Glucose levels and the heart – new concepts / What is new in TAVI? WHAT IS NEW IN TAVI? Table 1 Age (years, IQR) Diabetes duration (years) Females (%) Hypertension (%) Coronary heart disease (%) Stroke/TIA (%) Periph. arterial disease (%) Auton. neuropathy (%) HbA1c at baseline (%) HbA1c at 24 mo FU (%) Fasting Glucose baseline (mg/dl) Fasting Glucose 24 mo FU (mg/dl) Postprandial Gluc. baseline (mg/dl) Postprandial Gluc. 24 mo FU (mg/dl) Weight change 24 mo (kg) Mortality at 24 mo FU (%) Hypoglycaemia (24 mo FU, %) Hypoglycaemia with help (%) 1111 Met+DPP4 (n=783) Met+SU (n=327) p-value 64.1 (56.8–72.0) 4.6 27.6 83.8 15.8 4.1 5.2 3.1 7.3 6.8 137 122 176 152 −1.2 1.1 8.6 0.4 67.5 (58.2–72.8) 5.2 46.9 82.1 14.4 4.3 4.1 2.5 7.3 6.8 140 118 178 168 −0.6 1.9 15.1 0.8 <0.05 ns ns ns ns ns ns ns ns ns ns ns ns <0.05 <0.05 ns <0.001 <0.001 Conclusion: Patients receiving DPP4 inhibitors had more weight loss and a reduced risk for hypoglycaemia. There were no differences in the rate of micro- and macrovascular events during FU. U.M. Mogensen 1 , C. Andersson 2 , E.L. Fosbol 1 , T.K. Schramm 3 , A. Vaag 4 , N.M. Scheller 2 , C.T. Pedersen 5 , G. Gislason 2 , L. Kober 1 . 1 Rigshospitalet Copenhagen University Hospital, Heart Centre, Department of Cardiology, Copenhagen, Denmark; 2 Gentofte Hospital, Department of Cardiology, Copenhagen, Denmark; 3 Amager Hospital, Department of Cardiology, Copenhagen, Denmark; 4 Rigshospitalet - Copenhagen University Hospital, Department of Medical Endocrinology, Copenhagen, Denmark; 5 Aalborg Hospital of the Aarhus University Hospital, Department of Cardiology, Aalborg, Denmark Background: Dipeptidyl peptidase-4 (DPP-4) inhibitors and Glucagon Like Peptide-1 (GLP-1) agonists have recently been introduced in the treatment of type 2 diabetes and are mainly used as add-on therapy to metformin, either alone or with additional sulfonylureas (SU) and/or insulin. Data regarding long-term cardiovascular safety are sparse. Methods: All Danish inhabitants without a history of myocardial infarction or stroke initiating combinations of 2 or 3 glucose lowering therapies between May 9, 2007 and December 31, 2011 were followed for the risk of myocardial infarction, stroke, or all-cause mortality as a combined cardiovascular disease/safety endpoint. The different combinations included are presented in Fig.1. Rate ratios (RR) were calculated using time-dependent multivariable Poisson regression analysis adjusting for age, diabetes duration, comorbidity, income, calendar year and cardiovascular drugs. Results: A total of 42,254 initiated combination therapy. Numbers and events in each combination are presented in Fig.1. The adjusted analysis showed that metformin combined with DPP-4 inhibitor or GLP-1 agonist was associated with a similar and compared with SU+metformin lower risk. Triple combinations of DPP-4 inhibitor or GLP-1 agonist as add-on to SU+metformin were associated with similar risks as metformin+SU. Insulin combinations were generally associated with increased risk. T. Bauer 1 , A. Linke 2 , H. Sievert 3 , P. Kahlert 4 , R. Hambrecht 5 , G. Nickenig 6 , S. Sack 7 , U. Gerckens 8 , S. Schneider 9 , R. Zahn 1 . 1 Heart Center Ludwigshafen, Department of Cardiology, Ludwigshafen am Rhein, Germany; 2 University Hospital Leipzig, Department of Cardiology and Angiology, Leipzig, Germany; 3 CardioVascular Center Frankfurt, Department of Cardiology and Angiology, Frankfurt, Germany; 4 University Hospital of Essen, Department of Cardiology, Essen, Germany; 5 Hospital Links der Weser, Department of Cardiology and Angiology, Bremen, Germany; 6 University of Bonn, Department of Internal Medicine II – Cardiology, Pulmonology & Angiology, Bonn, Germany; 7 Munich-Schwabing Municipal Hospital, Department of Cardiology, Munich, Germany; 8 Community Hospital Bonn, Cardiology Center, Bonn, Germany; 9 Research Institute for Heart Attack Ludwigshafen (IHF), Ludwigshafen, Germany Background: Bicuspid aortic valves (BV) are considered a relative contraindication to transcatheter aortic valve implantation (TAVI). One of the main reasons is the presumed risk for paravalvular aortic regurgitation. However, case reports and small case series have suggested that TAVI can be successfully performed with acceptable clinical outcomes in high-risk patients with BV. Methods: Between 01/2009 and 06/2010 a total of 1424 patients with severe aortic stenosis undergoing TAVI were prospectively enrolled into the German TAVIRegistry. For the present analysis patients with valve-in-valve procedures were excluded and those with BV (n=38, 2.7%) were compared to those without BV (n=1357, 97.3%). Results: Patients characteristic did not markedly differ between the two groups (table). There was a strong tendency towards a higher rate of relevant aortic regurgitation after TAVI among patients with BV, whereas pacemakers were more often implanted in patients with tricuspid aortic valve. 30-day mortality was similar in both cohorts. In the Cox regression analysis BV was not associated with higher 1-year mortality (HR 0.64, 95%-CI 0.29-1.41). Age EuroSCORE risk NYHA III/IV Ejection fraction (%) Multivessel disease Transapical Edwards valve Procedural success Aortic regurgitation ≥II° Pacemaker implantation 30-day mortality 1-year mortality BV No BV P-value 80.7±6.6 18±10 84.3% 50±16 52.6% 15.8% 30.8% 100.0% 25.0% 16.7% 10.3% 13.2% 81.8±6.2 20±13 88.6% 53±15 38.1% 8.5% 18.0% 97.4% 14.7% 35.4% 10.8% 20.1% ns ns ns ns ns ns 0.03 ns 0.05 0.03 ns ns Conclusions: In selected patients with BV TAVI can be performed with a satisfactory clinical result. Although the risk for relevant aortic regurgitation seems to be higher among patients with BV, 1-year mortality is not elevated in comparison to patients with tricuspid aortic valves. 5931 | BEDSIDE Procedural complications predict the occurrence of acute kidney injury following TAVI S. Haussig 1 , F. Woitek 1 , J. Wilde 1 , N. Mangner 1 , R. Hoellriegel 1 , D. Holzhey 2 , S. Erbs 1 , F.W. Mohr 2 , G. Schuler 1 , A.H.P. Linke 1 . 1 University of Leipzig, Heart Center, Department of Internal Medicine and Cardiology, Leipzig, Germany; 2 University of Leipzig, Heart Center, Department of Cardiac Surgery, Leipzig, Germany Figure 1. Abbreviations: metfo = metformin, insu = insulin Conclusion: Combination therapy with DDP-4 inhibitors and GLP-1 agonists was not associated with increased cardiovascular risk compared with other conventional combinations of glucose-lowering treatments. Randomized prospective studies are needed to establish whether incretin-based therapies may be associated with differential safety profiles compared with older classes of glucose lowering therapies. Background: Transcatheter aortic valve implantation (TAVI) enables treatment of inoperable and high risk patients with severe aortic stenosis. The therapy is largely guided by angiography and multiple contrast injections are required to check device position during implantation. This might cause deterioration of renal function, especially in those with preexisting renal insufficiency and lead to inferior outcome. Therefore, it was aim of the present analysis to elucidate predictors of acute kidney injury (AKI) and assess its impact on short-term outcome at 30 days after TAVI. Methods and results: Patients with severe aortic stenosis, in which TAVI using the Medtronic CoreValve (MCV) was performed between 2006 and 2011 were included into the analysis. The occurrence of acute kidney injury according to the Valve Academic Research Consortium (VARC) definitions was recorded. Between January 2006 and November 2011, a total of 600 patients (Age 80.6±6.2 years, Logistic EuroScore 22±14%) with severe aortic stenosis were treated with the MCV in our institution. Of those, 102 patients (17%) developed AKI, 64 patients (10.7%) stage 1, 21 patients stage 2 (3.5%) and 17 patients (2.8%) stage 3 injury, respectively. Patients with AKI had more often preexisting renal insufficiency (38.2% of patients with AKI vs. 23.8% without AKI, p<0.01), peripheral artery occlusive disease (24.5% with AKI vs. 11.5% with- Downloaded from http://eurheartj.oxfordjournals.org/ by guest on September 30, 2014 5929 | BEDSIDE DPP-4 inhibitors and GLP-1 agonists in type 2 diabetes - early assessment of cardiovascular safety in a nationwide setting 5930 | BEDSIDE Transcatheter aortic valve implantation in bicuspid aortic valves: insights from the German TAVI registry