bluuebunny/crossref_metadata_2025 huggingface dataset:
Complete vs culprit-lesion-only myocardial revascularization in patients with out-of-hospital cardiac arrest: insights from the multicentric "Lombardia CARe" registry
Authors: Raone L , Bongiorno A , Bendotti S , Currao A , Primi R , Adamo M , Ghiraldin D , Marino M , Poli A , Affinito S , Maffeo D , Kajana V , Baldi E , Ferlini M , Savastano S
Published: October 2024

Background

Out-of-hospital Cardiac Arrest (OHCA) is a potentially devastating complication of patients with Myocardial Infarction (MI). Multivessel Disease (MVD) is a frequent occurrence in this setting, being present in nearly half patients undergoing Coronary Angiography (CAG). We previously reported that, in case of MI complicated by OHCA and evidence of MVD, a complete myocardial revascularization, as compared to culprit-lesion-only revascularization, was associated with an improved 1-year survival and favorable neurological outcomes. We aimed to validate and confirm these results on a multicentric scale with a larger patient cohort.

Methods

This is a multicentric, prospective, observational study. We considered all the consecutive patients with OHCA and MI enrolled in the Lombardia CARe Registry from January 1st 2015 to December 31st 2022 who underwent CAG in 6 centers in Northen Italy.

Results

A total of 623 patients were included; of these, 403 underwent CAG. Median age was 64 years, and about 80% had no previous history of ischemic heart disease. Median ejection fraction (EF) at presentation was 40%. MVD was present in 186 (46.1%) patients and was subsequently treated with either complete (32.3%) or incomplete (67.7%) coronary revascularization. Left anterior descendent (LAD) artery was the culprit lesion in almost 1/3 of patients. The 1-year survival rate was 78.3% in the complete revascularization group and 42.9% in the culprit-lesion-only revascularization group (p-value < 0.001). After correction for factors that were predictors on univariate analysis, complete revascularization strategy was independently associated with a reduced risk of death [HR: 0.27 (95% CI: 0.01 to 0.739; p = 0.01] and death or unfavorable neurological outcome [HR: 0.23 (95% CI: 0.08 to 0.67); p = 0.007].

Conclusions

Complete revascularization strategy was confirmed to be associated with an improvement of 1-year survival and with a good neurological outcome in patients resuscitated from OHCA. These results highlight the independent impact on survival of a complete coronary intervention strategy in patients with OHCA plus MVD.
Complete revascularisation versus culprit lesion only PCI in patients with non-ST-elevation myocardial infarction and multivessel disease.
Authors: Hung Y , Xuan H , Yiu K
Published: October 2024

Background

The incidence of non-ST-elevation myocardial infarction (NSTEMI) is escalating, with patients diagnosed with multivessel disease (MVD) facing more adverse clinical outcomes. Yet, optimal treatment strategies for NSTEMI patients with MVD remain uncertain.

Objectives

This study aimed to assess the clinical outcome of NSTEMI patients with MVD who underwent complete revascularization compared to those treated with the culprit lesion only.

Methods

Between 2014 and 2017, patients presenting with NSTEMI and MVD undergoing successful percutaneous coronary intervention (PCI) were retrospectively included. MVD was defined as patients having more than one lesion considered angiographically significant, exhibiting at least 50% stenosis of the vessel diameter on visual estimation, or having a Coronary Angiography-Derived Fractional Flow Reserve (caFFR) measurement of 0.80 or less. The main exclusion criteria were single vessel disease, and previous coronary-artery bypass grafting surgery. The primary endpoint of this study was major adverse cardiac events (MACE) at 3 years, defined as a composite of cardiac death, myocardial infarction, and ischemia-driven revascularization.

Results

A total of 358 patients were included (mean age: 67.34±12.77; male: 70.1%), 155 and 203 patients were stratified into complete revascularisation group and culprit-lesion-only PCI group respectively. During 3-year follow-up, the culprit-lesion-only PCI group exhibited a significantly elevated risk of MACE compared to the complete revascularization group (17.7% vs 7.74%; hazard ratio [HR] 2.412, 95% confidence interval [CI] 1.255 - 4.636, P = 0.008). The increase 3-year MACE rate was mainly driven by the higher rate of ischaemia-driven revascularization in the culprit-lesion-only PCI group (11.3% vs 3.23%, HR 3.637, 95% CI 1.383 - 9.566, P = 0.009).

Conclusion

In NSTEMI patients with MVD, complete revascularization was superior to culprit-lesion-only PCI in mitigating the risk of future MACE at 3 years, which is predominantly attributed by a reduced incidence of repeat revascularisations.
Young patients in the cardiac intensive care unit: insights from the critical care cardiology trials network registry
Authors: Isath A , Mahmood U , Sharma T , Smith D , Guo J , Berg D , Bohula E , Morrow D , Cooper H
Published: October 2024

Background

Elderly patients treated in the cardiac intensive care unit (CICU) have engendered much warranted investigation. However, little is known about young patients as another distinct population.

Purpose: To describe the demographics, clinical profiles, and outcomes of young CICU patients in order to understand any distinct needs and challenges of this population.

Methods: We analyzed consecutive admissions to adult CICUs from 2018 to 2023 in the Critical Care Cardiology Trials Network (CCCTN), a multicenter prospective registry of advanced CICUs in North America coordinated by the TIMI Study Group. Patients aged <40 years were classified as "young patients" and compared to patients ≥ 40 years of age.

Results: Among 29,035 CICU admissions during the study period, the median age was 67 years (25th, 75th %iles: 56, 70). Admissions 18 to 40 years of age comprised 6.7% (n=1959) of total admissions. The young cohort was more likely to be female (40.0% vs 36.4%, p=0.0015) and non-Caucasian (55.3% vs. 43.0%, p<0.0001). Traditional cardiovascular risk factors were less common among the young, as were prior cardiovascular diagnoses other than congenital heart disease and pulmonary hypertension. Initial SOFA scores and serum lactate levels were similar in the 2 groups (Table).

The most common CICU admission diagnoses in the young were heart failure (HF), arrhythmia, and acute coronary syndrome (ACS) (Panel A). Of these, HF was more common in the young (26.4% vs 19.5%, p<0.0001), while arrhythmia (16.8% vs 18.9%, p=0.03) and ACS (10.9% vs 29.4%, p<0.0001) were less common compared to the older group (Panel B). Tamponade, hypertensive emergency, and congenital disease were more common in the young (Panel B). Respiratory insufficiency was the most common indication for admission to CICU in the young (24.6%) followed by cardiogenic shock (22.4%), unstable arrythmia (15.7%), and cardiac arrest (12.7%, Panel C).

Critical care resources, other than coronary angiography/PCI, were utilized significantly more often in the young group (Panel D). Overall utilization of mechanical circulatory support (MCS) was modestly higher among the young cohort (13.1% vs. 11.4%, p=0.03, Panel D); however, among those managed with MCS, the % of MCS that was ECMO was higher among the young (29.3% vs 9.9%, p<0.0001). Young admissions had longer CICU stays (2.7 [1.2-5.9] vs 2.3 [1.2-4.9], p<0.0001). CICU mortality (6.5% vs 10.5%, p<0.0001) and hospital mortality (9.5% vs 14.4%, p<0.0001) were significantly lower in the young.

Conclusion: Patients under the age of 40 admitted to CICUs presented with similar disease severity to older patients but more often had shock or cardiac arrest, had longer ICU stays, and more use of advanced ICU therapies but with lower in-hospital mortality. This important patient cohort merits continued clinical and research focus.
Association between cardiogenic shock phenotype, vasopressor requirements and mortality
Authors: Sarma D , Kashani K , Hibbert B , Jentzer J C
Published: October 2024

Background

Greater vasopressor requirements predict higher mortality in patients with cardiogenic shock (CS).(1) The extent to which CS phenotype modifies the relationship between vasopressor dose and mortality risk is unknown.

Purpose

We investigated the association between in-hospital mortality and vasopressor dosing (expressed as norepinephrine equivalents [NEE]) during the first 24 hours of hospitalization across distinct CS phenotypes.

Methods

We included patients with CS admitted to our cardiac intensive care unit (CICU) between 2007 and 2015. Peak combined vasopressor doses during the first 24 hours of hospitalization were recorded as NEE. High dose vasopressor (HDV) use was defined as peak 24 hour NEE >0.3 mcg/kg/min. Unsupervised machine learning was used to assign patients to one of three phenotypes (non-congested, cardiorenal, and haemometabolic), as reported previously by our group and others.(2,3) The primary outcome was in-hospital mortality. Multivariable logistic regression was used to adjust for relevant covariates.

Results

A total of 1078 patients with CS (median age 69 years, 37% female, 59% with acute myocardial infarction) were admitted to our cardiac intensive care unit (CICU) between 2017 and 2015. The number of patients assigned to each CS phenotype were: haemometabolic (n=325, 30%), cardiorenal (n=314, 29%), non-congested (439, 41%). There was a strong incremental association between in-hospital mortality and NEE (Fig. 1, adjusted OR 1.104 per 0.1 mcg/kg/min, 95% CI 1.134–1.231, P<0.001), and patients receiving HDV (n=234, 22%) had significantly higher in-hospital mortality (57% vs 28%, p<0.001). Among patients who did not receive HDV, mortality was higher in haemometabolic CS (49%) compared to 24% in cardiorenal CS and 21% in non-congested CS (adjusted OR 3.58 relative to non-congested CS, 95% CI 2.46-5.23, p<0.001, Fig. 1). Among patients receiving HDV, hemometabolic CS was also associated with higher mortality (68%) than those with cardiorenal (46.2%) or non-congested CS (39.3%), (adjusted OR 3.26 relative to non-congested CS, 95% CI 1.75-6.18, P<0.001, Fig. 1).

Conclusion

Integration of CS phenotype with vasopressor requirements may provide incremental prognostic information in CS during the first 24 hours of admission, with haemometabolic CS portending a greater mortality risk even at lower NEE. Patients with HDV (particularly those requiring >=1 mcg/kg/min NEE) had high mortality irrespective of CS phenotype.Figure 1
Predictive models for mortality in cardiogenic shock: a systematic review and meta-analysis
Authors: Lim S L , Ng G W Y , Low C J W , Ling R R , Ng K J , Chan S P , Ramanathan K
Published: October 2024

Background

Cardiogenic shock (CS) is a time-critical emergency with high mortality and morbidity, yet prognostication remains challenging with neither guidelines nor consensus on the comparative applicability of existing risk scores used in CS. We aimed to evaluate discrimination and calibration of existing risk scores in predicting mortality in CS.

Methods

We searched MEDLINE, Embase, and Scopus databases up to 1 January 2024 for articles developing, redeveloping or validating a multivariable model predicting short-term mortality in adults with CS. Area under curve (AUC) statistics and observed versus expected (O:E) ratios were used to assess discrimination and calibration respectively. We conducted random-effects inverse-variance weighted meta-analyses on 6 prevalent, well-validated prediction models (IABP-SHOCK II, CardShock, SAPS II, SOFA, APACHE II and SAVE) to derive pooled estimates of AUCs and aggregate O:Es for each model. Subgroup analyses were conducted to identify sources of heterogeneity.

Results

We included 92 studies (115 study cohorts, 75,228 patients) in our analysis, with 43 unique prediction models identified. Our meta-analysis revealed that the CS-specific CardShock score had the overall best discrimination (AUC 0.73; 95% CI 0.70-0.76) and calibration (O:E 1.06; 95% CI 0.79-1.41). SOFA performed second best in discrimination (AUC: 0.72, 95%-CI: 0.68 to 0.75) but tended to underpredict mortality (AUC: 0.85, 95%-CI: 0.65-1.12). IABP and APACHE had comparable discrimination (AUC 0.71), IABP tended to overpredict (O:E 1.24; 95% CI 0.995-1.55) while APACHE (O:E 0.93; 95% CI 0.57-1.53) tended to underpredict mortality.

In subgroup analysis, CardShock performed best based on mechanical circulatory support type (AUC 0.74-0.76, O:E 0.82-0.99), location (AUC 0.67-0.87, O:E 1.00-1.25) and study type (AUC 0.73-0.97, O:E 0.91-1.99).

Conclusion

Among well-validated risk scores, the CardShock score performed best in discriminating and calibrating mortality. Its variable performance across subgroups underscores the need for more research to identify an ideal risk prediction model that considers emerging therapies and use in multiple scenarios.
Calcific aortic valve disease-associated long noncoding RNA H19 promotes the osteogenic transition of valvular interstitial cells via the JAG1/NOTCH1 axis
Authors: Hosen D R , Zhou C A N , Billig M E D , Goody M E D , Zimmer D R , Uchida D R , Pfeiffer D R , Jansen M E D , Nickenig D R
Published: October 2024

Background

Calcific aortic valve disease (CAVD) is the most prevalent valvular heart disease causing tremendous suffering globally. The osteogenic differentiation of the valvular interstitial cells (VICs) is a key process in the pathogenesis of CAVD leading to calcification and stiffening. Here, we focus on the contribution of long noncoding RNA H19 in the osteogenic differentiation of VICs promoting CAVD.

Methods and results

A human lncRNA array performed in AVS patients with coronary artery disease (CAD) revealed the differential expression of lncRNA H19. For the experiments in this study, loss of function (LOF) was performed in primary VICs isolated from the aortic valves of patients with CAVD, and commercially-available VICs. Therefore, H19 expression was effectively downregulated via RNAi. Subsequent gene expression analysis via RT-qPCR revealed that the expression of calcification markers RUNX2 and BMP2, as well as the expression of the H19 downstream targets JAG1 and NOTCH1 were unchanged after the H19 knockdown alone. Then, the VICs were additionally treated with osteogenic medium (OM) and procalcifying medium (PCM) for 7 d to induce the calcification of the cells. In the OM, inorganic phosphate is generated in an alkaline phosphatase (ALPL)-dependent manner and integrated into newly formed hydroxyapatite crystals, thus promoting cellular calcification. PCM contains inorganic phosphate to form hydroxyapatite crystals and is therefore not ALPL-dependent. Gene expression analysis via RT-qPCR and protein analysis via immunofluorescence revealed that the calcification markers BMP2 and RUNX2 were upregulated after H19 knockdown and calcification induction. This indicates that H19 regulates the expression of calcification makers promoting cellular calcification. Furthermore, RT-qPCR and immunoblotting revealed the differential expression of several potential H19 downstream targets, namely JAG1, NOTCH1, and STAT3. The analysis showed that the potential downstream targets were upregulated after H19 knockdown and calcification treatment hinting at the involvement of the NOTCH1 or STAT3 pathway in the pathogenesis of CAVD. Moreover, an Alizarin Red S staining of calcified nodules revealed reduced calcification after H19 knockdown and calcification treatment for 21 d. This demonstrates that H19 also regulates a late-stage event in the cellular calcification of VICs.

Conclusion

Our study showed that H19 regulates calcification marker expression and the expression of potential downstream targets JAG1, NOTCH1, and STAT3 both in healthy and AVS patient VICs. This hints at the involvement of the H19/JAG1/NOTCH1 pathway in the calcification of VICs, which might play a critical role in the pathogenesis of CAVD.
Valvular heart disease and out-of-hospital cardiac arrest
Authors: El-Chouli M , Mizrak I , Mohr G H , Malmborg M W , Gislason G , Bruun N E , Barcella C B
Published: October 2024

Background

The prevalence of valvular heart disease is on the rise. Severe valvular diseases are generally associated with high mortality, and aortic stenosis (AS) is associated with halved survival after out-of-hospital cardiac arrest (OHCA). Despite the severity of the prognosis of valvular heart diseases, their association with the risk of OHCA is not well-elucidated.

Purpose

The study aimed to examine the association between valvular heart disease and OHCA.

Method

We conducted a study using data from the nationwide Danish Cardiac Arrest Registry. We included adult OHCA patients with presumed cardiac origin. We compared OHCA cases with and without valvular heart disease, stratified by valvular disease type (AS, aortic regurgitation (AR), mitral stenosis (MS), and mitral regurgitation (MR) or multiple valvular diseases (more than 1 concomitant type of valvular disease)). We calculated the hazard ratios of OHCA using time-varying Cox regression models fitted with a nested case-control design. For each case, we matched up to five controls based on age, sex, year of OHCA, and two comorbidities: ischemic heart disease and congestive heart failure.

Results

We included 43,967 OHCA cases and 219,772 controls matched from the general population. In the total case population, the median age was 72 years, 68% were male, 26% had ischemic heart disease, 21% had congestive heart failure, and 57% had cardiovascular risk factors. We identified 1862 (4.23%) cases with AS, 336 (<1%) with AR, 31 with MS (<1%), 710 with MR (1.6%), and 605 with multiple valvular diseases (1.4%). Compared with cardiac arrest cases without valvular disease, cases with valvular disease were more likely to have ischemic heart disease (e.g., AS vs controls: 6.5% vs 1.7%, p<0.001) and congestive heart failure (e.g., MR vs controls: 3.5% vs 1%, p<0,001; AS vs controls: 8.2% vs 2.8%, p<0.001). AS, MS (HR: 1.67 [95%CI: 1.12; 2.51]), MR (HR: 1.38 [95%CI: 1.27; 1.50]) and multiple valvular diseases (HR: 1.36 [95%CI: 1.24; 1.49]) were significantly associated with higher hazard of OHCA (Figure 1); the strongest association was seen for AS (HR: 1.66 [95% CI: 1.58; 1.76]) (Figure 1). AR was not significantly associated with OHCA (HR: 1.05 [95%CI: 0.94; 1.19]).

Conclusion

In this Danish nationwide cardiac arrest cohort, aortic stenosis, aortic regurgitation, and mitral regurgitation were associated with increased rates of OHCA. The association was strongest in aortic stenosis patients. Focus on risk factors of OHCA in patients with valvular heart disease is warranted.Figure 1
Impact of body mass index on aortic valve stenosis and its clinical outcomes in early adulthood: a long-term study of young men
Authors: Lindgren M , Kontogeorgos S , Adiels M , Nielsen S , Robertson J , Mandalenakis Z , Aberg M , Aberg N D , Djekic D
Published: October 2024

Aims

Studies investigating associations between body mass index (BMI), incidence of aortic valve stenosis (AVS), and clinical outcomes in AVS patients are scarce.

Purpose

To investigate the relationship between BMI in youth and subsequent diagnosis of AVS. A secondary aim was to determine the role of obesity in clinical outcomes in individuals diagnosed with AVS.

Methods

This was a nationwide, register-based cohort study of 1 701 390 men (mean age, 18.3 ±0.8 years) enrolled in compulsory conscription for military service in Sweden from 1969 through 2005. Anthropometrics, blood pressure, fitness, muscle strength and IQ were recorded at baseline. AVS cases and cardiovascular outcomes were identified according to the International Classification of Diseases (ICD)-10 registered in the National patient register and Cause of Death Register through the Swedish 12-digit personal identification number. BMI (kg/m2) was categorized as <18.5, 18.5–<20, 20–<22.5, 22.5–<25, 25–<27.5, 27.5 <30, 30–<35, and 35–<50 kg/m2. Cox proportional hazard models were used to estimate the association between adolescent BMI and future hospitalization for AVS while adjusting for potential confounders. The BMI reference was set as 20–<22.5. Those who developed AVS formed a subcohort that was followed until a first clinical cardiovascular outcome of death, cardiovascular mortality, Heart failure, Atrial fibrillation, myocardial infarction, or ischaemic stroke.

Results

During a median follow-up of 32 years (IQR, 24-41 years), 5766 cases (mean age 54.7±9.4 years) of AVS were diagnosed. After adjustment, underweight subjects with a BMI of <18.5 kg/m2, compared to those with a low-normal BMI (20.0–<22.5 kg/m2) showed lower risk (HR 0.70; 95% CI 0.61–0.80) of AVS. The multivariable-adjusted HR for AVS increased from HR 1.28; 95% CI 1.17–1.39 for BMI 22.5–<25 kg/m2 to HR 1.91; 95% CI 1.12–3.25 for those with BMI 35–50 kg/m2. Further on, individuals diagnosed with AVS were followed for a median of ~5.5 years. The multivariable-adjusted HR for all-cause mortality, cardiovascular mortality, and heart failure for obese (BMI 30–50 kg/m2), compared to BMI <20.0 kg/m2 in men diagnosed with AVS, were 4.69 (95% CI 2.61–8.44), 4.09 (95% CI 1.72–9.73), and 2.76 (95% CI, 1.36–5.60), respectively.

Conclusions

Elevated BMI in youth, even within the normal range, is associated with increased risk of developing AVS, while subnormal BMI was protective. Excess weight in youth diagnosed with AVS is associated with higher risk of subsequent clinical outcomes. These findings are novel, generating new questions as to potential mechanisms and implying more vigilant monitoring of patients with AVS and a history of obesity in youth.Figure 1Figure 2
The prognostic role of left atrial mechanics but not left ventricular function in functional mitral regurgitation
Authors: Lu C T , Sung S H
Published: October 2024

Introduction

When atrial dilatation or ventricular dysfunction underline the development of functional mitral regurgitation (FMR), FMR has been categorized into ventricular and atrial type. Due to limited evidence of surgical correction, majority of patients with FMR were left untreated. We therefore investigated the clinical outcomes related to different phenotypes of FMR and the prognostic factors.

Methods

Subjects with severe or moderate to severe FMR, diagnosed by transthoracic echocardiography were eligible for this analysis. Three phenotypes of FMR, including atrial, ischemic and ventricular FMR were then classified. The left atrial (LA) strain and left ventricular (LV) global longitudinal strain (GLS) were measured. The study population were followed for a year.

Results

A total of 298 subjects (mean age 72.3 ± 14.0 years; 68% male) were enrolled, including 165 subjects of ischemic-type FMR (iFMR), 77 subjects of non-ischemic ventricular-type FMR (vFMR), and 56 subjects of atrial-type FMR (aFMR). The baseline characteristics, including age, gender, demography, and morbidities were similar between three groups, but aFMR group had higher LA reservoir strain and better LV GLS. During a mean follow-up duration of 283 days, there were 50 (17%) cases died within the first year. The Kaplan Meier curve analysis showed similar survival rate between three phenotypes of FMR. Body mass index (BMI), systolic blood pressure, diastolic blood pressure, history of myocardial infarction (MI), RV dysfunction, and a lower LA reservoir strain, but not LV GLS were crudely related to one-year mortality. In the multivariable Cox proportional regression analysis, LA reservoir strain was independently predictive of mortality (Hazard ratio for 1% increase and 95% confidence intervals: 0.943, 0.895-0.994).

Conclusions

Patients with aFMR also have despaired clinical outcomes as patients with vFMR or iFMR. LA reservoir function but not LV systolic function was predictive of worse clinical outcomes. The results may encourage the transcatheter therapy, approved for ventricular-type FMR, for the treatment of aFMR.Kaplan Meier curve analysisMultivariable CPH regression model
Vmax as an Index of right ventricular function in pulmonary hypertension
Authors: Bauer F , Mallet S , Besbes B , Si Belkacem N , Saidi N , Artaud-Macari E
Published: October 2024

Background

For assessing right ventricular function in pulmonary hypertension (PH), the optimal approach is through the use of load-independent parameters. While pressure-volume (PV) loops are not feasible in clinical settings, the maximum velocity of the contractile element under no load, known as Vmax, serves as an alternative measure that could be derived only from right-heart catheterization (RHC).

Objectives

To determine Vmax in patients undergoing RHC and to evaluate its correlation with echocardiographic parameters.

Methods

15 PH patients scheduled for risk stratification were subjected to RHC and echocardiography. The contractile velocity element (VCE) was calculated as VCE = 1 / (28.8 x P) x dP/dt, with P representing RV pressure in mm Hg and dP/dt its first derivative in mmHg/s. The P vs. VCE plot displays a peak VCE value, leading into a linear slope (red line, figure 1A) with Vmax as the zero-pressure intercept. Vmax was compared with 6 different echocardiographic parameters of RV function.

Results

They were six females and 9 males aging 61±6 y. Mean PH was 37,6±10,1 mm Hg and Vmax averaged 2,1±0,9 length/s (range from 0,8 to 4,4 length/s). Figure 1B illustrates 3 patients with deteriorated, mildly reduced and normal VCE. When compared to Vmax, tricuspid peak systolic tissue Doppler velocity and TAPSE shown the best correlation while RV fractional area change demonstrated the worse correlation (figure 2).

Conclusion

Vmax, an indicator of right ventricular systolic function that does not depend on load, can be obtained through right heart catheterization. Both tissue Doppler peak systolic velocity and tricuspid annular plane systolic excursion (TAPSE) have demonstrated a strong correlation with Vmax.Invasive pressureECHO parameters
Periprocedural changes in systolic pulmonary artery pressure in transcatheter aortic valve implantation
Authors: Wang Gottlieb A , Nilsson K , Settergren M , James S , Shahim B
Published: October 2024

Background

Pulmonary hypertension (PH) is common in patients with aortic stenosis and associated with increased mortality following transcatheter aortic valve replacement (TAVR). PH often improves after TAVR and systolic pulmonary artery pressure (sPAP) can change, but to what extent these changes in sPAP following TAVR affect long-term prognosis is unclear.

Purpose

To investigate the association between periprocedural changes in sPAP and long-term prognosis after TAVR.

Methods

Patients undergoing TAVR between 2012-2021 from the Swedish Transcatheter Cardiac Intervention Registry (SWENTRY) were included. sPAP was estimated from echocardiography before and after TAVR and categorized as: (1) No PH before and unchanged (≤5 mmHg change) after, (2) No PH before and worsened (>5 mmHg increase) after, (3) PH before and improved (>5 mmHg decrease) after, (4) PH before and unchanged after and (5) PH before and worsened after. An sPAP cutoff at >50 mmHg was applied for PH. Patients were followed for a median of 3.1 years for the primary endpoint heart failure hospitalizations (HFH) and the secondary endpoint all-cause mortality. Cox regression analyses were performed and adjusted for age, sex, body mass index, atrial fibrillation, eGFR class, diabetes, frailty, left ventricular ejection fraction and chronic obstructive pulmonary disease.

Results

In total, 4926 patients were included (mean age 82 years, 50% female) among whom 2596 (53%) patients had no PH and unchanged, 864 (18%) had no PH and worsened after, 912 (19%) had PH and improved after, 401 (8%) had PH and unchanged after and 153 (3%) had PH and worsened after. The mean sPAP levels preoperatively in each group were 36, 31, 60, 58, 57 mmHg respectively. Mean change in patients with no PH and worsened was +16 mmHg, in patients with PH and improved -20 mmHg and in patients with PH and worsened +14 mmHg. Cumulative incidence rates of HFH at 5 years among the five groups were 18%, 25%, 32%, 41%, and 52%, respectively (p<0.001). In adjusted analyses, there was a stepwise increase in the risk of HFH (Figure 1A) and all-cause mortality (Figure 1B) for no PH and worsened, PH and improved, PH and unchanged and PH and worsened as compared with no PH and unchanged.

Conclusion

Increase of periprocedural sPAP in patients with and without known PH before TAVR was associated with worse prognosis whereas reduction of sPAP was associated with improved outcomes.
Significant impact of a novel whole heart motion correction algorithm on cardiac computed tomography and aortic valve calcium scores
Authors: Aoki S , Takaoka H , Kitahara H , Matsuura K , Kinoshita M , Yashima S , Yoshida K , Suzuki K , Nishikawa Y , Matsumoto M , Sasaki H , Suzuki-Eguchi N , Kobayashi Y
Published: October 2024

Introduction

A new whole-heart motion-correction algorithm has been available in cardiac computed tomography (CT), and it has already revealed the higher diagnostic accuracy of significant coronary artery stenosis in cases with higher heart rate at the CT scan. Recently, aortic valve calcium scores (AVCS) are often measured for the decision-making of surgical treatment of aortic valve stenosis. However, the measurement of AVCS of the aortic valve has potential risks of motion artifact of the aortic valve. Therefore, we would like to know the clinical impact of a new whole-heart motion correction algorithm for accurately measuring aortic valve AVCS without motion artifacts.

Purpose

The purpose of this study is to evaluate the impact of a new whole-heart motion-correction algorithm on non-contrast cardiac CT images and the AVCS in trans-catheter aortic valve regurgitation (TAVR) candidates with severe aortic valve stenosis.

Materials and methods

Forty-two consecutive TAVR candidates (83 ± 7 years old, 21 males) who underwent ECG-gated CT using 256-row detector CT from November 2023 to February 2024 at our hospital were analyzed. The best phase non-contrast cardiac images were automatically selected, and they were reconstructed with both the standard (STD) algorithm and the new whole-heart motion-correction algorithm. AVCS was calculated using semi-automatic commercially available software. The aortic valve's image noise was also measured.

Results

Non-contrast best cardiac phase images were successfully reconstructed using the new motion correction algorithm in 36 patients (86%). The best cardiac phase was mainly the diastolic phase in 29 patients (81%). The overall Agatston score and calcified volume of the aortic valve in SSF2 were 1779 ± 896, and 1403 ± 689, respectively, and they were lower than 2195 ± 1132 and 1656 ± 851 of STD (all P < 0.01).

Conclusion

The new whole-heart motion-correction algorithm worked in almost all TAVR candidates, and revealed lower AVCS and shows a potential for increasing AVCS accuracy.
Predictors for mitral regurgitation improvement in patients with pure severe aortic regurgitation undergoing transcatheter aortic valve replacement: when can kill two birds with one stone?
Authors: Lin D , Pan W , Zhou D
Published: October 2024

Objective

Transcatheter aortic valve replacement (TAVR) has been recognized as a significant treatment for pure severe aortic regurgitation (PSAR). Part of patients with PSAR concurrently suffer from functional mitral regurgitation (FMR). Whether TAVR could improve FMR in patients with PSAR and the predictors have not yet been clarified. This study aims to explore predictors of FMR improvement in patients with PSAR undergoing TAVR and subsequently provide evidence for further clinical therapy.

Method

Patients with PSAR and FMR who underwent TAVR at Zhongshan Hospital Affiliated with Fudan University were enrolled from June 2021 to August 2023. Depending on whether FMR improved one month post-TAVR, they were divided into groups with or without FMR improvement. The baseline data, imaging results, and follow-up data of the patients were collected.

Result

This study included 75 patients, among whom 38 patients had improved FMR and 37 patients did not. Compared to patients without FMR improvement, more patients in the FMR-improved group were diagnosed with renal insufficiency (10.8% vs. 0%, p=0.018), left bundle branch block (8.1% vs. 0%, p= 0.037), and less right bundle branch block (0% vs. 10.5%, p=0.017). The transthoracic ultrasound examination showed that patients with FMR improvement were prone to have lower left ventricular ejection fraction (LVEF) and larger left ventricle end dimension diastole (LVEDd). A higher proportion of patients in the FMR-improved group were found to have had more moderate to severe FMR (28.9% vs. 2.7%, P=0.029). In both groups, the degree of aortic regurgitation was significantly improved during the 1-day and 1-month follow-ups post-TAVR (p<0.001). No significant differences were found in the incidence of postoperative adverse events between the two groups during the short-term follow-up.

Conclusion

FMR improvement is observed in approximately half of PSAR patients undergoing TAVR. A higher FMR degree, lower LVEF, and hypertension before TAVR are independent predictors of FMR improvement.Figure 1 AR and MR post TAVRTable 1 Logistic regression
Acute changes in right ventricular geometry and function following transcatheter tricuspid valve interventions
Authors: Bartkowiak J , Weckbach L T , Dernektsi C , Stolz L , Kothieringer C M , Fabian A , Szijarto A , Chong-Nguyen C , Stocker T , Brugger N , Kovacs A , Praz F , Hahn R T , Hausleiter J
Published: October 2024

Background

Little is known about acute changes in right ventricular (RV) function and geometry following transcatheter tricuspid edge-to-edge repair (T-TEER) or transcatheter tricuspid valve replacement (TTVR). Pressure-strain-volume loop-derived myocardial work metrics showed associations with myocardial energetics and contractility in conditions accompanied by volume overload, suggesting their potential utility in patients with tricuspid regurgitation (TR).

Purpose

To define acute changes in RV volumes and RV myocardial work following T-TEER and TTVR using conventional and pressure-strain-volume derived RV work metrics.

Methods

In this multicenter, observational study, 3D echocardiographic datasets and invasively acquired RV pressures were collected before and after transcatheter tricuspid valve procedure. Using dedicated software (ReVISION, Argus Cognitive) 3D RV volumes and strains were quantified and decomposed to longitudinal, radial and anterio-posterior motion. Forward stroke volume (SV) was calculated by subtracting TR volumes from RV 3D end-diastolic volume (EDV) and end-systolic volume (ESV) difference. Three-dimensional pressure-strain-volume loops were constructed and global RV work-index (RV-Wi) was calculated. Changes in RV parameters before and after the intervention were compared using paired-samples t test.

Results

Of 37 patients included in this study (65% male), 20 underwent T-TEER and 17 underwent TTVR. Compared to T-TEER patients, patients undergoing TTVR had higher prevalence of torrential TR at baseline but also achieved a higher reduction in TR volumes after the intervention (44 ± 11 ml vs 60 ± 16ml; p = 0,001). Following T-TEER there was a significant reduction in RV EDV (240 ± 93 ml vs 200 ± 80 ml; p < 0.001) and increase in SV (55 ± 34 ml vs 68 ± 26 ml; p = 0.036). Following TTVR there was a significant increase in RV ESV (121 ± 46 vs 146 ± 48, p = 0.003) and no significant change in SV (47 ± 24 ml vs 55 ± 20 ml; p = 0.143). There was significant reduction in RV strain and ejection fraction (EF) (all p < 0.001) primarily driven by reduction of radial motion component in both groups. RV-Wi increased in 35% (7/20) of T-TEER patients and in 18% of (3/17) TTVR patients.

Conclusion

An acute reduction in RV EF was observed in all patients and was mainly caused by decrease in RV EDV in T-TEER patients and increase in RV ESV in TTVR patients. Despite decrease of conventional metrics of RV function in both groups, an increase in RV-Wi was observed in 27% of all patients.Baseline and follow-up characteristicsCentral Figure
Characterization of tricuspid regurgitation in patients following left bundle branch pacing
Authors: Fernandez M A , Quispe Santos J F , Menduina Gallego I , Alonso-Martin C , Leta Petracca R , Li C H
Published: October 2024

Background

Pacemakers placed in the right ventricle apex can lead to mechanical and electrical dyssynchrony. There is a growing interest in more physiologically stimulating techniques, and in this context, left bundle branch pacing (LBBP) emerges as an option. In this pacemaker, the lead is positioned perpendicular to the septum approximately 15-20 mm below the tricuspid valve annulus, and the helix is advanced towards the left side (Image 1). There is limited data on the incidence of new-onset tricuspid regurgitation (TR) or deterioration of pre-existing TR following the implantation of this type of pacemaker.

Purpose

To characterize the incidence of TR or deterioration of pre-existing TR after LBBP and to determine if there are predictors of a higher degree of TR.

Methods

All patients who received a pacemaker with LBBP between January and October 2023 were consecutively recruited. A transthoracic echocardiogram following the implantation of the pacemaker was performed to assess the size and function of right heart chambers, degree of TR and position of pacemaker lead.

Continuous variables are expressed as mean ± SD or median [IQR] and categorical variables as absolute (%).

Results

There were 31 implants with a mean age of 73.4±8.7 years and 42% women. Nine patients (22.5%) had atrial fibrillation, and 7 patients (23%) had known coronary artery disease. The main indication for implant was a complete AV block (63.3%). Two patients had TR greater than moderate before the implantation of the pacemaker.

Mean time elapsed between implantation and follow-up echocardiogram was 5.8 months. The distance between the lead-implanted site to the tricuspid annulus (Lead-TA distance) was 26.7±10.5 mm, mean lead depth in the interventricular septum (IVS) was 7.7±1.8mm and the IVS thickness at the lead-implanted site was 10.6±2.1 mm. Overall, TR worsed less than 1 degree after the lead implant (table 2) and was significantly related with the Lead-TA distance (TR worsed 0.3 degrees in Lead-TA distances shorter than 26.7mm and TR reduced 0.2 degrees in Lead-TA distances longer than 26.7mm, p=0.037).

Conclusions

In the short term following the implantation of an LBBP pacemaker the distance from the lead to the tricuspid annulus has an acute impact on tricuspid regurgitation, with TR worsening at short Lead-TA distances and TR improving at longer distances.
Prognostic value of MELD-XI score and hemodynamic parameters in patients undergoing transcatheter tricuspid valve intervention
Authors: Edlinger C , Schlegl J , Bannehr M , Lichtenauer M , Kuecken T , Krutz A , Paar V , Neuss M , Haase-Fielitz A , Butter C
Published: October 2024

Background

Hepatorenal dysfunction is a strong prognostic predictor in patients with tricuspid regurgitation. Patients are often hospitalized with acute heart failure due to volume overload and peripheral hypoperfusion. End-organ dysfunction is associated with the development of right ventricular failure related to hemodynamic changes such as low cardiac output and passive congestion from increased right ventricular filling pressures.

Purpose

This study aimed to investigate the prognostic value of hepatorenal dysfunction using the Model for End-stage Liver Disease (MELD) Score, the modified version of the score, MELD-XI, and of parameters determined during right-heart catheterization in patients undergoing transcatheter tricuspid valve intervention.

Methods

In this single-center prospective cohort study, data from patients undergoing edge-to-edge repair or heterotopic minimal invasive tricuspid valve repair were analyzed. Serum creatinine, INR and bilirubin were measured and the MELD score as well as the MELD XI score was calculated. All patients underwent right heart catheterization before the intervention. Receiver operator characteristics with calculation of the area under the curve (AUC) were performed to determine the predictive value of MELD (XI) score and hemodynamic parameters for the combined endpoint of rehospitalization due to decompensated heart failure and mortality within 3 months.

Results

Data from 36 consecutive patients were analyzed. 28 patients underwent edge-to-edge repair and 8 patients heterotopic minimal invasive tricuspid valve repair. Mean age of patients was 80.2 ± 5.9 years; 33.3% (12/36) were male. Baseline characteristics are shown in table 1. Rehospitalization due to decompensated heart failure occurred in 9/36 patients (25%). Mortality within the first 3 months was 11% (4/36). The predictive value for the composite endpoint of the modified MELD IX score was AUC 0.82 (95 % CI 0.63-0.99; p=0.009), while the conventional MELD score had an AUC of 0.77 (95 % CI 0.55-0.99; p = 0.059) (figure 1). RV pressure (AUC 0.84, 95% CI 0.66-1.00, p= 0.012) and RA pressure (AUC 0.83, 95% CI 0.67-0.98, p=0.016) showed a good predictive value for the composite endpoint (figure 2). The combination of MELD XI (at admission) and RV or PA pressure improved the AUC (MELD XI + RV: AUC 0.85; MELD XI + PA: AUC 0.84).

Conclusion

In this pilot-study, the modified MELD XI score, as indicator of hepatorenal dysfunction, was identified as a potential marker for short-term outcome after interventional tricuspid valve treatment.
Preliminary results from the Polish Infective Endocarditis Registry (POL-ENDO): time to change clinical approach?
Authors: Orzech J , Zatorska K , Grabowski M , Jaworska Wilczynska M , Milkowska M , Kowalik I , Kukulski T , Lesiak M , Surdacki A , Hryniewiecki T
Published: October 2024

Background/Aims: Infective endocarditis (IE) is a severe valve disease associated with high morbidity and mortality. The aim of this preliminary study was to evaluate the profile and treatment outcomes of IE in Poland based on the POL-ENDO registry.

Methods

A prospective cohort, multicenter, observational study - the POL ENDO registry - of IE patients from 134 hospitals in Poland recruited between August 2022 and August 2023 was performed. We evaluated demographic, clinical, imaging, and treatment outcome data. A comparison of the Polish patients with those assessed in the ESC-EORP EURO-ENDO registry was performed.

Results

Among a total of 880 IE patients, 622 were male (70.7%). The POL-ENDO participants were older (61.4±16.7 years vs. 59.25±18.03 years, p=0.001). Native valve IE (NVIE) occurred more often in Poland (82.3% vs. 56.6%, p <0.001). Transthoracic echocardiography (TTE) was performed more frequently in Poland (93.6% vs. 89.8% p<0.001). New imaging techniques (CT/MRI/PET/SPECT) were less frequently used in Poland (CT: 53.2% vs. 41.3%, p<0.001; MRI: 18.7% vs. 6.4%, p<0.001). Heart failure (HF) occurred more often in Poland as inhospital complication (31.4% vs. 14%, p<0.001). Surgical treatment was less performed in Poland (51.2% vs. 36.9%, p<0.001). Inhospital mortality was higher in Poland (21% vs. 17%, p=0.008).

Conclusion

Polish patients with IE were significantly older and more comorbid. New imaging techniques are less frequently used in Poland. Echocardiography was performed more frequently in Poland as the diagnostic mainstay. Surgical treatment was significantly less frequent in Poland. Inhospital mortality in Poland is greater. The change of clinical practice in Poland should be considered.
Impact of mandatory preoperative dental screening on infective endocarditis in patients undergoing surgical valve replacement
Authors: Krasniqi L , Mortensen P , Ravn E J , Tofterup M , Terkelsen C J , Andersen N H , Modrau I , Stokbro K , Povlsen J A , Gerke O , Hallas J , Clavel M A , Riber L P , Dahl J S
Published: October 2024

Background

Guidelines recommend preoperative dental screening (PDS) prior to surgical valve replacement (SVR) to reduce risk of prosthetic valve infective endocarditis (IE). However, limited data support these recommendations.

Purpose

Investigate the effect of mandatory PDS on risk of IE in patients undergoing SVR.

Methods

A total of 1,207 patients undergoing SVR in Western-Denmark from 2020 to 2022 were included in this observational study. Patients were considered based on two applied PDS practices: mandatory PDS (MPDS), and no routine referral PDS (NPDS). Outcome data were retrieved from Danish registries and adjudicated using medical records. The primary endpoint was incidence of IE. Secondary endpoints were all-cause mortality, and the composite endpoint of IE and all-cause mortality. Key endpoints were also analyzed in a propensity score-matched (PSM) population.

Results

Of 805 patients in the MPDS, 93% (n=751) underwent subsequent PDS, compared to 5% (n=21) among 402 patients in the NPDS. Patients in the MPDS were older with higher rates of coexisting co-morbidities. During a median follow-up of 2.6 years (interquartile range 1.9-3.2 years), 3.3% (n=40) developed IE. The yearly incidence IE rate was higher in MPDS compared with NPDS (1.5% vs. 0.7%; p=0.08). All-cause mortality rate was higher in the MPDS (2-year mortality of 6.2% vs 2.3%, p=0.02) as well as the composite endpoint (p<0.01). Differences in IE rates, all-cause mortality, but not composite endpoint were abolished in 370 propensity score-matched patients.

Conclusion

Risk of IE was low regardless of PDS practice. MPDS prior to surgery did not alter the risk of IE or all-cause mortality in patients undergoing left-sided SVR in Denmark.Kaplan-Meier plot