PMID- 37337011
OWN - NLM
STAT- MEDLINE
DCOM- 20231023
LR  - 20231103
IS  - 1861-0692 (Electronic)
IS  - 1861-0684 (Print)
IS  - 1861-0684 (Linking)
VI  - 112
IP  - 10
DP  - 2023 Oct
TI  - Cardio-hepatic syndrome in patients undergoing transcatheter aortic valve 
      replacement.
PG  - 1427-1435
LID - 10.1007/s00392-023-02245-w [doi]
AB  - BACKGROUND: Cardiohepatic syndrome (CHS) has been identified as an important but 
      underrecognized survival predictor in multiple cardiovascular disease entities. 
      The objectives of this study were to evaluate the prevalence and prognostic value 
      of CHS in patients undergoing TAVR for severe aortic stenosis (AS). METHODS: The 
      study included patients with available laboratory parameters of hepatic function 
      who underwent TAVR from July 2013 until December 2019 at our center. CHS was 
      defined as an elevation of at least two of three laboratory cholestasis 
      parameters above the upper limit of normal (bilirubin, alkaline phosphatase, and 
      gamma glutamyl transferase). Study endpoints were three-year survival, technical 
      and device failure (VARC 3), as well as New York Heart Association (NYHA) 
      functional class at follow-up. RESULTS: Among a total of 953 analyzed patients 
      (47.6% females, median age 80.0 [76.0-85.0] years) CHS was present in 212 
      patients (22.4%). In patients with vs. without CHS, rates of technical (6.1% vs. 
      8.4%, p = 0.29) and device failure (18.9% vs. 17.3%, p = 0.59) were comparable. 
      NYHA functional class at baseline and follow-up was more severe in patients with 
      CHS. Nevertheless, heart failure symptoms improved from baseline to follow-up 
      irrespective of hepatic function. Three-year survival rates were significantly 
      lower in patients with CHS (49.4 vs. 65.4%, p < 0.001). The predictive value of 
      CHS persisted after adjustment in a multivariable analysis (hazard ratio 1.58, 
      p < 0.01). CONCLUSION: In patients undergoing TAVR, CHS is prevalent in 22% of 
      patients and is associated with increased postinterventional mortality. Thus, CHS 
      should be included in the decision-making process within the TAVR heart team. 
      Cardiohepatic syndrome (CHS) as defined by an elevation of at least two of three 
      laboratory cholestasis parameters above the upper limit of normal was prevalent 
      in 22% of patients undergoing TAVR for severe AS. The presence of CHS was 
      associated with more severe heart failure symptoms and worse three-year survival.
CI  - (c) 2023. The Author(s).
FAU - Stolz, Lukas
AU  - Stolz L
AUID- ORCID: 0000-0002-1362-1493
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, 
      Marchioninistr. 15, 81377, Munich, Germany.
FAU - Kirchner, Michael
AU  - Kirchner M
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, 
      Marchioninistr. 15, 81377, Munich, Germany.
FAU - Steffen, Julius
AU  - Steffen J
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, 
      Marchioninistr. 15, 81377, Munich, Germany.
FAU - Doldi, Philipp M
AU  - Doldi PM
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, 
      Marchioninistr. 15, 81377, Munich, Germany.
AD  - German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart 
      Alliance, Munich, Germany.
FAU - Braun, Daniel
AU  - Braun D
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, 
      Marchioninistr. 15, 81377, Munich, Germany.
FAU - Weckbach, Ludwig T
AU  - Weckbach LT
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, 
      Marchioninistr. 15, 81377, Munich, Germany.
FAU - Stocker, Thomas J
AU  - Stocker TJ
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, 
      Marchioninistr. 15, 81377, Munich, Germany.
FAU - Low, Kornelia
AU  - Low K
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, 
      Marchioninistr. 15, 81377, Munich, Germany.
FAU - Fischer, Julius
AU  - Fischer J
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, 
      Marchioninistr. 15, 81377, Munich, Germany.
FAU - Haum, Magda
AU  - Haum M
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, 
      Marchioninistr. 15, 81377, Munich, Germany.
FAU - Theiss, Hans D
AU  - Theiss HD
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, 
      Marchioninistr. 15, 81377, Munich, Germany.
FAU - Rizas, Konstantinos
AU  - Rizas K
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, 
      Marchioninistr. 15, 81377, Munich, Germany.
AD  - German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart 
      Alliance, Munich, Germany.
FAU - Orban, Martin
AU  - Orban M
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, 
      Marchioninistr. 15, 81377, Munich, Germany.
AD  - German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart 
      Alliance, Munich, Germany.
FAU - Peterss, Sven
AU  - Peterss S
AD  - Herzchirurgische Klinik und Poliklinik, Klinikum der Universitat Munchen, Munich, 
      Germany.
FAU - Nabauer, Michael
AU  - Nabauer M
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, 
      Marchioninistr. 15, 81377, Munich, Germany.
AD  - German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart 
      Alliance, Munich, Germany.
FAU - Massberg, Steffen
AU  - Massberg S
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, 
      Marchioninistr. 15, 81377, Munich, Germany.
AD  - German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart 
      Alliance, Munich, Germany.
FAU - Hausleiter, Jorg
AU  - Hausleiter J
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, 
      Marchioninistr. 15, 81377, Munich, Germany.
AD  - German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart 
      Alliance, Munich, Germany.
FAU - Deseive, Simon
AU  - Deseive S
AD  - Medizinische Klinik und Poliklinik I, Klinikum der Universitat Munchen, 
      Marchioninistr. 15, 81377, Munich, Germany. Simon.Deseive@med.uni-muenchen.de.
AD  - German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart 
      Alliance, Munich, Germany. Simon.Deseive@med.uni-muenchen.de.
LA  - eng
PT  - Journal Article
DEP - 20230619
PL  - Germany
TA  - Clin Res Cardiol
JT  - Clinical research in cardiology : official journal of the German Cardiac Society
JID - 101264123
SB  - IM
MH  - Female
MH  - Humans
MH  - Aged, 80 and over
MH  - Male
MH  - *Transcatheter Aortic Valve Replacement/adverse effects
MH  - *Aortic Valve Stenosis/diagnosis/surgery
MH  - Treatment Outcome
MH  - *Heart Failure
MH  - *Cholestasis
MH  - Aortic Valve/surgery
MH  - Risk Factors
PMC - PMC10562337
OTO - NOTNLM
OT  - Aortic stenosis
OT  - Cardiohepatic syndrome
OT  - Congestion
OT  - Heart failure
OT  - Liver function
OT  - TAVR
COIS- JH has received speaker honoraria from and serves as consultant for Edwards 
      Lifesciences. SD and JS received speaker honoraria from AstraZeneca. DB received 
      speaker honoraria from Abbott Vascular. LW reports speaker honoraria from 
      AstraZeneca and Bayer. MO received speaker honoraria from Abbott Medical, 
      AstraZeneca, Abiomed, Bayer vital, BIOTRONIK, Bristol-Myers Squibb, CytoSorbents, 
      Daiichi Sankyo Deutschland, Edwards Lifesciences Services and Sedana Medical. The 
      other authors have no conflict of interest to declare.
EDAT- 2023/06/20 01:08
MHDA- 2023/10/23 00:44
PMCR- 2023/06/19
CRDT- 2023/06/19 23:22
PHST- 2023/02/13 00:00 [received]
PHST- 2023/06/05 00:00 [accepted]
PHST- 2023/10/23 00:44 [medline]
PHST- 2023/06/20 01:08 [pubmed]
PHST- 2023/06/19 23:22 [entrez]
PHST- 2023/06/19 00:00 [pmc-release]
AID - 10.1007/s00392-023-02245-w [pii]
AID - 2245 [pii]
AID - 10.1007/s00392-023-02245-w [doi]
PST - ppublish
SO  - Clin Res Cardiol. 2023 Oct;112(10):1427-1435. doi: 10.1007/s00392-023-02245-w. 
      Epub 2023 Jun 19.