Prognostic impact of anemia and iron-deficiency anemia in a contemporary cohort of patients undergoing transcatheter aortic valve implantation

Rheude, Tobias; Pellegrini, Costanza; Michel, Jonathan; Trenkwalder, Teresa; Mayr, N. Patrick; Kessler, Thorsten; Kasel, Albert M.; Schunkert, Heribert; Kastrati, Adnan; Hengstenberg, Christian; Hüsser, Oliver

doi:10.1016/j.ijcard.2017.06.024

Cited by 44 publications

(56 citation statements)

References 31 publications

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“…This prospective study shows that both ID, as defined in patients with HF, and anaemia are common comorbidities in patients with severe AS, with a prevalence of 53% and 20%, respectively. The prevalence of anaemia in our patients was relatively low compared with what has been observed in recent studies on patients with AS mainly referred for TAVI, where the prevalence of anaemia has been reported to be between 22% and 57% 18–21. This is most likely explained by differences in patient characteristics.…”

Section: Discussioncontrasting

confidence: 79%

“…Patients with AS typically have numerous comorbidities, including anaemia, which occurs in 22%–57% of patients 18–21. Anaemia in patients with AS is associated with reduced QoL, poorer functional capacity and reduced survival 18 19. However, in patients with AS, we do not know the prevalence of non-anaemic ID or the consequences of having ID.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and prognostic implication of iron deficiency and anaemia in patients with severe aortic stenosis

et al. 2018

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ObjectiveThe aim of this study was to evaluate the prevalence and prognostic implication of iron deficiency (ID) and anaemia in patients with severe aortic stenosis (AS).MethodsIn an observational study of consecutive patients referred for aortic valve replacement (AVR), we assessed a wide range of biomarkers of iron status, including the definition of ID commonly applied in patients with chronic heart failure (ferritin <100 µg/L or ferritin 100–299 µg/L with a transferrin saturation <20%). The endpoints were short-term (one-year) and long-term (median 4.7 years, IQR: 3.8–5.5) mortality and major adverse cardiovascular events (MACE) within the first year after inclusion.Results464 patients were included in this substudy. 91 patients (20%) received conservative treatment and 373 patients (80%) received AVR. ID was detected in 246 patients (53%). 94 patients (20%) had anaemia. Patients with ID had an overall worse clinical profile than patients without ID. During follow-up, 129 patients (28%) died. Neither ID as defined above, soluble transferrin receptor nor hepcidin were associated with short-term or long-term mortality or MACE independent on treatment allocation. Anaemia was associated with one-year mortality in conservatively treated patients.ConclusionsID and anaemia are prevalent in patients with severe AS. In our cohort, ID did not provide independent prognostic information on top of conventional risk factors. More studies are required to determine how to correctly diagnose ID in patients with AS.Trial registration numberNCT01794832.

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Section: Discussioncontrasting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Prevalence and prognostic implication of iron deficiency and anaemia in patients with severe aortic stenosis

et al. 2018

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“…Five studies [53][54][55][56][57] (3746 patients) were included in the analysis for anaemia using the predefined cutoff values. The pooled result was an HR of 2.09 (95% CI: 0.93-4.66) and was not a significant predictor for 1-year mortality, but nevertheless showed a clear trend.…”

Section: Anaemiamentioning

confidence: 99%

Preoperative frailty parameters as predictors for outcomes after transcatheter aortic valve implantation: a systematic review and meta-analysis

et al. 2020

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Guidelines suggest using frailty characteristics in the work-up for a transcatheter aortic valve implantation (TAVI). There are many frailty-screening tools with different components. The prognostic value of the individual parameters in frailty is as yet unclear. The objective of this systematic review and meta-analysis was to find and pool predictors for 1-year mortality after TAVI. We followed a twostep approach. First, we searched for randomised controlled trials on TAVI to identify frailty parameters used in these studies. Second, we searched for publications on these frailty parameters. Articles were included for pooled analysis if the studied frailty parameters were dichotomised with clear cutoff values based on common standards or clinical practice and reported adjusted hazard ratios (HR) of 1-year mortality after TAVI. We calculated pooled effect estimates of 49 studies based on dichotomised frailty scores (

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“…Anemia is a common finding among patients with severe AS. Rheude et al [6] and Tjahjadi et al [7] reported a 45% and a 30.1% prevalence of anaemia (World Health Organization definition) among patients undergoing surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI), respectively. On the other hand, it has been postulated that the prevalence of calcific AS is much higher in patients with idiopathic GIB compared to non-idiopathic GIB and the general population.…”

Section: Epidemiologymentioning

confidence: 99%

Aortic stenosis and anemia with an update on approaches to managing angiodysplasia in 2018

et al. 2020

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Angiodyplasia and aortic stenosis are both conditions that are highly prevalent in elderly people and can often co-exist. Recent studies suggest that this association is related to subtle alterations in plasma coagulation factors. The Von Willebrand factor is the strongest link between aortic stenosis and bleeding associated with gastrointestinal angiodysplasia. With an ageing population, the disease burden of aortic stenosis and its association with angiodysplasia of the bowel makes this an incredibly underdiagnosed yet important condition. Clinicians should be aware of this association when dealing with elderly patients presenting either with unexplained anemia, gastrointestinal bleeding or with aortic stenosis. A high index of suspicion and appropriate diagnostic techniques followed by appropriate and prompt treatment could be life-saving. No clear guidelines exist on management but surgical aortic valve replacement is thought to offer the best hope for long-term resolution of bleeding. With a growing number of technological armamentarium in the management of such patients, especially with the advent of transcatheter aortic valve implantation, new options can be offered even to elderly patients with comorbidities for whom conventional surgery would have been impossible.

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Prognostic impact of anemia and iron-deficiency anemia in a contemporary cohort of patients undergoing transcatheter aortic valve implantation

Cited by 44 publications

References 31 publications

Prevalence and prognostic implication of iron deficiency and anaemia in patients with severe aortic stenosis

Prevalence and prognostic implication of iron deficiency and anaemia in patients with severe aortic stenosis

Preoperative frailty parameters as predictors for outcomes after transcatheter aortic valve implantation: a systematic review and meta-analysis

Aortic stenosis and anemia with an update on approaches to managing angiodysplasia in 2018

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