting, and ParticipantsThis retrospective registry-based analysis used data on 139 695 patients from the Society for Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (TVT) Registry, inclusive of patients 80 years and younger undergoing TAVR from August 2019 to September 2023.InterventionBalloon-expandable valve (BEV) TAVR with the SAPIEN family of devices.Main Outcomes and MeasuresComorbidities (heart failure, coronary artery disease, dialysis, and others) and outcomes (death, stroke, and hospital readmission) of patients younger than 65 years compared to patients aged 65 to 80 years.ResultsIn the years surveyed, 13 849 registry patients (5.7%) were younger than 65 years, 125 846 (52.1%) were aged 65 to 80 years, and 101 725 (42.1%) were 80 years and older. Among those younger than 65, the mean (SD) age was 59.7 (4.8) years, and 9068 of 13 849 patients (65.5%) were male. Among those aged 65 to 80 years, the mean (SD) age was 74.1 (4.2) years, and 77 817 of 125 843 patients (61.8%) were male. Those younger than 65 years were more likely to have a bicuspid aortic valve than those aged 65 to 80 years (3472/13 755 [25.2%] vs 9552/125 001 [7.6%], respectively; P < .001). They were more likely to have congestive heart failure, chronic lung disease, diabetes, immunocompromise, and end stage kidney disease receiving dialysis. Patients younger than 65 years had worse baseline quality of life (mean [SD] Kansas City Cardiomyopathy Questionnaire score, 47.7 [26.3] vs 52.9 [25.8], respectively; P < .001) and mean (SD) gait speed (5-meter walk test, 6.6 [5.8] seconds vs 7.0 [4.9] seconds, respectively; P < .001) than those aged 65 to 80 years. At 1 year, patients younger than 65 years had significantly higher readmission rates (2740 [28.2%] vs 23 178 [26.1%]; P < .001) and all-cause mortality (908 [9.9%] vs 6877 [8.2%]; P < .001) than older patients. When propensity matched, younger patients still had higher 1-year readmission rates (2732 [28.2%] vs 2589 [26.8%]; P < .03) with similar mortality to their older counterparts (905 [9.9%] vs 827 [10.1%]; P = .55).Conclusions and RelevanceAmong US patients receiving BEV TAVR for severe aortic stenosis in the low–surgical risk era, those younger than 65 years represent a small subset. Patients younger than 65 years had a high burden of comorbidities and incurred higher rates of death and readmission at 1 year compared to their older counterparts. These observations suggest that heart team decision-making regarding TAVR for most patients in this age group is clinically valid.
Outcomes of Balloon-Expandable Transcatheter Aortic Valve Replacement in Younger Patients in the Low-Risk Era
ImportanceGuidelines advise heart team assessment for all patients with aortic stenosis, with surgical aortic valve replacement recommended for patients younger than 65 years or with a life expectancy greater than 20 years. If bioprosthetic valves are selected, repeat procedures may be needed given limited durability of tissue valves; however, younger patients with aortic stenosis may have major comorbidities that can limit life expectancy, impacting decision-making.ObjectiveTo characterize patients younger than 65 years who received transcatheter aortic valve replacement (TAVR) and compare their outcomes with patients aged 65 to 80 years.Design, Setting, and ParticipantsThis retrospective registry-based analysis used data on 139 695 patients from the Society for Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (TVT) Registry, inclusive of patients 80 years and younger undergoing TAVR from August 2019 to September 2023.InterventionBalloon-expandable valve (BEV) TAVR with the SAPIEN family of devices.Main Outcomes and MeasuresComorbidities (heart failure, coronary artery disease, dialysis, and others) and outcomes (death, stroke, and hospital readmission) of patients younger than 65 years compared to patients aged 65 to 80 years.ResultsIn the years surveyed, 13 849 registry patients (5.7%) were younger than 65 years, 125 846 (52.1%) were aged 65 to 80 years, and 101 725 (42.1%) were 80 years and older. Among those younger than 65, the mean (SD) age was 59.7 (4.8) years, and 9068 of 13 849 patients (65.5%) were male. Among those aged 65 to 80 years, the mean (SD) age was 74.1 (4.2) years, and 77 817 of 125 843 patients (61.8%) were male. Those younger than 65 years were more likely to have a bicuspid aortic valve than those aged 65 to 80 years (3472/13 755 [25.2%] vs 9552/125 001 [7.6%], respectively; P < .001). They were more likely to have congestive heart failure, chronic lung disease, diabetes, immunocompromise, and end stage kidney disease receiving dialysis. Patients younger than 65 years had worse baseline quality of life (mean [SD] Kansas City Cardiomyopathy Questionnaire score, 47.7 [26.3] vs 52.9 [25.8], respectively; P < .001) and mean (SD) gait speed (5-meter walk test, 6.6 [5.8] seconds vs 7.0 [4.9] seconds, respectively; P < .001) than those aged 65 to 80 years. At 1 year, patients younger than 65 years had significantly higher readmission rates (2740 [28.2%] vs 23 178 [26.1%]; P < .001) and all-cause mortality (908 [9.9%] vs 6877 [8.2%]; P < .001) than older patients. When propensity matched, younger patients still had higher 1-year readmission rates (2732 [28.2%] vs 2589 [26.8%]; P < .03) with similar mortality to their older counterparts (905 [9.9%] vs 827 [10.1%]; P = .55).Conclusions and RelevanceAmong US patients receiving BEV TAVR for severe aortic stenosis in the low–surgical risk era, those younger than 65 years represent a small subset. Patients younger than 65 years had a high burden of comorbidities and incurred higher rates of death and readmission at 1 year compared to their older counterparts. These observations suggest that heart team decision-making regarding TAVR for most patients in this age group is clinically valid.
Retinal BioAge Reveals Indicators of Cardiovascular-Kidney-Metabolic Syndrome in US and UK Populations
BackgroundThere is a growing recognition of the divergence between biological and chronological age, as well as the interaction among cardiovascular, kidney, and metabolic (CKM) diseases, known as CKM syndrome, in shortening both lifespan and healthspan. Detecting indicators of CKM syndrome can prompt lifestyle and risk-factor management to prevent progression to adverse clinical events. In this study, we tested a novel deep-learning model, retinal BioAge, to determine whether it could identify individuals with a higher prevalence of CKM indicators compared to their peers of similar chronological age.MethodsRetinal images and health records were analyzed from both the UK Biobank population health study and the US-based EyePACS 10K dataset of persons living with diabetes. 77,887 retinal images from 44,731 unique participants were used to train the retinal BioAge model. For validation, separate test sets of 10,976 images (5,476 individuals) from UK Biobank and 19,856 retinal images (9,786 individuals) from EyePACS 10K were analyzed. Retinal AgeGap (retinal BioAge – chronological age) was calculated for each participant, and those in the top and bottom retinal AgeGap quartiles were compared for prevalence of abnormal blood pressure, cholesterol, kidney function, and hemoglobin A1c.ResultsIn UK Biobank, participants in the top retinal AgeGap quartile had significantly higher prevalence of hypertension compared to the bottom quartile (36.3% vs. 29.0%, p<0.001), while the prevalence was similar for elevated non-HDL cholesterol (77.9% vs. 78.4%, p=0.80), impaired kidney function (4.8% vs. 4.2%, p=0.60), and diabetes (3.1% vs. 2.2%, p=0.24). In contrast, EyePACS 10K individuals in the top retinal AgeGap quartile had higher prevalence of elevated non-HDL cholesterol (49.9% vs. 43.0%, p<0.001), impaired kidney function (36.7% vs. 23.1%, p<0.001), suboptimally controlled diabetes (76.5% vs. 60.0%, p<0.001), and diabetic retinopathy (52.9% vs. 8.0%, p<0.001), but not hypertension (53.8% vs. 55.4%, p=0.33).ConclusionA deep-learning retinal BioAge model identified individuals who had a higher prevalence of underlying indicators of CKM syndrome compared to their peers, particularly in a diverse US dataset of persons living with diabetes.Clinical PerspectiveWhat Is New?Accelerated biological aging predicted by a novel deep-learning analysis of standard retinal images was able to detect multiple indicators of the new cardiovascular-kidney-metabolic syndrome in US and UK populations.What Are the Clinical Implications?Rapid, point-of-care analysis of images from routine eye exams can broaden access to the detection and awareness of adverse cardiovascular, kidney, and metabolic health.With the broad range of prevention interventions to reduce progression of cardiovascular-kidney-metabolic syndrome, earlier and broader detection is important to improve public health outcomes.
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