bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of gender on coronary atherosclerosis and inflammatory biomarker profile: a CT angiographic study
Authors: Bittner D , Roesner C , Goeller M , Raaz-Schrauder D , Dey D , Kilian T , Achenbach S , Marwan M
Published: October 2022

Background and aims

The burden of coronary atherosclerosis differs between men and women. Beyond traditional cardiovascular risk factors, inflammatory biomarkers can influence plaque formation and progression. We analyzed the influence of gender difference on coronary atherosclerosis and inflammatory cytokines.

Methods

Coronary CT-Angiography was performed in 301 patients and plaque morphology was quantitatively and qualitatively assessed using semi-automated software (Autoplaque version 2.5, Cedars-Sinai Medical Center, Los Angeles, CA). We analyzed total (TPV), non-calcified (NCPV), calcified (CPV) and low-density plaque volume in mm3 (LDPV, defined as plaque attenuation <30HU). Serum was analyzed for various cytokines including Interleukin (IL)-1a, IL-1b, IL-2, IL-4, IL-6, IL-7, IL-8, IL-10, IL-13, Il-15, IL-17, TNF-a, IFNg, CRP, MCP-1, MIP-1a, Eotaxin, G_CSF and GM-CSF using Luminex assay.

Results

Out of 301 patients, 94 (31%) were female and 207 (69%) were male. As compared to women, men were significantly younger (62 vs. 57 years, p<0.001) and showed a higher BMI (28 vs. 26 kg/m2, p=0.005). No differences were seen for hypertension, hyperlipidemia, diabetes, smoking habits and family history of CAD. All plaque characteristics showed significant higher values in men as compared to women (all p<0.05). In men, cytokine profile showed significantly lower serum levels for IL-2 (3.20 [3.20; 7.01] vs. 4.31 [3.20; 9.68]; p=0.01) and Interferon-gamma (3.20 [3.20; 14.72] vs. 8.76 [3.20; 26.26]; p<0.001) and significantly higher levels for MCP-1 (224 [117; 327] vs. 155 [49; 260]; p<0.001). In multivariable logistic regression analysis, Interferon-gamma showed significant inverse association to male gender (OR 0.35; 95% CI: 0.17–0.72; p=0.004), but IL-2 and MCP-1 did not. The association of Interferon-gamma to gender was independent of age (OR 0.57; 95% CI: 0.43–0.76; p<0.001) and BMI (OR 2.12; 95% CI 1.25–3.62; p=0.006)

Conclusion

Coronary plaque volume and morphology significantly differs between men and women and so does the inflammatory cytokine profile. Albeit significantly lower coronary plaque burden in women, serum levels of interferon-gamma - a known pro-inflammatory cytokine - was significantly higher in women with independent association to gender. Whether interferon-gamma plays contradicting roles in the process of coronary atherosclerosis in men and women needs to be explored in future studies to identify potential gender-specific targets for therapeutic interventions.

Funding Acknowledgement

Type of funding sources: None.
Transcatheter aortic valve implantation (TAVI) with zero contrast in patients with impairment of renal function. A single centre experience
Authors: Travaglio N , Elicio A , Pignatelli G , Cavalla F , Pantaleo P
Published: October 2022

Transcatheter aortic valve implantation (TAVI) represents nowaday a safe and effective alternative to traditional surgery for patients with high and intermediate surgical risk. However, the risk of contrast induced nephropathy still remains a major concern and a real challenge in patients with baseline chronic kidney disease (CKD). Aim of our new approach, has been to find a solution capable to reduce or contain the incidence of acute renal damage after TAVI caused by the use of contrast dye in CKD patients.

In the last twelve months, out of 85 patients admitted to our Center for severe symptomatic aortic stenosis, addressed to TAVI, 18 patients (mean age: 81.8 years, NYHA class III) presented CKD with mean creatinine value: 2.39 mg/dl; GFR: 24.46 ml/min/1.73 m2. Three patients had previously undergone surgical revascularization with coronary artery bypass graft and in 3 cases we performed a valve-in-valve procedure for degeneration of valvular bioprostheses.They were selected for our zero contrast protocol; all these patients underwent pre-procedural chest and abdomen CT scan without dye, together with a Lower Limb Eco-Color Doppler scan.Coronary angiography had been carried out in a previous hospitalization.

The valve size choice was determined after measurements of the CT scan and echo images (both two- and three-dimensions) were compared. Data obtained (valve perimeter, area and the two main valve diameters) were strongly similar with the two techniques, without significant differences. The new valve deployment was monitored under constant fluoroscopy and transesophageal (TOE) visualization. A single pig tail catheter was placed in the non coronary sinus to facilitate valve annulus localization on fluoroscopy. The TOE selected view for TAVI deployment was the mid esophageal long axis. Proper prosthesis positioning was determined by measuring the protruding portion through the left ventricle outflow tract, and prevent possible impairment of diastolic mitral valve movement. In 17 cases a transfemoral percutaneous approach was used and only in one case surgical isolation of the right carotid artery was necessary due to the occlusion of every other peripheral access. Four patients needed a post implant dilatation for significant residual left ventricle/aortic gradient. All patients underwent the TAVI procedure successfully. In the post-TAVI phase, two patients underwent definitive PM implantation for third degree atrioventricular block despite adequately high implantation of the valve.At discharge, mean creatinine value was 1.9 mg/dl and mean GFR was 32.2 ml/min/1.73 m2. All patients survived the procedure and were discharged alive, after a further mean Hospital stay of four days. In conclusion, TAVI zero contrast is a safe, feasible and winning procedure to consider in patients with severely impaired renal function.

Funding Acknowledgement

Type of funding sources: None.
Bioprosthetic valve fracture during valve-in-valve transcatheter aortic valve replacement: multicenter propensity matched analysis
Authors: Bonnet G , Panagides V , Vincent F , Faroux L , Corona S , Modine T , Metz D , Van Belle E , Pibarot P , Leroux L , Rodes-Cabau J , Ternacle J
Published: October 2022

Background

Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) can be completed by bioprosthetic valve fracture (BVF) to reduce final transvalvular gradients. The aim was to compare outcomes in ViV-TAVI patients with versus without BVF.

Methods

Consecutive patients undergoing ViV-TAVI procedure in four international centers were included, from 2010 to 2021. We used a 1:2 propensity score-matching method to compare postprocedural hemodynamic, complications, and long-term outcomes. Patients were matched for baseline characteristics, time since prior surgery, and characteristics of surgical bioprothesis (type and size).

Results

A total of 390 patients were analyzed, including 40 BVF. Propensity matching 1:2 yielded 38 patients in BVF group and 76 patients in no-BVF group. There was no difference in procedural complications rate and in-hospital deaths (5.1%) between the two groups. Post-procedural hemodynamic parameters significantly improved using BVF: aortic valve area (1.4 cm2 [IQR: 1.23 to 2.3] vs. 1.3 cm2 [IQR: 1.05 to 1.61], p=0.008), mean aortic gradient (12mmHg [IQR: 7.5 to 16.5] vs. 17mmHg [IQR: 11 to 22], p=0.008) and peak velocity (2.2m/s [IQR: 1.8 to 2.7] vs. 2.6m/s [IQR: 2.2 to 3.1], p=0.027). BVF had an additional benefit in the smallest surgical valve (≤21 mm). The use of BVF was independently associated with improved hemodynamic parameters. Overall survival in the matched cohort was 87.8±3.7% at 2-year follow-up, without difference between groups (87.5±6.9% in the BVF group vs. 88.4±4.2% in the no-BVF group, p=0.85).

Conclusion

Compared to ViV-TAVI alone, BVF was safe and improved immediate hemodynamic and long-term outcomes, especially in patients with small surgical aortic bioprosthesis.

Funding Acknowledgement

Type of funding sources: None.
5-year outcomes of patients with mitral structural valve deterioration treated with transcatheter valve in valve implantation
Authors: Schamroth Pravda N , Mishaev R , Levi A , Witberg G , Shapira Y , Orvin K , Talmor Barkan Y , Hamdan A , Sharoni R , Perl L , Sagie A , Vaknin Assa H , Kornowski R , Codner P
Published: October 2022

The Valve-in-Valve (ViV) technique is an emerging alternative for the treatment of bioprosthetic structural valve deterioration (SVD) in the mitral position. We report on intermediate-term outcomes of patients with symptomatic SVD in the mitral position who were treated by transcatheter mitral valve-in-valve (TM-ViV) implantation during the years 2010–2019 in our center. Three main outcomes were examined during the follow-up period: NYHA functional class, TM-ViV hemodynamic data per echocardiography, and mortality. Our cohort consisted of 49 patients (mean age 77.4±10.5 years, 65.3% female). The indications for TM-ViV were mainly for regurgitant pathology (77.6%). All 49 patients were treated with a balloon-expandable device. The procedure was performed via transapical access in 17 cases (34.7%) and transfemoral vein / trans-atrial septal puncture in 32 cases (65.3%). Mean follow-up was 4.4±2.0 years. 98% and 91% of patients were in NYHA I/II at 1 and 5 years respectively. Mitral regurgitation was ≥ moderate in 86.3% of patients prior to the procedure and this decreased to 0% (p<0.001) following the procedure and was maintained over 2 years follow-up. The mean trans-mitral valve gradients decreased from pre-procedural values of 10.1±5.1mmHg to 7.0±2.4mmHg at one month following the procedure (p=0.03). Mortality at one year was 16% (95%, CI 5–26) and 35% (95%, CI 18–49) at 5 years. ViV in the mitral position offers an effective and durable treatment option for patients with SVD at high surgical risk.

Funding Acknowledgement

Type of funding sources: None.
Outcome of transcutaneous edge-to-edge mitral valve repair in patients with diabetes mellitus: results from a real-world cohort
Authors: Kirschfink A , Alachkar M N , Vogt F , Schroeder J , Lehrke M , Frick M , Almalla M , Marx N , Altiok E
Published: October 2022

Background

Transcutaneous edge-to-edge repair (TEER) has become a treatment option for selected patients with severe mitral regurgitation (MR). Analysis of the COAPT trial indicated patients with diabetes mellitus to have higher death rates and a trend to higher rates of heart failure hospitalization (HFH) than those without diabetes. However, in that study only patients with secondary MR with specific criteria were included and there are only limited data on diabetes patients in real-world settings.

Purpose

This study sought to evaluate safety and efficacy of TEER in patients with diabetes mellitus in comparison to non-diabetics.

Methods

In this monocentric study 340 consecutive patients with severe primary and secondary MR who underwent TEER were included. Immediate results of the procedure, intrahospital as well as one-year outcome were compared between patients with and without diabetes.

Results

Diabetes was present in 109 patients (32%) of the study group. Patients with diabetes were younger (75±8 vs. 78±8 years; p=0.003), had more often ischemic cardiomyopathy (68% vs. 48%, p<0.001), previous coronary-artery bypass graft (35% vs. 20%; p=0.002) and arterial hypertension (89% vs. 75%; p<0.001) compared to those without diabetes. All other baseline clinical and imaging characteristics including NYHA class, left ventricular dimensions and function (ejection fraction: 38±13% vs. 41±14%; p=0.10) as well as severity of MR were not different between both patient groups (Table 1).

Success of the procedure was comparable between patients with and without diabetes (95% vs. 95%; p=0.84). There was no difference in intrahospital mortality between both groups (5.5% vs. 4.8%; p=0.98). At one-year follow up, there was no difference regarding all-cause mortality (24.2% vs. 23.0%; p=0.72), HFH (37.4% vs. 31.0%, p=0.23), NYHA class (p=0.11) or MR severity (p=0.20) between both groups (Table 2).

Conclusion

In contrast to previous published data on patients with diabetes and severe MR TEER seems to be similar safe and effective in a real-world setting compared to non-diabetics.

Funding Acknowledgement

Type of funding sources: None.
Trans-catheter edge-to-edge mitral valve repair in patients with acute decompensated heart failure due to severe mitral regurgitation – a single centre experience
Authors: Makmal N , Silbermintz N , Faierstein K , Raphael R , Moeller C , Canetti M , Maor E , Kuperstein R , Hai I , Butnaru A , Oren D , Guetta V , Fefer P
Published: October 2022

Introduction

Recent series have demonstrated the benefit of trans-catheter edge-to-edge mitral valve repair (TEER) in acutely ill hospitalised patients with severe mitral regurgitation (MR) and intractable heart failure despite intensive intravenous therapy. We describe our cumulative experience with such patients at the Sheba Medical Centre over a 10 year period.

Purpose

The purpose of this study was to evaluate the safety and efficacy of TEER in hospitalized patients with acute decompensated heart failure and severe MR that was deemed to play a major role in the patients' deterioration.

Methods

We included 30 hospitalised patients with intractable heart failure and MR ≥3+ (20 males; mean age 74.2±10.6 years; 10 had cardiogenic shock). MR was primary in 4, secondary in 24 and mixed in 2 patients. Acute results were assessed by echocardiography prior to discharge and safety was evaluated clinically, according to the occurrence of procedure-related adverse events. Mortality data were drawn from the national death registry.

Results

TEER devices were successfully implanted in 28 patients. Early (POD 1) procedure-failure was noted in one patient due to recurrence of flail. There was no peri-procedural mortality. Two patients were hemodynamically unstable during the procedure. One patient had peri-procedural access site bleeding necessitating blood transfusion. Following intervention, 16 patients required ICU care (mean stay 4.8±2.5 days), shock was recorded in 7 patients, 16 required hemodynamic support, and 8 required invasive ventilation. At 30 days 7 patients had died and an additional 4 died 1 to 6 months following intervention. However, mortality in the remaining patients was low with only 3 additional deaths up to 4 years after the procedure (80% of patients alive at 6 months). MR reduction was achieved in 24 patients (to ≤mild in 10 and to moderate in 11). At 12 months follow up MR severity was mild in 3 (37.5%) and moderate in 5 (62.5%) patients. Only 1 patient reported HF rehospitalisation during the year following the procedure.

Conclusion

TEER for hospitalised patients with severe MR and intractable heart failure is safe, associated with high early mortality, and good long-term outcome for patients alive 6 months after the procedure. More research is needed to better characterise patients likely to benefit from TEER in this clinical scenario.

Funding Acknowledgement

Type of funding sources: None.
Effect of frailty on in-hospital outcomes after transcatheter mitral valve repair
Authors: Lopez J , Karpel D , Obaed N , Mark J , Wahood W , Ramos F , Jazaerly M , Chait R
Published: October 2022

Background

Mitral regurgitation (MR) is a common valvular disorder associated with significant morbidity and mortality. Transcatheter mitral valve repair (TMVr) is a minimally invasive procedure indicated for the treatment of selected patients with moderate-severe or severe primary MR. Despite a lack of a universal definition, frailty has been associated with poor post-procedural outcomes. Albeit several trials have examined individual prognostic factors in this population, there is a paucity of data regarding the effect of frailty on in-hospital outcomes after TMVr.

Purpose

To further elucidate the association of frailty with in-hospital outcomes in patients undergoing TMVr.

Methods

The national inpatient sample (NIS) database, which is part of the Healthcare Cost and Utilization Project (HCUP), was queried from 2016 to 2019 to identify all who underwent TMVr. International classification of diseases, tenth revision clinical modification (ICD-10-CM) codes were used to divide patients into frail and non-frail study groups. Frailty was defined using Johns Hopkins Adjusted Clinical Groups diagnosis cluster for frailty. Multivariate linear and logistic regression analysis was performed to compare in-hospital mortality, hospital length of stay, non-home discharge, and iatrogenic cardiac complications among Frail and Non-Frail groups.

Results

A total of 30,660 patients who underwent TMVr were identified. The mean age was 76±11.6 years. Of those, 2,950 (9.6%) were identified as frail. The overall in-hospital mortality rate for the entire study population was 1.89%. Compared to non-frail patients, those identified as frail had greater odds of in-hospital mortality (AOR= 2.13, 95% CI 1.29–3.51, p<0.001) and non-home discharge (AOR= 4.34, 95% CI 3.54–5.32, p<0.001). However, there was no statistically significant difference in hospital length of stay and rates of iatrogenic cardiac complications.

Conclusions

Frailty models continue to be underutilized as a prognostic tool in clinical practice. After following HCUP guidelines, our analysis found that frailty is independently associated with increased in-hospital mortality and non-home discharge in patients undergoing TMVr. Therefore, we recommend that further efforts in incorporating frailty models in the pre-procedural assessment of patients undergoing TMVr should be sought along with a standardized predictive model for defining frailty.

Funding Acknowledgement

Type of funding sources: None.
Right ventricular reverse remodeling after mitral valve transcatheter edge-to-edge repair
Authors: Stolz L , Weckbach L , Doldi P , Orban M , Braun D , Stocker T , Higuchi S , Orban M , Wild M , Massberg S , Hagl C , Naebauer M , Hausleiter J
Published: October 2022

Background

Right ventricular dysfunction (RVD) is an important predictor for outcome in patients undergoing transcatheter mitral or tricuspid valve edge-to-edge repair (M/T-TEER). Due to the unique anatomy and contraction pattern of the RV, three-dimensional echocardiography (3DE) has emerged as a valuable tool in the assessment of RV function. While 3DE data showed RV reverse remodeling (RVRR) following T-TEER, respective data are absent in the setting of M-TEER.

Purpose

We sought to assess RVRR after M-TEER using 3DE comparing baseline and follow-up RV measurements.

Methods

Patients undergoing M-TEER treatment for relevant MR between August 2016 and February 2021 with eligible transthoracic 3DE of the RV at baseline and follow-up were included in the study. 3DE comprised RV end-diastolic and end-systolic volumes (RVEDV3D, RVESV3D), total RV stroke volume (RVSV3D) and RV ejection fraction (RVEF3D). Further, RV length (RVL3D) as well as RV basal (RVbase3D) and mid-ventricular diameters (RVmid3D) were derived from 3DE. RVRR was assessed as change in the respective 3DE parameters of RV dimensions between baseline and follow-up.

Results

A total of 66 patients (45.5% female; age 78.5±8.2 years; EuroScore II 4.6±3.6%) were included in the study. From baseline to latest available follow-up (median interval 364 days, interquartile range 180–728 days), a significant reduction of RVEDV3D and RVESV3D was observed (RVEDV3D 140.2±50.2 ml to 128.1±46.1 ml, p<0.01 and RVESV3D 93.1±37.8ml to 87.1±34.7ml, p=0.04). The decrease in 3D-derived linear RV dimensions primarily occurred in the septolateral direction, while RV length did not change significantly. The observed RVRR was associated with significant reduction of TR severity. Of note, patients with RVRR showed also left ventricular reverse remodeling (LVRR).

Conclusion

M-TEER is an effective treatment option for patients with MR which leads to LVRR and RVRR.

Funding Acknowledgement

Type of funding sources: None.
Transcatheter tricuspid annuloplasty with band implantation and its safety profile: a single-center experience
Authors: Martinez Moya R R , Ortega Perez R , Pardo Sanz A , Salido Tahoces L , Sanchez Recalde A , Abellas Sequeiros M , Mestre Barcelo J L , Fernandez Golfin C , Garcia Martin A , Hinojar Baydes R , Rivas Garcia S , Manjon Rubio H , Zamorano Gomez J L
Published: October 2022

Introduction

Severe tricuspid regurgitation is a prevalent valve disease with a negative impact on the prognosis and quality of life of patients. Transcatheter tricuspid annuloplasty with band implantation is an alternative for the treatment of this pathology in patients with high surgical risk. Due to the recent development of this device, data regarding its safety are scarce. The objective of this study was to describe the adverse events and complications related to transcatheter tricuspid annuloplasty with band implantation in our center in order to assess its safety.

Methods

In a series of 27 patients, the incidence of adverse events related to the procedure was analysed, considering death, stroke, myocardial infarction (MI), bleeding complications (extensive or life-threatening), vascular complications (pseudoaneurism), coronary complications, device-related secondary intervention (DRSI), device-related cardiac surgery (DRCS), renal failure (RF) or conduction system disturbance (CSD). Likewise, the incidence of death and hospitalizations due to heart failure in a 15-month follow-up was evaluated.

Results

No deaths, stroke, MI, DRCS, RF or CSD were recorded in relation with the percutaneous band implantation. There was 1 (3.7%) bleeding related to femoral venous vascular access that required suture and compression for 30 minutes. Development of 1 (3.7%) pseudoaneurysm was observed which was resolved with ultrasound-guided thrombin injection and 2 (7.4%) perforations of the right coronary artery (1 requiring stent implantation and another one self-limited without flow compromise). There was 1 (3.7%) patient with failed band implantation and eventual percutaneous bicaval prosthesis implantation was required. After a follow-up of 15 months, 2 (7.4%) deaths from non-cardiological causes (exacerbation of chronic obstructive pulmonary disease and traumatic brain injury) and 3 (11.1%) admissions due to decompensated heart failure were documented.

Conclusion

Transcatheter tricuspid annuloplasty with band implantation appears to be a safe technique with a low incidence of complications for treating patients with severe tricuspide regurgitation and high surgical risk.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Gobierno de España
Machine learning models for 1-year mortality prediction in hypertensive patients undergoing coronary artery bypass grafting surgery
Authors: Behnoush A H , Khalaji A , Hosseini K , Jameie M , Fallahzadeh A , Sheikhy A
Published: October 2022

Background

A significant proportion of patients undergoing coronary artery bypass grafting (CABG) surgery has a variety of comorbidities such as hypertension. Hypertensive patients tend to have poorer prognoses and higher mortality from acute coronary syndrome in short- and mid-term follow-ups. Machine learning (ML) prediction methods are now widely used in different clinical settings, operating more accurately and efficiently than clinicians and traditional scores in many instances.

Purpose

This study was designed to develop and evaluate the ML prediction models of 1-year mortality in hypertensive patients undergoing CABG in our institute during 2005–2015.

Methods

Several baseline and procedural characteristics of CABG hypertensive cases were collected. Train and test data were divided with the proportion of 70:30. Due to a high 1-year survival rate, the synthetic minority oversampling technique (SMOTE) was implemented. In addition, the optimal threshold for determination of sensitivity and specificity was found using 10-fold cross-validation in the train data. After performing feature selection using the random forest method, prediction models were developed using: Support Vector Machine (SVM), Naïve Bayes (NB), Logistic Regression (LR), K-Nearest Neighbors (K-NN), Extreme Gradient Boosting (XGB), and Random Forest (RF) algorithms. Area Under the ROC (Receiver Operating Characteristic) Curve (AUC) in addition to sensitivity, specificity, and accuracy were used to assess the performance of the models.

Results

Among 8943 hypertensive CABG patients with 1-year follow-up, the mean age was 68.27±9.29 years, of whom 303 died during the study period. Eleven features from a total of 26 were chosen to train the models. The most important prediction features being selected were total ventilation time, ejection fraction, triglyceride, and age. LR (AUC=0.819) and XGB (AUC=0.812) outperformed RF (AUC=0.804), NB (AUC=0.791), SVM (AUC=0.715) and KNN (AUC=0.718). The LR model demonstrated the highest specificity (83.00%) and accuracy (82.37%) while the XGB model was the most sensitive one (88.00%).

Conclusion

An applicable prediction system can help clinicians' decision-making for the risk of 1-year mortality in hypertensive CABG patients which may have higher death rate compared with normal population. Although LR, RF, and XGB performance were almost similar and more favourable than the other three, LR remained the most promising predictor, given its AUC.

Funding Acknowledgement

Type of funding sources: None.
Revascularization strategies versus optimal medical therapy in chronic coronary syndrome: a systematic review and network meta-analysis
Authors: Galli M , Benenati S , Zito A , Capodanno D , Biondi-Zoccai G , Ortega-Paz L , D'Amario D , Porto I , Burzotta F , Trani C , De Caterina R , Escaned J , Gaudino M , Angiolillo D J , Crea F
Published: October 2022

Background

Whether revascularization reduces ischemic events and improves prognosis in patients with chronic coronary artery syndrome (CCS) without left main (LM) disease or reduced left ventricle ejection fraction (LVEF) remains a topic of debate. Nevertheless, the impact of revascularization on outcomes in patients with CCS may be influenced by the revascularization strategy adopted.

Purpose

We aimed at evaluating the comparative effects of different revascularization strategies in patients with CCS.

Methods

A total of 18 randomized controlled trials including angiography-guided percutaneous coronary intervention (PCI), physiology-guided PCI and coronary artery bypass graft (CABG), were included. Effect estimates included direct comparisons for all treatments and direct and indirect evidence were in agreement for all included outcomes, fulfilling the consistency assumption. Incidence rate ratios (IRR) and associated 95% confidence intervals (CIs) were used to adjust outcomes according to follow-up durations. Medical therapy was used as reference strategy.

Results

Compared with medical therapy, at a mean follow-up of 5.1 years, all revascularization strategies were associated with a reduction of the primary endpoint, as defined in each trial, the extent of which was modest with angiography-guided PCI (IRR 0.86, 95% CI 0.75–0.99) and greater with physiology-guided PCI (IRR 0.60, 95% CI 0.47–0.77) and CABG (IRR 0.58, 95% CI 0.48–0.70). Moreover, angiography-guided PCI was associated with increased primary endpoint compared to physiology-guided PCI (IRR 1.43, 95% CI 1.14–1.79) and CABG (IRR 1.49, 95% CI 1.27–1.74). CABG was the only strategy associated with reduced myocardial infarction (IRR 0.68, 95% CI 0.52–0.90), cardiovascular death (IRR 0.76, 95% CI 0.64–0.89), and all-cause death (IRR 0.87, 95% CI 0.77–0.99), but increased stroke (IRR 1.69, 95% CI 1.04–2.76). Results were consistent at secondary analysis exploring the impact on outcomes of baseline characteristics, such as 3-vessel disease, diabetes mellitus, year of publication or stents used.

Conclusions

In CCS patients without LM disease or reduced LVEF, physiology-guided PCI and CABG were associated with better outcomes than angiography-guided PCI. Compared with medical therapy, CABG was the only revascularization strategy associated with a reduction of myocardial infarction and death rates, at the cost of higher risk of stroke.

Funding Acknowledgement

Type of funding sources: None.
Soluble urokinase plasminogen activator receptor predicts survival and hospitalization for heart failure in elective cardiac surgery
Authors: Koller L , Steinacher E , Hofer F , Kazem N , Laufer G , Fleck T , Wojta J , Steinlechner B , Richter B , Hengstenberg C , Niessner A , Sulzgruber P
Published: October 2022

Aims

The study investigated the prognostic value of soluble urokinase plasminogen activator receptor (suPAR) patients undergoing cardiac surgery and calculated a simplified biomarker score comprising suPAR, N-terminal pro B-type natriuretic peptide (NT-proBNP) and age.

Methods and results

Biomarkers were assessed in a cohort of 478 patients undergoing elective cardiac surgery. After a median follow-up of 4.2 years a total of 72 (15.1%) patients died. SuPAR, NT-proBNP and age were independent prognosticators of mortality in a multivariable Cox regression model after adjustment for EuroScoreII. We then calculated a simplified biomarker score comprising age, suPAR and NT-proBNP, which had a superior prognostic value compared to EuroScoreII (Harrel's C of 0.76 vs 0.72; P for difference = 0.02). Besides long-term mortality, the biomarker score had an excellent performance predicting one-year mortality and hospitalization due to heart failure.

Conclusion

The biomarker suPAR and NT-proBNP were strongly and independently associated with mortality in patients undergoing cardiac surgery. A simplified biomarker score comprising only 3 variables (age, suPAR and NT-proBNP) performed better than the established EuroScoreII with respect to intermediate and long-term outcome as well as hospitalization due to heart failure. As such, integration of established and upcoming biomarkers in clinical practice may provide improved decision support in cardiac surgery.

Funding Acknowledgement

Type of funding sources: None.
Outcomes of heart transplantation in adults and pediatrics congenital heart disease: a systematic review and meta-analysis
Authors: Mendel B M , Holiyono H I H , Angellia P A , Prakoso R P , Siagian S N S
Published: October 2022

Background

Heart transplantation (HTx) has progressed from an experimental therapy option to a well-established therapeutic option for congenital heart disease (CHD) patients in end-stage heart failure, thus we can expect a large number of people with CHD to be evaluated for HTx in the next decades.

Objective

To create a systematic review and meta-analysis regarding short-term and long-term outcomes of HTx in end-stage adults and pediatrics CHD patients.

Methods

Four online databases were screened from the date of inception to January 2022, where the acquired studies were assessed using the PRISMA statement. The inclusion criteria were cohort studies that evaluated outcomes of heart transplantation in end-stage congenital heart disease patients. The mortality of adults and pediatrics population were analyzed using random-effect model, showed as summary statistics of overall risk ratio (RR) with 95% confidence interval (CI). Quality appraisal was conducted using the STROBE statement.

Result

Ten studies met the inclusion criteria and were eligible to be analyzed. The pediatric population had stronger 1-year mortality risk [Std. Mean difference 0.62, 95% CI, 0.12 to 3.07; P<0.00001] and 5-year mortality risk [Std. Mean difference 0.82, 95% CI, 0.37 to 1.84; P<0.00001], while adult population were found to have higher overall post-transplantation mortality risk [Std. mean difference 1.17, 95% CI 0.66 to 2.08; P<0.00001].

Conclusion

Adults CHD patients experienced higher mortality rate following heart transplantation, with improved long-term survival in comparison to pediatrics CHD recipients. However, further study should be conducted with standardized subjects as there is moderate quality of evidence and higher heterogeneity during our meta-analysis.

Funding Acknowledgement

Type of funding sources: None.
Can carotid angioplasty stenting be better than endarterectomy or best medical treatment for patients with carotid stenosis?
Authors: Fernandes R , Silva J D , Ferreira J M , Goncalves L
Published: October 2022

Background

Carotid stenosis is responsible for a considerable amount of strokes and related deaths. Carotid angioplasty stenting (CAS), endarterectomy (CEA) and best medical treatment (BMT) are important in preventing major cardiovascular (CV) events.

Methods

We conducted a systematic review and meta-analysis, with randomized controlled trials (RCT), to compare CAS with CEA and BMT regarding the short and long-term major periprocedural and follow-up CV events (stroke, myocardial infarction, and death) in symptomatic and asymptomatic carotid stenosis. We searched for RCT published from 2008 to 2021 in databases such as Pubmed/MEDLINE, B-On, Embase, Clinical Trials from U.S. National Library of Medicine and International Clinical Trials Registry Platform, between July of 2018 and January of 2019, and in October of 2021.

Results

Nine RCT were included, with a total of 9162 participants for CAS versus (vs) CEA, and 513 participants for CAS vs TMO. Compared with CEA, CAS is associated with periprocedural stroke and death in symptomatic patients (HR=1.65, 95% CI: 1.29–2.11, p=0.05, I2=62%), due to higher stroke events than deaths. That association does not occur in asymptomatic patients in which CAS is not associated with periprocedural stroke or death (CAS=8.55%, CEA=7.05%, p=0.09). During follow-up there were no significant differences between CAS and CEA in symptomatic patients regarding stroke (HR=1.51, 95% CI: 1.23–1.84, p=0.57, I2=0%) and death (HR=1.10, 95% CI: 0.93–1.30, p=0.69, I2=0%). Periprocedural myocardial infarction (MI) incidence is higher in CEA (CAS=1.1%; CEA=2.3%; p=0.03), without influence of symptomatic status. CAS is not inferior to CEA, in both symptomatic and asymptomatic patients with high surgery risk, as for periprocedural and one year CV major events (CAS=12.2%, CEA=20.1%, absolute difference = −7.9, 95% CI: −16.4–0.7, p=0.004). BMT had no significant findings vs CAS in asymptomatic patients (HR=3.5, 95% CI: 0.42–29.11, p=0.246).

Conclusion

CAS is not inferior to CEA as for the periprocedural and one-year major CV events in patients with normal surgery risk. However, there is a higher risk of periprocedural stroke in CAS for symptomatic patients, and of periprocedural MI in CEA with no influence of symptomatic status. CAS seams to prevent middle and long-term ipsilateral stroke in symptomatic patients. BMT has yet to prove not to be inferior to CAS in asymptomatic patients.

Funding Acknowledgement

Type of funding sources: None.
Survival and renal outcomes of direct heart transplant from veno-arterial extracorporeal membrane oxygenation support
Authors: Kanwal A , Ohira S , Levine A , Isath A , Pan S , Dhand A , Aggarwal-Gupta C , Lanier G M , Gass A , Spielvogel D , Kai M
Published: October 2022

Backgrounds

Patients on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support are given the highest priority for cardiac transplantation (OHT) in the new UNOS heart allocation policy adopted in October 2018. Although patients may receive an organ quicker there may not be enough time to recover end-organ function. To date, little is known about survival and renal outcomes of direct OHT in patients that have been supported with VA-ECMO as a bridge to transplant due to limited experience in most transplant centers.

Purpose

The aim of this study was to investigate survival and renal outcomes of direct OHT in patients supported with VA-ECMO prior to transplant.

Methods

From January 2010 to February 2022, 23 patients who received single organ OHT alone directly from VA-ECMO support were retrospectively analyzed (16 patients after the new allocation policy). Kaplan-Meier analysis was used to estimate event-free survival.

Results

The median age of recipients was 48 years. The median length of pre-transplant VA-ECMO support was 5 days. Additional pre-transplant support with intra-aortic balloon pump or Impella was utilized in 15 patients (65.2%) and 2 patients (9%) respectively. There was a trend toward improvement of serum creatinine after initiation of VA-ECMO support (Pre-ECMO: 1.66±1.22 mg/dl vs. Pre-OHT: 1.20±0.74 mg/dl, P=0.084). Four patients required preoperative renal replacement therapy (RRT); three were on RRT at the time of OHT. The median ischemic time of donor hearts was 168 minutes. VA-ECMO support was continued in 10 patients (43.5%) after OHT.

Hospital mortality was 8.7% (2 patients). Post-transplant RRT was required in 9 patients (39.1%), and, of these, 5 patients were transitioned to permanent dialysis. Among the 14 patients who did not require post-transplant RRT, none required RRT during the follow-up period (median, 21.5 months). Kaplan-Meier survival analysis showed that estimated survival at 1 year and 3 years were 86.1%, and 77.5%, respectively (Figure 1A). The freedom from dialysis rate was 82.4% at 1 year, and 74.9% at 3 years (Figure 2A). Both survival (100% vs. 66.7%, P=0.008, Fig.1B) and dialysis free rate (100% vs. 55.6%, P=0.002, Figure 2B) at one-year were significantly worse in patients who required postoperative RRT.

Conclusions

To our knowledge this is the largest single center study of OHT in patients that were supported with VA-ECMO. VA-ECMO as a bridge to end-organ recovery and OHT resulted in excellent outcomes. Patients who required post-transplant RRT more likely to require long-term dialysis, while those that did not receive RRT showed favorable outcomes. Overall survival in this patient population is comparable to patients that were not on VA-ECMO prior to transplant.

Funding Acknowledgement

Type of funding sources: None.
Implication of long non-coding RNAs in the pathophysiology of cardiac rejection and its accuracy in diagnosis
Authors: Perez-Carrillo L , Gimenez-Escamilla I , Trivino J C , Martinez-Dolz L , Portoles M , Tarazon E , Rosello-Lleti E
Published: October 2022

Background

The complementation of the endomyocardial biopsy or even its replacement by the use of a non-invasive method is one of the great challenges in the investigation of cardiac rejection. However, the limitations of the serum markers identified so far limit their use in clinical practice. In recent years, many long non-coding RNAs (lncRNAs) have been identified along with their role in different biological functions. However, the utility of lncRNAs in cardiac rejection has not been explored.

Purpose

We aimed to determine the expression of lncRNAs in serum of patient with cardiac rejection and evaluate the diagnostic capacity as potential biomarkers for the non-invasive detection of mild (grade 1R) or moderate/severe (grade ≥2R) cellular rejection.

Methods

RNA sequencing analysis (Illumina HiSeq 2500) was performed on forty serum samples from transplant recipients undergoing routine endomyocardial biopsies. Twenty eight samples were diagnosed with RCA (RCA Grade 1R, n=16; and RCA Grade ≥2R, n=12) and 12 samples had no diagnosed rejection.

Results

Of the 10,144 lncRNAs detected in serum, 5.1% presented differential expression in patients with cardiac rejection of Grade ≥2R. Fifty-six molecules showed excellent diagnostic ability in moderate-severe rejection (AUC >0.900) and fifty-one molecule were even able to detect mild rejection with good diagnostic ability for moderate-severe rejection (AUC >0.800). Three lncRNAs stand out: EGFR-AS1 (≥2R, AUC=0.871, p<0.01; 1R, AUC=0.921, p<0.0001), AC008649.2 (≥2R, AUC=0.867, p<0.01; 1R, AUC=0.807, p<0.01) and AP001652.1 (≥2R, AUC=0.848, p<0.01; 1R, AUC=0.855, p<0.01).

Conclusions

A large number of lncRNAs with excellent diagnostic capacity for acute cellular rejection have been identified. In addition, we highlight 3 long non-coding (EGFR-AS1, AC008649.2 and AP001652.1) that maintain a good diagnostic capacity even in the mildest degrees. Therefore, we propose these non-coding RNAs as potential biomarkers of cardiac rejection. Although the function of these non-coding RNAs in acute cellular rejection is unknown, it is important to take into account in future studies the pathways in which they participate in order to elucidate the mechanisms involved in the development of this pathology.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute of Health Carlos III European Regional Development Fund (ERDF)
Donor hypernatremia is associated with increased mortality after heart transplantation
Authors: Oehler D , Immohr M , Boettger C , Erbel-Khurtsidze S , Aubin H , Bruno R , Holst T , Horn P , Westenfeld R , Kelm M , Tudorache I , Akhyari P , Lichtenberg A , Boeken U
Published: October 2022

Objective

Donor hypernatremia has been associated with primary graft dysfunction in heart transplantation and is known to be associated with impaired outcome following liver and renal transplantation. However, controversial data exist regarding the impact of sodium deregulation in patient survival after heart transplantation (HTx). This study aims to investigate the impact of donor sodium levels on early morbidity and short- and midterm survival following HTx.

Methods

Between September 2010 and June 2021, a total of n=218 patients underwent HTx in our centre. From those, 214 could be included retrospectively in our study. For each donor, sodium levels were collected and different cut-off levels from 145 to 159 mmol/l were investigated by Kaplan-Meier-analysis. Then, recipients were divided in three groups regarding donor sodium: Normonatremia (133–145 mmol/l, n=73), mild hypernatremia (146–156 mmol/l, n=105) and severe hypernatremia (>156 mmol/l, n=35). Recipient and donor variables were reviewed and compared, including peri- and postoperative characteristics and recipient survival after up to 5 years after transplantation.

Results

All patients were comparable regarding baseline characteristics and perioperative parameters. Regarding early mortality, 90-day survival was significantly reduced only in patients with severe donor hypernatremia in comparison to normonatremia (see table 1 and fifgure 1, 90% vs. 71%, p=0.02), but not in mild normonatremia (89%, p=0.89). 1-year survival was comparable in all groups (p>0.28).

Conclusion

Donor hypernatremia was associated with reduced short-term survival, while correlation weakens >1 year after HTx. Future prospective studies are needed to confirm the possible cut-off value of 156 mmol/l for donor-acceptancy.

Funding Acknowledgement

Type of funding sources: None.
Racial differences of right ventricular remodelling in systemic hypertension unveiled by multiparametric cardiovascular magnetic resonance
Authors: Mohamed A T , Georgiopoulos G , Faconti L , Asher C , Vennin S , McNally R , Vasileios S , Alfakih K , Lamata P , Keehn L , Chowienczyk P , Masci P G
Published: October 2022

Background

Patients with systemic hypertension (HTN) of African ancestry (Afr-a) are at greater risk of heart failure (HF), hospitalisation and death than those of European ancestry (Eu-a). Compelling evidence suggests that left ventricular (LV) remodelling and hypertrophy are more prevalent in Afr-a than Eu-a hypertensives due to either a high clustering of cardiovascular risk-factors and/or a difference in genetic background. Prior studies in Eu-a subjects have shown that uncomplicated HTN is associated with right ventricular (RV) hypertrophy and remodelling which may contribute to development of HF. However, the impact of ethnicity on RV remodelling in HTN remains speculative.

Purpose

To investigate the influence of ethnicity on RV remodelling/hypertrophy in patients with HTN using cardiovascular magnetic resonance (CMR).

Methods

In this cross-sectional study we included 16 Afr-a and 32 Eu-a age- and sex-matched healthy-volunteers, and 63 Afr-a and 47 Eu-a hypertensives. All participants underwent a CMR exam (1.5-Tesla, Aera, Siemens-Healthcare, Erlangen-Germany). LV and RV volumes, masses and function were measured according to the current recommendations. Blood pressure was recorded during the CMR.

Results

Age- and sex-matched Afr-a and Eur-a healthy-volunteers (37±10 vs 37±12 years, P=0.975; male 53% vs 44%; P=0.539) exhibited closely comparable LV and RV volumes, masses, and end-diastolic volume/mass ratios. In the HTN group, despite Afr-a hypertensives being roughly 5 years older than Eu-a, baseline characteristics including cardiovascular risk factors, mean blood pressure, body-mass-index, and body composition metrics were similar between the two groups (Figure 1). Afr-a hypertensives also had greater LV and RV masses and mass/end-diastolic volume ratios than Eur-a hypertensives (Figure 2). RV mass correlated with LV mass in both ethnic groups (r=0.593 in Eu-a and r=0.569 in Afr-a; both P<0.001). Multivariable linear regression analysis showed that RV mass was independently associated with African descendance after correction for major confounders including LV mass, biventricular volumes, and body composition.

Conclusion

Our findings support the notion that Afr-a and Eur-a healthy-volunteers have comparable left and right ventricular geometry and masses, arguing against genetic-determinate ventricular geometry and myocardial mass in this population. However, Afr-a individuals exhibit higher sensitivity to myocardial hypertrophy in response to HTN which translates into greater biventricular masses and remodelling, compared to Eu-a hypertensives.

Funding Acknowledgement

Type of funding sources: None.