Effect on Outcomes and Exercise Performance of Anemia in Patients With Aortic Stenosis Who Underwent Transcatheter Aortic Valve Replacement
The objectives of this study were to determine the causes and impact of anemia and hemoglobin level on functional status, physical performance, and quality of life in the preprocedural evaluation and follow-up of transcatheter aortic valve replacement (TAVR) candidates. A total of 438 patients who u...
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| Veröffentlicht in: | The American journal of cardiology 2015-02, Vol.115 (4), p.472-479 |
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| creator | DeLarochellière, Hugo, MSc Urena, Marina, MD Amat-Santos, Ignacio J., MD Ribeiro, Henrique B., MD Allende, Ricardo, MD Laflamme, Louis, MSc Laflamme, Jérôme, MSc Paradis, Jean-Michel, MD Dumont, Eric, MD Doyle, Daniel, MD Mohammadi, Siamak, MD DeLarochellière, Robert, MD Côté, Melanie, MSc Laroche, Vinçent, MD Rodés-Cabau, Josep, MD |
| description | The objectives of this study were to determine the causes and impact of anemia and hemoglobin level on functional status, physical performance, and quality of life in the preprocedural evaluation and follow-up of transcatheter aortic valve replacement (TAVR) candidates. A total of 438 patients who underwent TAVR were included. Anemia was defined as a hemoglobin level |
| doi_str_mv | 10.1016/j.amjcard.2014.11.033 |
| format | Article |
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A total of 438 patients who underwent TAVR were included. Anemia was defined as a hemoglobin level <12 g/dl in women and <13 g/dl in men. Before TAVR, anemia was encountered in 282 patients (64.4%). A potential treatable cause of anemia was detected in 90.4% of patients and was attributed to iron deficiency in 53% of them. The occurrence of anemia was an independent predictor of poorer performance in the 6-minute walk test (6MWT), a lower Duke Activity Status Index score, and Kansas City Cardiomyopathy Questionnaires overall, clinical, and social limitation scores (p <0.05 for all). A lower hemoglobin level was associated with a higher prevalence of New York Heart Association class III to IV (p <0.001) and correlated negatively with the results of all functional tests (p <0.02 for all). At follow-up, anemia was found in 62% of patients and was associated with poorer performance in the 6MWT (p = 0.023). A lower hemoglobin level after TAVR was a predictor of poorer New York Heart Association class (p = 0.020) and correlated negatively with the distance walked in the 6MWT (r = −0.191, p = 0.004) and Duke Activity Status Index score (r = −0.158, p = 0.011) at 6-month follow-up. In conclusion, anemia was very common in TAVR candidates and was attributed to iron deficiency in more than half of them. The presence of anemia and lower hemoglobin levels determined poorer functional status before and after the TAVR procedure. These results highlight the importance of implementing appropriate measures for the diagnosis and treatment of this frequent co-morbidity to improve both the accuracy of preprocedural evaluation and outcomes of TAVR candidates.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2014.11.033</identifier><identifier>PMID: 25549880</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Anemia ; Anemia - epidemiology ; Anemia - physiopathology ; Aortic Valve Stenosis - complications ; Aortic Valve Stenosis - physiopathology ; Aortic Valve Stenosis - surgery ; Cardiomyopathy ; Cardiovascular ; Exercise - physiology ; Exercise Test ; Female ; Follow-Up Studies ; Heart attacks ; Humans ; Incidence ; Logistics ; Male ; Mortality ; Multivariate analysis ; Older people ; Quality of Life ; Quebec - epidemiology ; Questionnaires ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Studies ; Transcatheter Aortic Valve Replacement ; Variables ; Vitamin B</subject><ispartof>The American journal of cardiology, 2015-02, Vol.115 (4), p.472-479</ispartof><rights>Elsevier Inc.</rights><rights>2015 Elsevier Inc.</rights><rights>Copyright © 2015 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Feb 15, 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c551t-9b71ec2a48a8b628afe6e52eadf598fbbb738cc4285a259e4b76b2eb778f45cd3</citedby><cites>FETCH-LOGICAL-c551t-9b71ec2a48a8b628afe6e52eadf598fbbb738cc4285a259e4b76b2eb778f45cd3</cites><orcidid>0000-0002-3428-617X ; 0000-0003-3901-8382 ; 0000-0002-6816-1033 ; 0000-0002-0886-7878 ; 0000-0002-2311-4129</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002914914021742$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25549880$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>DeLarochellière, Hugo, MSc</creatorcontrib><creatorcontrib>Urena, Marina, MD</creatorcontrib><creatorcontrib>Amat-Santos, Ignacio J., MD</creatorcontrib><creatorcontrib>Ribeiro, Henrique B., MD</creatorcontrib><creatorcontrib>Allende, Ricardo, MD</creatorcontrib><creatorcontrib>Laflamme, Louis, MSc</creatorcontrib><creatorcontrib>Laflamme, Jérôme, MSc</creatorcontrib><creatorcontrib>Paradis, Jean-Michel, MD</creatorcontrib><creatorcontrib>Dumont, Eric, MD</creatorcontrib><creatorcontrib>Doyle, Daniel, MD</creatorcontrib><creatorcontrib>Mohammadi, Siamak, MD</creatorcontrib><creatorcontrib>DeLarochellière, Robert, MD</creatorcontrib><creatorcontrib>Côté, Melanie, MSc</creatorcontrib><creatorcontrib>Laroche, Vinçent, MD</creatorcontrib><creatorcontrib>Rodés-Cabau, Josep, MD</creatorcontrib><title>Effect on Outcomes and Exercise Performance of Anemia in Patients With Aortic Stenosis Who Underwent Transcatheter Aortic Valve Replacement</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>The objectives of this study were to determine the causes and impact of anemia and hemoglobin level on functional status, physical performance, and quality of life in the preprocedural evaluation and follow-up of transcatheter aortic valve replacement (TAVR) candidates. A total of 438 patients who underwent TAVR were included. Anemia was defined as a hemoglobin level <12 g/dl in women and <13 g/dl in men. Before TAVR, anemia was encountered in 282 patients (64.4%). A potential treatable cause of anemia was detected in 90.4% of patients and was attributed to iron deficiency in 53% of them. The occurrence of anemia was an independent predictor of poorer performance in the 6-minute walk test (6MWT), a lower Duke Activity Status Index score, and Kansas City Cardiomyopathy Questionnaires overall, clinical, and social limitation scores (p <0.05 for all). A lower hemoglobin level was associated with a higher prevalence of New York Heart Association class III to IV (p <0.001) and correlated negatively with the results of all functional tests (p <0.02 for all). At follow-up, anemia was found in 62% of patients and was associated with poorer performance in the 6MWT (p = 0.023). A lower hemoglobin level after TAVR was a predictor of poorer New York Heart Association class (p = 0.020) and correlated negatively with the distance walked in the 6MWT (r = −0.191, p = 0.004) and Duke Activity Status Index score (r = −0.158, p = 0.011) at 6-month follow-up. In conclusion, anemia was very common in TAVR candidates and was attributed to iron deficiency in more than half of them. The presence of anemia and lower hemoglobin levels determined poorer functional status before and after the TAVR procedure. These results highlight the importance of implementing appropriate measures for the diagnosis and treatment of this frequent co-morbidity to improve both the accuracy of preprocedural evaluation and outcomes of TAVR candidates.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anemia</subject><subject>Anemia - epidemiology</subject><subject>Anemia - physiopathology</subject><subject>Aortic Valve Stenosis - complications</subject><subject>Aortic Valve Stenosis - physiopathology</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Cardiomyopathy</subject><subject>Cardiovascular</subject><subject>Exercise - physiology</subject><subject>Exercise Test</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Incidence</subject><subject>Logistics</subject><subject>Male</subject><subject>Mortality</subject><subject>Multivariate analysis</subject><subject>Older people</subject><subject>Quality of Life</subject><subject>Quebec - epidemiology</subject><subject>Questionnaires</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Studies</subject><subject>Transcatheter Aortic Valve Replacement</subject><subject>Variables</subject><subject>Vitamin B</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqNks9u1DAQhyMEotvCI4AsceGSxePYiXMBrarlj1SpFW3haDnOROslsbe2t9Bn6Evj1W5B6gVOlq1vftbMN0XxCugcKNTv1nM9rY0O_ZxR4HOAOa2qJ8UMZNOW0EL1tJhRSlnZAm-PiuMY1_kKIOrnxRETgrdS0llxvxwGNIl4R863yfgJI9GuJ8tfGIyNSC4wDD5M2hkkfiALh5PVxDpyoZNFlyL5btOKLHxI1pDLhM5Hmx9Xnly7HsPPzJCroF00Oq0wYXhgv-nxFslX3Iza4JSxF8WzQY8RXx7Ok-L64_Lq9HN5dv7py-nirDRCQCrbrgE0THOpZVczqQesUTDU_SBaOXRd11TSGM6k0Ey0yLum7hh2TSMHLkxfnRRv97mb4G-2GJOabDQ4jtqh30YFtaScM4D6P1DBOPA81oy-eYSu_Ta43EimuKwZpQ3LlNhTJvgYAw5qE-ykw50CqnZi1VodxKqdWAWgsthc9_qQvu0m7P9UPZjMwIc9gHlytxaDiib7MdjbkAWr3tt_fvH-UYIZrbNGjz_wDuPfblRkiqrL3Xbtlgs4ZdBwVv0G1PDMpg</recordid><startdate>20150215</startdate><enddate>20150215</enddate><creator>DeLarochellière, Hugo, MSc</creator><creator>Urena, Marina, MD</creator><creator>Amat-Santos, Ignacio J., MD</creator><creator>Ribeiro, Henrique B., MD</creator><creator>Allende, Ricardo, MD</creator><creator>Laflamme, Louis, MSc</creator><creator>Laflamme, Jérôme, MSc</creator><creator>Paradis, Jean-Michel, MD</creator><creator>Dumont, Eric, MD</creator><creator>Doyle, Daniel, MD</creator><creator>Mohammadi, Siamak, MD</creator><creator>DeLarochellière, Robert, MD</creator><creator>Côté, Melanie, MSc</creator><creator>Laroche, Vinçent, MD</creator><creator>Rodés-Cabau, Josep, MD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3428-617X</orcidid><orcidid>https://orcid.org/0000-0003-3901-8382</orcidid><orcidid>https://orcid.org/0000-0002-6816-1033</orcidid><orcidid>https://orcid.org/0000-0002-0886-7878</orcidid><orcidid>https://orcid.org/0000-0002-2311-4129</orcidid></search><sort><creationdate>20150215</creationdate><title>Effect on Outcomes and Exercise Performance of Anemia in Patients With Aortic Stenosis Who Underwent Transcatheter Aortic Valve Replacement</title><author>DeLarochellière, Hugo, MSc ; Urena, Marina, MD ; Amat-Santos, Ignacio J., MD ; Ribeiro, Henrique B., MD ; Allende, Ricardo, MD ; Laflamme, Louis, MSc ; Laflamme, Jérôme, MSc ; Paradis, Jean-Michel, MD ; Dumont, Eric, MD ; Doyle, Daniel, MD ; Mohammadi, Siamak, MD ; DeLarochellière, Robert, MD ; Côté, Melanie, MSc ; Laroche, Vinçent, MD ; Rodés-Cabau, Josep, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c551t-9b71ec2a48a8b628afe6e52eadf598fbbb738cc4285a259e4b76b2eb778f45cd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anemia</topic><topic>Anemia - epidemiology</topic><topic>Anemia - physiopathology</topic><topic>Aortic Valve Stenosis - complications</topic><topic>Aortic Valve Stenosis - physiopathology</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Cardiomyopathy</topic><topic>Cardiovascular</topic><topic>Exercise - physiology</topic><topic>Exercise Test</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Incidence</topic><topic>Logistics</topic><topic>Male</topic><topic>Mortality</topic><topic>Multivariate analysis</topic><topic>Older people</topic><topic>Quality of Life</topic><topic>Quebec - epidemiology</topic><topic>Questionnaires</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Studies</topic><topic>Transcatheter Aortic Valve Replacement</topic><topic>Variables</topic><topic>Vitamin B</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>DeLarochellière, Hugo, MSc</creatorcontrib><creatorcontrib>Urena, Marina, MD</creatorcontrib><creatorcontrib>Amat-Santos, Ignacio J., MD</creatorcontrib><creatorcontrib>Ribeiro, Henrique B., MD</creatorcontrib><creatorcontrib>Allende, Ricardo, MD</creatorcontrib><creatorcontrib>Laflamme, Louis, MSc</creatorcontrib><creatorcontrib>Laflamme, Jérôme, MSc</creatorcontrib><creatorcontrib>Paradis, Jean-Michel, MD</creatorcontrib><creatorcontrib>Dumont, Eric, MD</creatorcontrib><creatorcontrib>Doyle, Daniel, MD</creatorcontrib><creatorcontrib>Mohammadi, Siamak, MD</creatorcontrib><creatorcontrib>DeLarochellière, Robert, MD</creatorcontrib><creatorcontrib>Côté, Melanie, MSc</creatorcontrib><creatorcontrib>Laroche, Vinçent, MD</creatorcontrib><creatorcontrib>Rodés-Cabau, Josep, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Biochemistry Abstracts 1</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>DeLarochellière, Hugo, MSc</au><au>Urena, Marina, MD</au><au>Amat-Santos, Ignacio J., MD</au><au>Ribeiro, Henrique B., MD</au><au>Allende, Ricardo, MD</au><au>Laflamme, Louis, MSc</au><au>Laflamme, Jérôme, MSc</au><au>Paradis, Jean-Michel, MD</au><au>Dumont, Eric, MD</au><au>Doyle, Daniel, MD</au><au>Mohammadi, Siamak, MD</au><au>DeLarochellière, Robert, MD</au><au>Côté, Melanie, MSc</au><au>Laroche, Vinçent, MD</au><au>Rodés-Cabau, Josep, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect on Outcomes and Exercise Performance of Anemia in Patients With Aortic Stenosis Who Underwent Transcatheter Aortic Valve Replacement</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2015-02-15</date><risdate>2015</risdate><volume>115</volume><issue>4</issue><spage>472</spage><epage>479</epage><pages>472-479</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>The objectives of this study were to determine the causes and impact of anemia and hemoglobin level on functional status, physical performance, and quality of life in the preprocedural evaluation and follow-up of transcatheter aortic valve replacement (TAVR) candidates. A total of 438 patients who underwent TAVR were included. Anemia was defined as a hemoglobin level <12 g/dl in women and <13 g/dl in men. Before TAVR, anemia was encountered in 282 patients (64.4%). A potential treatable cause of anemia was detected in 90.4% of patients and was attributed to iron deficiency in 53% of them. The occurrence of anemia was an independent predictor of poorer performance in the 6-minute walk test (6MWT), a lower Duke Activity Status Index score, and Kansas City Cardiomyopathy Questionnaires overall, clinical, and social limitation scores (p <0.05 for all). A lower hemoglobin level was associated with a higher prevalence of New York Heart Association class III to IV (p <0.001) and correlated negatively with the results of all functional tests (p <0.02 for all). At follow-up, anemia was found in 62% of patients and was associated with poorer performance in the 6MWT (p = 0.023). A lower hemoglobin level after TAVR was a predictor of poorer New York Heart Association class (p = 0.020) and correlated negatively with the distance walked in the 6MWT (r = −0.191, p = 0.004) and Duke Activity Status Index score (r = −0.158, p = 0.011) at 6-month follow-up. In conclusion, anemia was very common in TAVR candidates and was attributed to iron deficiency in more than half of them. The presence of anemia and lower hemoglobin levels determined poorer functional status before and after the TAVR procedure. These results highlight the importance of implementing appropriate measures for the diagnosis and treatment of this frequent co-morbidity to improve both the accuracy of preprocedural evaluation and outcomes of TAVR candidates.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25549880</pmid><doi>10.1016/j.amjcard.2014.11.033</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-3428-617X</orcidid><orcidid>https://orcid.org/0000-0003-3901-8382</orcidid><orcidid>https://orcid.org/0000-0002-6816-1033</orcidid><orcidid>https://orcid.org/0000-0002-0886-7878</orcidid><orcidid>https://orcid.org/0000-0002-2311-4129</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0002-9149 |
| ispartof | The American journal of cardiology, 2015-02, Vol.115 (4), p.472-479 |
| issn | 0002-9149 1879-1913 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1680442116 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Aged Aged, 80 and over Anemia Anemia - epidemiology Anemia - physiopathology Aortic Valve Stenosis - complications Aortic Valve Stenosis - physiopathology Aortic Valve Stenosis - surgery Cardiomyopathy Cardiovascular Exercise - physiology Exercise Test Female Follow-Up Studies Heart attacks Humans Incidence Logistics Male Mortality Multivariate analysis Older people Quality of Life Quebec - epidemiology Questionnaires Retrospective Studies Risk Factors Severity of Illness Index Studies Transcatheter Aortic Valve Replacement Variables Vitamin B |
| title | Effect on Outcomes and Exercise Performance of Anemia in Patients With Aortic Stenosis Who Underwent Transcatheter Aortic Valve Replacement |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-09T22%3A36%3A58IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Effect%20on%20Outcomes%20and%20Exercise%20Performance%20of%20Anemia%20in%20Patients%20With%20Aortic%20Stenosis%20Who%20Underwent%20Transcatheter%20Aortic%20Valve%20Replacement&rft.jtitle=The%20American%20journal%20of%20cardiology&rft.au=DeLarochelli%C3%A8re,%20Hugo,%20MSc&rft.date=2015-02-15&rft.volume=115&rft.issue=4&rft.spage=472&rft.epage=479&rft.pages=472-479&rft.issn=0002-9149&rft.eissn=1879-1913&rft.coden=AJCDAG&rft_id=info:doi/10.1016/j.amjcard.2014.11.033&rft_dat=%3Cproquest_cross%3E3571210091%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1648620072&rft_id=info:pmid/25549880&rft_els_id=S0002914914021742&rfr_iscdi=true |