Background: ATTR-CM has an age dependent prevalence and is a disorder that almost exclusively affects older adults. Objective evaluations of function are critical to assessing and managing ATTR-CM in older adults. The short physical performance battery (SPPB) is a valid measure of functional capacity that predicts morbidity and mortality in older adults but its utility in ATTR-CM remains unknown. Aims/hypothesis: To establish SPPB as a useful marker of disease severity and predictor of outcomes in ATTR-CM. We hypothesized that SPPB scores would correlate with validated markers of ATTR-CM severity and improve clinical prediction. Methods: This is a retrospective analysis of patients referred to the Columbia University Cardiac Amyloid Program. Patients were stratified into low (SPPB 0-6), moderate (7-9), and high (10-12) cohorts based on initial SPPB score and baseline characteristics were compared between groups. Cox proportional hazard models and Kaplan Meier (KM) curves were generated to assess associations with mortality as well as a composite of death and cardiovascular (CV) hospitalization in follow-up. Results: A total of 263 patients, age 78 years (IQR 73, 84), 86% male, 22% with ATTRv (variant) and 78% with ATTRwt (wild type) were studied. SPPB showed no limitation in 59%, mild limitation in 33%, and severe limitation in 8%. Lower SPPB was associated (p <0.05) with older age, prior stroke/TIA, shorter 6-minute walk test, elevated NT-proBNP and HS-troponin, worse quality of life metrics on Kansas City Cardiomyopathy Questionnaire, more advanced NYHA and Mayo stages, and higher Columbia scores. On multivariate regression (adjusted for age, sex, genotype, NYHA), SPPB was independently associated with the composite of mortality and CV hospitalization, with each point increase corresponding to 13% lower incidence of the outcome (HR 0.87, p=0.01). Chair stands score, one of three SPPB subdomains, was independently associated with the composite and mortality. KM curves showed significant association with SPPB and both the composite and mortality (Fig. 1). Conclusions: SPPB score is a marker of ATTR-CM severity, associated with validated biomarkers and staging systems, and independently predicts clinical outcomes.
Introduction: Advanced tricuspid regurgitation (TR) is associated with adverse cardiovascular outcomes. Herein, we report demographics of patients presenting to a tertiary valve center and characterize measures of TR severity and right ventricular (RV) function. Methods: We conducted a single center retrospective analysis of patients referred to a specialty valve clinic from January 2016 to September 2020 with a primary or secondary diagnosis of tricuspid regurgitation. Baseline clinical, echocardiographic, and hemodynamic variables were evaluated. Results: A total of 348 patients were included. Median age was 79 years (IQR 70, 84), and 54% were female. Torrential TR was present in 41% (n = 146), massive in 11% (n = 40), severe 34% (n = 120), and moderate or less in 9% (n = 31). Increase in TR severity was associated with RV, right atrial, and annular dilatation. There was no difference in RV function between groups assessed by TAPSE or S’. Right atrial pressure v-wave was higher with increase in TR severity. Pulmonary arterial (PA) pressures were significantly different between groups, as was pulmonary vascular resistance (PVR): lower PA pressures and PVR were seen with increase in TR severity. There were no differences in cardiac output across groups, though a numeric trend in decreasing cardiac output was noted with increase in TR severity from severe to torrential. There was increase in S’/PASP and decrease in pulmonary artery pulsatility index seen with increasing TR severity. Conclusion: Patients referred for TR are frequently advanced in age with massive or torrential tricuspid regurgitation and evidence of adverse right ventricular remodeling. Increasing severity of advanced TR was associated with RV hemodynamic decompensation. Preservation of two-dimensional measures of right ventricular function in the setting of progressive TR, as well as markers of right ventricular-vascular coupling, may suggest these are late markers of right ventricular compromise.
Abstract Objective To characterize patients with coronavirus disease 2019 (COVID-19) in a large New York City (NYC) medical center and describe their clinical course across the emergency department (ED), inpatient wards, and intensive care units (ICUs). Design Retrospective manual medical record review. Setting NewYork-Presbyterian/Columbia University Irving Medical Center (NYP/CUIMC), a quaternary care academic medical center in NYC. Participants The first 1000 consecutive patients with laboratory-confirmed COVID-19. Methods We identified the first 1000 consecutive patients with a positive RT-SARS-CoV-2 PCR test who first presented to the ED or were hospitalized at NYP/CUIMC between March 1 and April 5, 2020. Patient data was manually abstracted from the electronic medical record. Main outcome measures We describe patient characteristics including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition. Results Among the first 1000 patients, 150 were ED patients, 614 were admitted without requiring ICU-level care, and 236 were admitted or transferred to the ICU. The most common presenting symptoms were cough (73.2%), fever (72.8%), and dyspnea (63.1%). Hospitalized patients, and ICU patients in particular, most commonly had baseline comorbidities including of hypertension, diabetes, and obesity. ICU patients were older, predominantly male (66.9%), and long lengths of stay (median 23 days; IQR 12 to 32 days); 78.0% developed AKI and 35.2% required dialysis. Notably, for patients who required mechanical ventilation, only 4.4% were first intubated more than 14 days after symptom onset. Time to intubation from symptom onset had a bimodal distribution, with modes at 3-4 and 9 days. As of April 30, 90 patients remained hospitalized and 211 had died in the hospital. Conclusions Hospitalized patients with COVID-19 illness at this medical center faced significant morbidity and mortality, with high rates of AKI, dialysis, and a bimodal distribution in time to intubation from symptom onset.
Abstract Aims Characterize the impact of residual tricuspid regurgitation (TR) on right ventricle (RV) remodeling and clinical outcomes after transcatheter tricuspid valve intervention. Methods We performed a single‐center retrospective analysis of transcatheter tricuspid valve repair (TTVr) or replacement (TTVR) patients. The primary outcomes were longitudinal tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), pulmonary artery systolic pressure (PASP), and RV dimensions (RVd). We used multivariable linear mixed models to evaluate association with replacement versus repair and degree of TR reduction with changes in these echo measures over time. Multivariable Cox regression was used to identify associations between changes in these echo measures and a composite clinical outcome of death, heart failure hospitalization, or re‐do tricuspid valve intervention. Results We included a total of 61 patients; mean age was 77.5 ± 11.7 and 62% were female. TTVR was performed in 25 (41%) and TTVr in 36 (59%). Initially, 72% ( n = 44) had ≤ severe TR and 28% ( n = 17) had massive or torrential TR. The median number of follow up echos was 2: time to 1st follow‐up was 50 days (interquartile range [IQR]: 20, 91) and last follow‐up was 147 (IQR: 90, 327). Median TR reduction was 1 (IQR: 0, 2) versus 4 (IQR: 3, 6) grades in TTVr versus TTVR ( p < 0.0001). In linear mixed modeling, TTVR was associated with decline in TAPSE and PASP, and TR reduction was associated with decreased RVd. In multivariable Cox regression, greater RVd was associated with the clinical outcome (hazard ratio: 9.27, 95% confidence interval: 1.23–69.88, p = 0.03). Conclusion Greater TR reduction is achieved by TTVR versus TTVr, which is in turn associated with RV reverse remodeling. RV dimension in follow‐up is associated with increased risk of a composite outcome of death, heart failure hospitalization, or re‐do tricuspid valve intervention.
