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Jonathan Afilalo

David B Hogan, Colleen J Maxwell, Jonathan Afilalo, Rakesh C Arora, Sean M Bagshaw, Jenny Basran, Howard Bergman, Susan E Bronskill, Caitlin A Carter, Elijah Dixon, Brenda Hemmelgarn, Kenneth Madden, Arnold Mitnitski, Darryl Rolfson, Henry T Stelfox, Helen Tam-Tham, Hannah Wunsch
There is general agreement that frailty is a state of heightened vulnerability to stressors arising from impairments in multiple systems leading to declines in homeostatic reserve and resiliency, but unresolved issues persist about its detection, underlying pathophysiology, and relationship with aging, disability, and multimorbidity. A particularly challenging area is the relationship between frailty and hospitalization. Based on the deliberations of a 2014 Canadian expert consultation meeting and a scoping review of the relevant literature between 2005 and 2015, this discussion paper presents a review of the current state of knowledge on frailty in the acute care setting, including its prevalence and ability to both predict the occurrence and outcomes of hospitalization...
March 2017: Canadian Geriatrics Journal: CGJ
Jonathan Afilalo
With the emergence of transcatheter aortic valve replacement (TAVR) as a therapeutic option to treat high-risk older adults suffering from aortic stenosis, the geriatric concept of frailty has assumed mainstream relevance for cardiovascular practitioners. We have eagerly adopted tools to objectify the definition of frailty and accordingly discern good and bad candidates among a pool of complex octogenarians with multiple chronic conditions - a daunting yet mission-critical task. Initial studies published during the first half of this decade revealed that frailty status was one of the top predictors of mid-term mortality and incident disability after TAVR1, leading to its integration in clinical care pathways and predictive risk models...
March 16, 2017: Circulation
Catherine Talbot-Hamon, Jonathan Afilalo
No abstract text is available yet for this article.
February 9, 2017: Journal of the American Geriatrics Society
Scott L Hummel, Craig M Alpert, Christos Galatas, Jonathan Afilalo
No abstract text is available yet for this article.
April 2017: American Journal of Medicine
Jesse Zuckerman, Matthew Ades, Louis Mullie, Amanda Trnkus, Jean-Francois Morin, Yves Langlois, Felix Ma, Mark Levental, José A Morais, Jonathan Afilalo
BACKGROUND: Frailty assessment can help predict which older adults will experience adverse events after cardiac surgical procedures. Low muscle mass is a core component of frailty that is suboptimally captured by self-reported weight loss; refined measures using computed tomographic (CT) images have emerged and are predictive of outcomes in noncardiac surgical procedures. The objective of this study was to evaluate the association between CT muscle area and length of stay (LOS) after cardiac surgical procedures...
November 15, 2016: Annals of Thoracic Surgery
Suzanne V Arnold, Jonathan Afilalo, John A Spertus, Yuanyuan Tang, Suzanne J Baron, Philip G Jones, Michael J Reardon, Steven J Yakubov, David H Adams, David J Cohen
BACKGROUND: A series of models have been developed to identify patients at high risk for poor outcomes after transcatheter aortic valve replacement (TAVR) to help guide treatment choices, offer patients realistic expectations of long-term outcomes, and support decision making. OBJECTIVES: This study examined the performance of the previously developed TAVR Poor Outcome risk models in an external dataset and explored the incremental contribution of geriatric domains to model performance...
October 25, 2016: Journal of the American College of Cardiology
Francesco Ferrara, Lawrence G Rudski, Olga Vriz, Luna Gargani, Jonathan Afilalo, Antonello D'Andrea, Michele D'Alto, Alberto M Marra, Edvige Acri, Anna Agnese Stanziola, Stefano Ghio, Antonio Cittadini, Robert Naeije, Eduardo Bossone
BACKGROUND: TAPSE provides a simple, reproducible estimate of the longitudinal function of the right ventricle (RV). However, the normal limits and physiologic correlates of tricuspid annular plane systolic excursion (TAPSE) are not exactly known. The aim of this study was to explore the full spectrum of TAPSE values and determine the physiologic correlates of TAPSE. METHODS AND RESULTS: From June 2007 to December 2013, 1168 healthy subjects [mean age 45.1±16years, range 16 to 92; 555 (47...
November 15, 2016: International Journal of Cardiology
Jonathan Afilalo
Population aging has redefined cardiovascular medicine toward multifaceted patient-oriented care, with frailty emerging as a fundamental concept. The definition of frailty is ardently debated between opposing constructs: phenotypic criteria and accumulated deficits. Phenotypic criteria revolve around age-related loss of muscle mass and strength, known as sarcopenia. Skeletal muscle is crucial for functioning, mobility, energetics, and is the body's primary reservoir for amino acids. Sarcopenia can be assessed objectively, serving as an incremental predictor of adverse health outcomes and a therapeutic target for muscle-building interventions...
September 2016: Canadian Journal of Cardiology
James B Hermiller, Steven J Yakubov, Michael J Reardon, G Michael Deeb, David H Adams, Jonathan Afilalo, Jian Huang, Jeffrey J Popma
BACKGROUND: Few studies have examined the impact of novel indices of comorbidity, frailty, and disability on outcomes after transcatheter aortic valve replacement (TAVR). OBJECTIVES: This study analyzed patients from the Medtronic CoreValve U.S. Pivotal Trial program to develop a simple scoring system that incorporates standard and novel predictor variables. METHODS: A multidisciplinary heart team used objective criteria, such as The Society of Thoracic Surgeons Predicted Risk of Mortality (STS PROM), and subjective criteria to assess patients' eligibility for TAVR...
July 26, 2016: Journal of the American College of Cardiology
Jonathan Afilalo, Sunghee Kim, Sean O'Brien, J Matthew Brennan, Fred H Edwards, Michael J Mack, James B McClurken, Joseph C Cleveland, Peter K Smith, David M Shahian, Karen P Alexander
IMPORTANCE: Prediction of operative risk is a critical step in decision making for cardiac surgery. Existing risk models may be improved by integrating a measure of frailty, such as 5-m gait speed, to better capture the heterogeneity of the older adult population. OBJECTIVE: To determine the association of 5-m gait speed with operative mortality and morbidity in older adults undergoing cardiac surgery. DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study was conducted from July 1, 2011, to March 31, 2014, at 109 centers participating in the Society of Thoracic Surgeons Adult Cardiac Surgery Database...
June 1, 2016: JAMA Cardiology
Jonathan Afilalo, Russell Steele, Warren J Manning, Kamal R Khabbaz, Lawrence G Rudski, Yves Langlois, Jean-Francois Morin, Michael H Picard
BACKGROUND: The age cutoff to define elderly is controversial in cardiac surgery, empirically ranging from ≥65 to ≥80 years. Beyond semantics, this has important implications as a starting point for clinical care pathways and inclusion in trials. We sought to characterize the relationship between age and adverse outcomes in patients undergoing cardiac surgery and to derive and validate prognosis-based age cutoffs. METHODS AND RESULTS: Six thousand five hundred seventy one consecutive adult patients undergoing cardiac surgery at 3 hospitals in the United States and Canada were included in the cohort...
July 2016: Circulation. Cardiovascular Quality and Outcomes
Jonathan Afilalo
No abstract text is available yet for this article.
May 2016: Circulation. Cardiovascular Quality and Outcomes
Joakim Alfredsson, Amanda Stebbins, J Matthew Brennan, Roland Matsouaka, Jonathan Afilalo, Eric D Peterson, Sreekanth Vemulapalli, John S Rumsfeld, David Shahian, Michael J Mack, Karen P Alexander
BACKGROUND: Surgical risk scores do not include frailty assessments (eg, gait speed), which are of particular importance for patients with severe aortic stenosis considering transcatheter aortic valve replacement. METHODS AND RESULTS: We assessed the association of 5-m gait speed with outcomes in a cohort of 8039 patients who underwent transcatheter aortic valve replacement (November 2011-June 2014) and were included in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry...
April 5, 2016: Circulation
Samuel Mamane, Louis Mullie, Nicolo Piazza, Giuseppe Martucci, José Morais, Antonio Vigano, Mark Levental, Kristoff Nelson, Ruediger Lange, Jonathan Afilalo
BACKGROUND: Psoas muscle area (PMA) is a novel measure of frailty that can be efficiently measured from computed tomography images to help predict risk in older adults referred for transcatheter aortic valve replacement (TAVR). The objective of this study was to determine if PMA would be incrementally predictive of mortality and morbidity after TAVR. METHODS: The pre-TAVR computed tomography scans of 208 consecutive patients at 2 hospitals in Montreal and Munich were analyzed to measure the cross-sectional area of the left and right psoas muscles on a single axial slice at the level of L4...
February 2016: Canadian Journal of Cardiology
Michael Goldfarb, Richard Sheppard, Jonathan Afilalo
Frailty is increasingly recognized in older adults with cardiovascular disease, particularly in those with heart failure (HF). A growing body of evidence has shown that frailty has a negative effect on survival, hospitalizations, disability, and quality of life. Beyond frailty, additional domains captured by a comprehensive geriatric assessment contribute incremental value in predicting outcomes and identifying treatment targets. Exercise training is ideally suited to this setting as it can concomitantly improve physical frailty and HF symptoms...
November 2015: Current Cardiology Reports
Michael Goldfarb, Laura Drudi, Mohammad Almohammadi, Yves Langlois, Nicolas Noiseux, Louis Perrault, Nicolo Piazza, Jonathan Afilalo
BACKGROUND: There is currently no accepted standard for reporting outcomes following cardiac surgery. The objective of this paper was to systematically review the literature to evaluate the current use and definition of perioperative outcomes reported in cardiac surgery trials. METHODS AND RESULTS: We reviewed 5 prominent medical and surgical journals on Medline from January 1, 2010, to June 30, 2014, for randomized controlled trials involving coronary artery bypass grafting and/or valve surgery...
August 17, 2015: Journal of the American Heart Association
David Claveau, Adam Piha-Gossack, Sayuri N Friedland, Jonathan Afilalo, Lawrence Rudski
STUDY OBJECTIVE: We evaluate the incidence of complications associated with the use of nitrates in patients presenting with acute pulmonary edema and concomitant moderate or severe aortic stenosis compared with patients without aortic stenosis. Nitrates are contraindicated in severe aortic stenosis because of the theoretical yet unproven risk of precipitating profound hypotension. METHODS: A cohort design with retrospective chart review study was conducted at two Canadian hospitals...
October 2015: Annals of Emergency Medicine
Jonathan Afilalo, Julia Grapsa, Petros Nihoyannopoulos, Jonathan Beaudoin, J Simon R Gibbs, Richard N Channick, David Langleben, Lawrence G Rudski, Lanqi Hua, Mark D Handschumacher, Michael H Picard, Robert A Levine
BACKGROUND: Tricuspid regurgitation (TR) is a risk factor for mortality in pulmonary hypertension (PH). TR severity varies among patients with comparable degrees of PH and right ventricular remodeling. The contribution of leaflet adaptation to the pathophysiology of TR has yet to be examined. We hypothesized that tricuspid leaflet area (TLA) is increased in PH, and that the adequacy of this increase relative to right ventricular remodeling determines TR severity. METHODS AND RESULTS: A prospective cohort of 255 patients with PH from pre and postcapillary pathogeneses was assembled from 2 centers...
May 2015: Circulation. Cardiovascular Imaging
Andrew N Stammers, D Scott Kehler, Jonathan Afilalo, Lorraine J Avery, Sean M Bagshaw, Hilary P Grocott, Jean-Francois Légaré, Sarvesh Logsetty, Colleen Metge, Thang Nguyen, Kenneth Rockwood, Jitender Sareen, Jo-Ann Sawatzky, Navdeep Tangri, Nicholas Giacomantonio, Ansar Hassan, Todd A Duhamel, Rakesh C Arora
INTRODUCTION: Frailty is a geriatric syndrome characterised by reductions in muscle mass, strength, endurance and activity level. The frailty syndrome, prevalent in 25-50% of patients undergoing cardiac surgery, is associated with increased rates of mortality and major morbidity as well as function decline postoperatively. This trial will compare a preoperative, interdisciplinary exercise and health promotion intervention to current standard of care (StanC) for elective coronary artery bypass and valvular surgery patients for the purpose of determining if the intervention improves 3-month and 12-month clinical outcomes among a population of frail patients waiting for elective cardiac surgery...
March 9, 2015: BMJ Open
Roberto M Lang, Luigi P Badano, Victor Mor-Avi, Jonathan Afilalo, Anderson Armstrong, Laura Ernande, Frank A Flachskampf, Elyse Foster, Steven A Goldstein, Tatiana Kuznetsova, Patrizio Lancellotti, Denisa Muraru, Michael H Picard, Ernst R Rietzschel, Lawrence Rudski, Kirk T Spencer, Wendy Tsang, Jens-Uwe Voigt
The rapid technological developments of the past decade and the changes in echocardiographic practice brought about by these developments have resulted in the need for updated recommendations to the previously published guidelines for cardiac chamber quantification, which was the goal of the joint writing group assembled by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. This document provides updated normal values for all four cardiac chambers, including three-dimensional echocardiography and myocardial deformation, when possible, on the basis of considerably larger numbers of normal subjects, compiled from multiple databases...
March 2015: European Heart Journal Cardiovascular Imaging
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