bluuebunny/crossref_metadata_2025 huggingface dataset:
A new right-heart failure staging system in patients with severe tricuspid regurgitation. Prognostic implications
Authors: Gomez Polo J G P , Miguel Angel Marquez Rivera M A M R , Patricia Mahia P M , Itziar Gomez Salvador I G S , Esther Perez David E P D , Pere Pericas P P , Jose Antonio Parada Barcia J A P B , Carlos Izurieta C I , Ana Revilla Orodea A R O , Vanessa Monivas V M , Ana Testa A T , Lara Miguel L M , Laura Gutierrez L G , Jose Alberto San Roman J A S R , Isidre Vilacosta I V
Published: October 2024

Objective

Our aim was to describe a new right-heart failure (RHF) staging system in patients with severe tricuspid regurgitation (TR).

Methods

Multicenter, observational, and prospective registry in which all patients with severe TR have been consecutively collected within a 6-month period, classified according to their clinical condition and right ventricular status, and followed up for one year.

Results

A total of 1247 patients with severe TR [mean age: 76.7±10.5 years, 876 women (70.2%)] were included: 810 (64.9%) met criteria for severe TR, 301 (24.1%) massive TR, and 136 (11%) torrential TR. A new RHF staging was proposed depending on clinical condition, RV dilation and RV systolic dysfunction (Table). The largest group of patients had a normal right ventricle with signs/symptoms of RHF (41%). Death due to refractory HF occurred in 9,2% of patients, hospitalization for HF in 20,8%, and 12,3% underwent TR interventions. In the multivariate analysis the predictors of CV mortality were age, impaired renal function, previous HF admission, massive and torrential TR and Stages III and IV of the new right-heart failure staging system (figure).

Conclusion

The new RHF staging system accurately stratifies patients with severe TR into prognostic categories.
Mortality risk in patients with carotid artery disease undergoing carotid endarterectomy compared to the general population
Authors: Di Venanzio L , Mahmoudi Hamidabad N , Lewis B R , Tiwari A , Rajai N , Copley E A , Rajotia A , Lutgens E , Lerman L O , Nardi V , Lerman A
Published: October 2024

Background

Patients with carotid artery disease undergoing carotid endarterectomy (CEA) appear to be at high risk of all-cause mortality during their follow-up. However, the possible predictors of this adverse outcome are not elucidated yet.

Purpose

We aimed to test cardiovascular (CV) risk factors as possible predictors of all-cause mortality in patients undergoing CEA and to determine whether there is a difference between the mortality rate of our study cohort and the general population.

We hypothesize that CEA-treated patients have a higher mortality rate during follow-up after surgery than the general population, which is not related to the presence of CV risk factors.

Methods

We prospectively enrolled and followed up patients undergoing CEA. Univariate and multivariable Cox regression were performed to test whether common CV risk factors (demographics, laboratory values, comorbidities, and events before CEA) were predictive of all-cause mortality. We then compared the standardized mortality ratio (SMR) of our population and the age-sex-matched Minnesota (MN) general population at 5,10, and 21 years of follow-up after CEA.

Results

A total of 710 patients were followed for a median of 7.1 [2.9-11.9] years after CEA. Mortality occurred in 198 (27.0%) patients during the follow-up. The median time to event was 11.0 [10.0-12.0] years. Age was the only predictor of all-cause mortality in CEA-treated patients in multivariable models adjusted for known CV risk factors (Model 1: HR 1.03 [95%CI 1.01-1.06]; p=0.004; Model 2: HR 1.02 [95%CI 1.00-1.04]; p=0.023) (Table 1). However, the CEA-treated group had a higher mortality rate than would have been expected in the MN population (log-rank p<0.001) (Fig.1A). Compared to the MN population, at 5 years of follow-up only patients <60 years old had a higher SMR (4.53 [1.95-8.92]; p=0.001), whereas, at 10 years and 21 years of follow-up, our study population had a higher mortality rate at any age (Fig.1B).

Conclusions

The elevated mortality risk post-CEA in our cohort cannot be solely attributed to chronological aging. The underlying process of atherosclerosis likely contributes to all-cause mortality, and plaque characteristics may offer additional insight into the risk stratification of this patient group.All cause mortality predictors after CEAStudy population vs. MN population SMR
Adverse outcomes following carotid artery stenting in echolucent plaques: a systematic review and meta-analysis
Authors: Ibrahimi P , Jashari F J , Pllana E P , Henein M Y
Published: October 2024

Objective

Conflicting evidence exists regarding carotid artery stenting (CAS) interventions on echolucent plaques and adverse outcomes. This meta-analysis aims to assess the relationship between carotid plaque echogenicity and adverse outcomes following CAS.

Methods

We conducted a systematic search of electronic databases (PubMed, MEDLINE, EMBASE and Cochrane Center Register) up to January 2024. Two researchers independently assessed the eligibility of studies that used ultrasound to assess carotid artery plaque echogenicity and its relationship with adverse outcomes after CAS. We used web-based systematic review production software RevMan to conduct the analysis.

Results

Eight studies including 810 patients’ data that have reported on in-stent restenosis, distal embolization and stroke after CAS were meta-analyzed. Mean age of the participants was 68±11 years and 43% were females. CAS performed on echolucent plaques demonstrated a higher frequency of association with distal microembolization OR=3.64 (95% CI 2.11-6.30, p<0.001), in-stent restenosis OR=2.87 (95% CI 1.84-4.47, p=0.003) and stroke OR=3.80 (95% CI 1.93-7.44, p<0.001). In the pooled analysis covering all adverse outcomes following CAS, the OR was 3.28 (95% CI 2.41-4.45, p<0.001, I2=25%).

Conclusions

Arterial stenting performed on echolucent carotid plaques was more frequently associated with adverse outcomes, such as stroke, distal microembolization, and in-stent restenosis.
Left atrial cardiomyopathy predicts stroke recurrence and atrial fibrillation
Authors: Friderichsen L , Larsen B S , Aplin M , Hoest N , Hadad R , Christensen L M , Christensen H , Havsteen I , Bertelsen L , Lund M A V , Jespersen T , Linz D , Sajadieh A
Published: October 2024

Background

Markers of atrial cardiomyopathy, encompassing both left atrial (LA) structure and function, have been linked to an increased long-term risk of ischemic stroke and atrial fibrillation (AF). However, the short-term risk associated with these markers in patients with stroke without previously known or detected AF during stroke workup remains insufficiently characterized.

Purpose

To investigate the association between functional and structural markers of atrial cardiomypathy using cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) in patients with stroke of either i) undetermined etiology or ii) small or large-vessel stroke and the recurrence of stroke or new-onset AF.

Methods

Between 2019 and 2021 we consecutively included 91 patients with a recent stroke (<30 days) without known or detected AF during at least 48-hours of continuous monitoring. All patients had CMR with LGE to determine LA emptying fraction, LA volumes, and LA fibrosis. The primary endpoint was a composite of stroke recurrence or new-onset AF.

Results

Baseline characteristics are presented in Table 1. Over a median follow-up of 2.3 years, fourteen patients (15%) reached the combined endpoint of stroke or new-onset AF. Multivariable cause specific regression analysis demonstrated that a lower LA emptying fraction was associated with the primary endpoint (hazard ratio [HR], 1.41 per 5% decrease [95% CI, 1.09–1.82]). LA volumes and LA fibrosis did not show any associations with the combined endpoint (Table 2). Subgroup analysis indicated that the results were predominantly driven by new-onset AF in patients with stroke of undetermined etiology

Conclusion

Our results suggests that LA emptying fraction, measured using CMR, may serve as a prognostic indicator for stroke recurrence or new-onset atrial fibrillation in patients without detected AF, especially in those with stroke of undetermined etiology. Surprisingly, LA fibrosis was not associated with either recurrence of stroke or new-onset AF.
Elevated GDF-15 is associated with stroke severity, myocardial injury and poor clinical outcome in patients after acute ischemic stroke
Authors: Mihalovic M , Mikulenka P , Linkova H , Stetkarova I , Peisker T , Tousek P
Published: October 2024

Background

GDF-15 is emerging as a biomarker of cardiometabolic risk and disease burden. Increased concentrations of circulating GDF-15 are associated with increased mortality in patients with acute coronary syndromes or heart failure.

Purpose

We aimed to describe relation between GDF-15 elevation with stroke severity, myocardial injury and poor clinical outcome in patients after acute ischemic stroke (AIS).

Methods

Patients after AIS were enrolled in our study. Blood samples were obtained from patients at the time of admission, 24 and 48 hours later to determine the plasma levels of GDF-15 and high-sensitive troponin I (hs-cTnI). Receiver-operating characteristic (ROC) curve analysis was used to determine the diagnostic accuracy and optimal elevation cut-off values of GDF-15 on day 1 for the severity of acute stroke defined by NIHSS score. The optimal cut off in our group was 1776 pg/ml (Sensitivity 0,8, Specificity 0,52). Myocardial injury was defined by fourth universal definition of myocardial infarction using hs-cTnI. Demographic characteristics, clinical data, functional outcome, and all-cause mortality at 1 year were compared between groups according to GDF-15 levels. National Institutes of Health Stroke Scale (NIHSS) at the time of admission and the modified Rankin Scale (mRS) 90 days following the patient’s discharge from the hospital were used to assess stroke severity and clinical outcome. All analyses were performed with SPSS 29.0 (SPSS Inc).

Results

Between August 2020 and August 2022, 177 patients after AIS were enrolled. Elevated GDF-15 was observed in 71 patients (40,1%). Most common comorbidities included arterial hypertension, dyslipidemia, type 2 DM and atrial fibrillation. In analysis, we observed a connection between elevated GDF-15 with unfavourable outcome evaluated by mRS at 90 days (HR 2.57, 95% CI 1,44 to 4,57, p=0.001) and with all-cause death at 1 year (HR 4.479, 95% CI 1,81 to 11,09, p=0.001). GDF-15 elevation was associated with myocardial injury (Figure 1C). Moreover, individuals with moderate to severe and severe strokes (NIHSS 16-42) displayed higher GDF-15 levels compared to those with minor to moderate stroke (Figure 1D). The Kaplan-Meier survival curve accentuated a significantly elevated all-cause mortality among patients with increased GDF-15 (p < 0.001) (Figure 2). In multivariate regression analysis elevated GDF-15 was associated with atrial fibrillation and high-sensitive troponin I elevation.

Conclusion

The conclusions drawn suggest that heightened GDF-15 is associated with increased stroke severity, myocardial injury and unfavourable outcome.
Risk of death in patients with early cardiovascular complications following ischaemic stroke: an individual patient data pooled analysis from the VISTA database
Authors: Ishiguchi H , Huang B , El-Bouri W K , Dawson J , Lip G Y H , Abdul-Rahim A H
Published: October 2024

Background

Early cardiovascular complications may occur in patients following ischaemic stroke (stroke-heart-syndrome, SHS). We investigated the risk of death in patients with SHS, and across the SHS manifestations.

Methods

Data were sought from the Virtual International Stroke Trials Archive (VISTA), an international repository of clinical trials data. We reviewed relevant adverse events and classified patients into two cohorts based on the incidence of cardiovascular complications within 30 days post-stroke (acute coronary syndrome [ACS] including acute myocardial injury, heart failure [HF]/left ventricular [LV] dysfunction, atrial fibrillation [AF]/atrial flutter [AFL], other arrhythmia/ ECG abnormalities, and cardio-respiratory arrest [CRA]), i.e. those with SHS and those with stroke-only (without SHS).

Using Cox proportional hazards model, we evaluated the 90-day risk of death trajectories associated with SHS. We also compared the 90-day risk of death across SHS manifestations excluding CRA, using multivariate analysis.

Results

Among 15,054 patients with ischaemic stroke (mean age 72±11 years; 55% male), 1,787 (11.8%; 95% confidence interval [CI]: 11.3-12.3, Table 1) developed SHS, with incidence peaked at day 3 post-stroke (interquartile range: 2-5). Other arrhythmia/ECG abnormalities were the most prevalent (6.5%; 95%CI: 6.1-6.9), followed by AF/AFL, HF/LV dysfunction, ACS/acute myocardial injury, and CRA. Patients who developed SHS between 10-30 days post-stroke had significantly higher risks of death compared to those with SHS within the first 0-3 days (adjusted hazard ratio [HR]: 2.13 [1.57-2.89]). In the multivariate-adjusted analysis which includes 13 background factors such as age and sex, SHS manifested as ACS/acute myocardial injury and HF/LV dysfunction were associated with highest risk of death within 90-day post-stroke (adjusted hazard ratio [HR] [95% CI], HR 2.13 (1.08-4.18) and HR 2.28 (1.42-3.66), respectively, Figure 1).

Conclusions

Stroke-heart syndrome is associated with high risk of death, with greater risk observed with the delayed SHS onset. Among the SHS manifestations, ACS/acute myocardial injury and HF/LV dysfunction were associated with the highest risk of death post-stroke.Figure 1
Impact of preoperative quantitative flow ratio on long term coronary artery bypass grafts patency
Authors: Andreka J , Maaroufi A , Bertolone D , Klopfenstein M , Stark C , Kanoun Schnur S S , Pranevicius R , Ruzsa Z , Fournier S , Barbato E , Toth G G
Published: October 2024

Background

Preoperative fractional flow reserve (FFR) in the native coronaries is a known predictor of long-term graft patency after coronary artery bypass graft (CABG) surgery. Quantitative flow ratio (QFR) is an angiogram-based functional assessment tool of coronary stenoses. Its predictive value of graft patency is unknown.

Purpose

To investigate the impact of preoperative QFR value on long-term graft patency after CABG.

Methods

In this retrospective multicentric study we included consecutive patients treated with CABG between 2011 and 2022, with available coronary angiogram before and at any timepoint after CABG. Three-vessel QFR analysis of the preoperative angiography has been performed. Follow-up angiography was checked for graft patency. Only vessels entered the analysis for which baseline QFR was appropriate and which has been bypassed.

Results

400 patients were included with mean age of 67±8 years. They received on average 2.0±0.9 bypasses. 788 coronaries and bypasses were analyzed, among the latter 455 were arterial and 333 were veins. 37% were placed on LAD, 26% on RCA and 26% on the LCx. Stenosis severity at baseline was 73±22% with a QFR value of 0.68±0.30.

Follow-up angiographies were performed at 34±29 months. Overall graft patency was 83%, with higher occlusion rate for venous than arterial conduits (27% vs 9%, respectively; HR 3.9 [2.60-5.88]). Occlusion rate was lower for grafts implanted on QFR significant native vessels versus those, placed on non-significant ones (13% vs 30%, respectively; HR 2.86 [1.93-4.26]). Benefit was maintained for both, arterial (5% vs 22%, respectively; HR 5.23 [2.78-10.38]), as well as for venous conduits (24% vs 39%; HR 2.09 [1.21-3.50]).

Conclusion

QFR significantly predicts graft patency irrespective of whether the graft is arterial or venous. However, patency of venous grafts is poor, even if implanted on functionally significant native stenotic coronaries.Graft patency
Intravascular ultrasound-guided versus angiography-guided percutaneous coronary intervention for acute myocardial infarction with cardiogenic shock
Authors: Kim Y , Lee O H , Heo S J , Johnson T W , Kim J S , Kim B K , Choi D , Hong M K , Jang Y , Jeong M H
Published: October 2024

Background

Intravascular ultrasound (IVUS) potentially improves short and long-term clinical outcomes of percutaneous coronary intervention (PCI). However, evidence regarding its efficacy in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI) is limited.

Objectives

This study investigated the impact of IVUS-guided PCI in patients with AMI and CS.

Methods

From the pooled data based on a series of Korean AMI registries during 2011–2020, we identified 1,418 consecutive patients who underwent PCI with second generation drug-eluting stent (DES) for AMI and CS. The primary endpoint was the 1-year rate of target lesion failure (TLF), defined as the composite of cardiac death, target vessel myocardial infarction, and ischemic-driven target lesion revascularization.

Results

Among the patients, 294 (20.7%) and 1,124 (79.3%) underwent IVUS-guided and angiography-guided PCI with second generation DES implantation, respectively. No significant difference was observed in the 1-year TLF between both groups after IPTW analysis (hazard ratio 0.93, 95% confidence interval 0.65–1.34, p=0.70) (Figure A). Additionally, the adjusted landmark analysis for TLF at 30 days and between 30 days and 1 year after PCI demonstrated no significant difference between the groups (Figure B).

Conclusions

In patients with AMI and CS who underwent PCI with second-generation DES, IVUS-guided PCI did not improve clinical outcomes with respect to 1-year TLF compared with angiography-guided PCI.Figure
Prognostic impact of intravascular imaging in percutaneous coronary intervention according to procedural complexity
Authors: Song P S
Published: October 2024

Background/Introduction

Few randomized controlled trials have shown reduction of adverse cardiac events with intravascular imaging (IVI)-guided percutaneous coronary intervention (PCI) compared with conventional angiography. However, data for IVI in complex PCI remains scarce.

Purpose

Current study investigated whether optimization of stent implantation in the IVI-guided PCI could improve the efficacy of PCI across various degrees of PCI procedural complexity.

Methods

This study was post-hoc analysis of the RENOVATE-COMPLEX-PCI (Randomized Controlled Trial of Intravascular Imaging Guidance Versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention) trial. Study population was stratified according to PCI procedural complexity assessed by the ESC criteria into low-, moderate-, or high-procedural complexity group. The high-procedural complexity group consisted of patients meeting at least one of the clinical risk criteria [diabetes mellitus, chronic kidney disease, defined as glomerular filtration rate between 15 and 60 mL/min, prior myocardial infarction (MI), peripheral artery disease, age < 45 years, multivessel coronary artery disease] and at least one of the procedural risk criteria (≥3 stents implanted, ≥3 lesions treated, total stent length >60 mm, left main PCI, chronic total occlusion, bifurcation lesion treated with 2 stents). The primary endpoint was target vessel failure (TVF), a composite of cardiac death, target vessel-related MI, or clinically driven target vessel revascularization.

Results

At a median follow-up of 2.1 years (interquartile range 1.4 to 3.0 years), the risk of TVF significantly increased in a stepwise fashion from the low- (reference group) to the moderate- (adjusted hazard ratio [HR]: 3.530; 95% confidence interval [CI]: 1.226-10.163, p=0.019) and high-procedural complexity group (adjusted HR: 3.951; 95% CI: 1.576-9.908; p=0.003). The effect of IVI-guided PCI was heterogeneous per PCI procedural complexity, with a significant benefit in patients who underwent high-procedural complexity PCI (adjusted HR: 0.598; 95% CI: 0.370-0.966) compared with those who had low-procedural complexity PCI (adjusted HR: 1.969; 95% CI: 0.217-17.881). Importantly, the magnitude of the benefit with IVI-guided PCI was progressively greater per increase in procedural complexity (p for interaction=0.026).

Conclusions

In patients who underwent complex PCI, compared with a conventional angiography, IVI-guided PCI significantly reduced the risk of adverse cardiac events with a magnitude that was greater for higher procedural complexity.
Intravascular imaging-guided PCI in patients with acute myocardial infarction and cardiogenic shock
Authors: Joh H S , Lee S H , Lee J M
Published: October 2024

Background

There are no clinical data regarding efficacy of intravascular imaging-guided percutaneous coronary intervention (PCI) compared with angiography-guided PCI in patients with acute myocardial infarction (AMI) and cardiogenic shock.

Purpose

The current study sought to evaluate the impact of intravascular imaging-guided PCI in patients with AMI and cardiogenic shock.

Methods

Among a total of 28,732 patients from the nationwide pooled registry of KAMIR-NIH and KAMIR-Ⅴ, a total of 1,833 patients (6.4%) with AMI and cardiogenic shock who underwent PCI of the culprit vessel were selected. The primary endpoint was major adverse cardiovascular events (MACE) at 1 year, a composite of cardiac death, MI, repeat revascularization, and definite or probable stent thrombosis.

Results

Among the study population, 375 patients (20.5%) underwent intravascular imaging-guided PCI and 1,458 patients (79.5%) underwent angiography-guided PCI. Intravascular imaging-guided PCI showed significantly lower risk of 1-year MACE compared with angiography-guided PCI (19.5% vs 28.2%; adjusted hazard ratio [HR], 0.59; 95% confidence interval [CI], 0.45-0.77; P<0.001), mainly driven by lower risk of cardiac death (13.7% vs. 24.0%; adjusted HR, 0.53; 95% CI, 0.39-0.72; P<0.001). These results were consistent in propensity score matching (HR, 0.68; 95% CI, 0.46-0.99), inverse probability weighting (HR, 0.61; 95% CI, 0.45-0.83), and Bayesian analysis (odds ratio, 0.66, 95% credible interval, 0.49-0.88).

Conclusion

In AMI patients with cardiogenic shock, intravascular imaging-guided PCI was associated with lower risk of MACE at 1-year than angiography-guided PCI, mainly driven by the lower risk of cardiac death. Further randomized controlled trial is warranted to confirm these findings.Central illustration
The evolution of endothelial dysfunction according to the length of the implanted stent on the background of nebivolol therapy
Authors: Simionov L , Dolghi V , Dumanschi C , Ivanov V , Ceasovschih A
Published: October 2024

Introduction

The development of atherosclerosis is the driving cause for arterial interventions using coronary stents. Long-stent implantation can increase the vascular injury thereby contributing to the progression of endothelial dysfunction (ED) by the degradation and reduction bioavailability of the nitric oxide (NO) - thus increasing the risk of major cardiovascular events.

Purpose

Evaluation the evolution of endothelial dysfunction biomarker depending on the length of the stent implanted on the background of nebivolol therapy.

Methods

The study included 100 patients with stable angina pectoris II–III functional class (age 59.72±0.59 years) undergoing PCI with stent implantation who started the treatment with nebivolol 5mg per day tangent to the conventional treatment and were exposed to PCI with stent implantation, depending on the stent’s length they were divided in three groups: I group - 14 patients with implanted stent’s length ≤15 mm, II group - 57 subjects with implanted stent’s length =15-30 mm and the III group -29 cases where the implanted stent’s length was ≥30 mm. In all the groups was appreciated in blood the endothelial dysfunction’s marker - NO. This marker was assessed preprocedural, postprocedural (after 24 hours) and at intervals of one month, 3,6,12 months after coronary angioplasty, the NO level being compared between these groups and the reference pattern consisting of 20 healthy people.

Results

The circulating level of nitric oxide determined in I group -61,28±6,92 μM/L and in the II group -56.6±3.03 μM/L and the III group52.39±3.35 was compromised at the preprocedural stage versus the reference pattern - 78.67±2.72 μM/L. During the post- PCI period (first 24 hours), the biomarker level’s was reduced in I group -52.35±1.66 μM/ L, II group -53.74±2.77 μM/L and III group - 52.98±2.91 μM/L. After one month after the intervention on the backroung of the treatment with nebivolol, was recorded a gaing of the NO value in I group - 64.97±5.35 μM/L, II group -63.15±3.99 μM /L and the III group-59.38±4.46 μM/L. The NO serum concentration during the period 3 and 6 months continued to increase in all groups vs the reference pattern. At the 12-month period, the NO level remained high in all the studied groups versus the baseline: I group 99.2±1.1 μM / L (p>0.05), II group-97.96±2.2 μM/L (p<0.001) and the III group -97.65±1.9 μM/L (p<0.001).

Conclusion

The stent’s length = 15-30 mm and ≥30 mm reveals the presence of an expanded atherosclerotic process, the substrate of which is constituted by the endothelial dysfunction, this being confirmed by the low preprocedural level of NO. The stent implantation procedure induced the accentuation of endothelial dysfunction, and the 12-month nebivolol treatment favored the increase of NO serum concentraon in all groups by 24.9% vs the reference pattern and by 73.3% vs baseline.
Risk stratification using the academic research consortium high bleeding risk criteria in patients with atrial fibrillation undergoing percutaneous coronary intervention
Authors: Tanabe Y , Kitahara H , Yamazaki T , Hiraga T , Abe K , Kobayashi Y
Published: October 2024

Background

Previous studies have reported that the academic research consortium high bleeding risk (ARC-HBR) criteria are useful to predict the risk of bleeding events in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI). However, there are few studies investigating the predictive value of the ARC-HBR criteria in patients with atrial fibrillation (AF) undergoing PCI.

Purpose

The purpose of this study was to investigate whether the ARC-HBR criteria can be applied to long-term risk stratification in patients with AF undergoing PCI.

Methods

Patients with AF undergoing PCI at 15 institutions between January 2015 and March 2021 were enrolled. The ARC-HBR score was calculated by assigning 1 point for each major criterion and 0.5 points for each minor criterion. Clinical outcomes within 1 year, including major adverse cardiovascular events (MACE: all-cause death, myocardial infarction, stent thrombosis, and stroke) and major bleeding events (BARC 3 or 5), were evaluated.

Results

A total of 723 patients were included in this analysis. The best cut-off values of J-HBR score determined by ROC curve analysis to predict MACE and major bleeding events were both 3.0. Of 723 patients, 161 (22.3%) had ARC-HBR score ≥3.0. In Kaplan-Meier curve analyses, the incidence of MACE as well as major bleeding events was significantly higher (log-rank p<0.001 and p=0.010) in patients with ARC-HBR score ≥3.0 compared to those with ARC-HBR score <3 (Figure 1).

Conclusion

The ARC-HBR score may be useful in assessing the risk of MACE, including thrombotic events, as well as bleeding events in AF patients undergoing PCI.Figure 1
The impact of prosthesis-patient mismatch on clinical outcomes in patients undergoing transcatheter aortic valve implantation
Authors: Omori A , Taniguchi T , Sano M , Ooka J , Azumi Y , Murai R , Okada T , Toyota T , Sasaki Y , Kim K , Kobori A , Ehara N , Kinoshita M , Furukawa Y
Published: October 2024

Background

There is considerable debate on the impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve implantation (TAVI) on clinical outcomes.

Objectives

This study aimed to assess the impact of PPM after TAVI on clinical outcomes.

Methods

The current study population included 467 patients undergoing TAVI at our Hospital between 2014 and 2023. PPM was defined as moderate if ≥0.65 but <0.85 cm2/m2 (≥0.55 but <0.70 cm2/m2 if obese: body mass index>30 kg/m2) or severe if <0.65 cm2/m2 (<0.55 cm2/m2 if obese) at the indexed effective orifice area measured by transthoracic echocardiography at discharge. The primary outcome was a composite of all-cause death or heart failure hospitalization. Median follow-up duration was 2 years (Interquartile: 0.9 - 4.0 years).

Results

The median age of the current study population was 83.9 years. Moderate and severe PPM were seen in 78 (17%) and 11 (2%) patients, respectively. The factors associated with PPM included small valve size (SAPIEN 20 mm or CoreValve/Evolut 23 mm), balloon-expandable valves, and atrial fibrillation, but not post dilatation. There was no significant difference of the incidence of PPM between SAPIEN XT and SAPIEN 3 (21% and 21%, P= 0.98). PPM was not seen in SAPIEN 3 Ultra RESILIA (n= 0/10). The cumulative 3-year incidences of the primary outcome after TAVI were not significantly different between patients with and without PPM (22% and 27%, P= 0.42) (Figure 1 and 2). There was no significant difference of the primary outcome between patients with and without elevated (>20 mmHg) post-TAVI gradient (18% and 27%, P= 0.17). After adjusting confounders, the excess risk of PPM at discharge for the primary outcome was not significant (adjusted hazard ratio: 0.86, 95% confidence interval: 0.56-1.31, P= 0.48).

Conclusions

PPM was not associated with worse clinical outcomes in contemporary patients undergoing TAVI.Kaplan-Meier analysis and log-rank testcumulative incidence
Unlocking the future: machine learning models for predicting in-hospital mortality after transcatheter aortic valve replacement: a single-arm meta-analysis
Authors: Ahmed H , Mahmoud Ismayl M I , Manvir Mangat M M , Anirudh Palicherla A P , Rama Ellauzi R E , Ruth Ann Kalathil R K , Suma Pusapati S P , Jalal Dufani J D , Ahmed Aboeata A A , Nandan Anavekar N A , Andrew Goldsweig A G
Published: October 2024

Background

Transcatheter aortic valve replacement (TAVR) continues to be increasingly performed. While machine learning has demonstrated utility in predicting adverse outcomes in various cardiovascular procedures, its effectiveness in predicting in-hospital mortality in TAVR remains uncertain.

Purpose

We aimed to examine the accuracy of machine learning in predicting in-hospital mortality in TAVR.

Methods

We searched PubMed and Cochrane databases up to February 2024 for observational studies assessing the diagnostic accuracy of machine learning for predicting in-hospital mortality in TAVR. Extracted data included study characteristics, patient demographics, type of predictive model used, and area under the receiver operating characteristic curves (AUC). Predictive accuracy was assessed by pooling AUC of machine-learning models across studies. AUC values ranging from 0.80 to 0.90, 0.70 to 0.80, 0.60 to 0.70, and 0.50 to 0.60 corresponded to excellent, good, fair, and poor discrimination ability, respectively (1). We used a random effects model to estimate the overall effect size with a 95% confidence interval (CI). Heterogeneity was evaluated with the I2 test.We conducted subgroup analyses based on the type of machine-learning model utilized to assess for any potential differences in predictive accuracy.

Results

A total of three studies were identified, comprising a study population of 70,714 patients. Across studies, eight machine learning models were utilized, consisting of three artificial neural network models, one logistic regression model, one naive Bayes model, two random forest models, and one support vector machine model. Pooled AUC showed excellent accuracy of machine learning in predicting in-hospital mortality in TAVR (0.92; 95% CI 0.90 - 0.95). Subgroup analyses revealed similar yet excellent accuracy across all types of machine learning models utilized: artificial neural network (0.92; 95% CI 0.86-0.99), logistic regression (0.92; 95% CI 0.89-0.95), naive Bayes (0.90; 95% CI 0.88-0.92), random forest (0.94; 95% CI 0.87-1.00), and support vector machine (0.94; 95% CI 0.91-0.96).

Conclusion

Our study suggests that utilizing machine learning can accurately predict in-hospital mortality in TAVR. Operators of TAVR procedures may benefit from incorporating machine learning prediction models in their clinical practice. Further exploration of machine learning on outcomes in TAVR is needed to verify our findings.
Identification of new instances of white matter hyperintensities in patients following TAVI (from the CAPITA study)
Authors: Hemelrijk K , Van Nieuwkerk A C , Leeuwis A E , Majoie C B L M , Daemen M J A P , Bron E , Moonen J E F , De Sitter A , Bouma B J , Harms A , Van Der Flier W M , Baan J , Piek J , Biessels G J , Delewi R
Published: October 2024

A third of patients diagnosed with symptomatic severe aortic valve stenosis and scheduled for transcatheter aortic valve implantation (TAVI) exhibit some level of cognitive impairment. The prospective CAPITA study aimed to systematically evaluate the impact of TAVI on cerebral and cognitive outcomes in patients undergoing the procedure. In this report, we focus on the identification of new incidence of white matter hyperintensities (WMH) and the correlation with changes in cognitive functioning.

The CAPITA (CArdiac OutPut, Cerebral Blood Flow and Cognition In Patients With Severe Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation) study is a prospective study of cerebral and cognitive outcomes following TAVI. Patients underwent magnetic resonance imaging (MRI) and extensive neuropsychological testing at baseline and three month follow-up. New cerebral infarcts were defined according to NeuroARC criteria. We examined the incidence of new WMH in terms of volume (Δ mL) and number on FLAIR MRI, and explored the correlation between new WMH and cognitive functioning.

A total of 148 patients were included who underwent TAVI between August 2020 and October 2022. Mean age was 80.5±5.7 years, of whom 43% female with a median STS-PROM of 2.0% (IQR 1.4%-2.9%). Median baseline WMH comprised 127 (IQR 32-216) lesions, with a total volume of 13.1 (IQR 7.0-24.6) mL. At 3 months follow-up, the number of lesions increased to 164 (IQR 121-301) lesions, with a total volume of 13.3 (IQR 5.8-21.5) mL. Median WMH volume increase was 0.1 (IQR 0.0-0.3) ml (p=0.02). A total of 9 patients (9.5%) had an increase of 1 mL of WMH or more. At follow-up, 12% of patients exhibited cognitive decline of >0.5SD. These patient tended to have a greater increase in white matter hyperintensity volume (1.26±2.96 ml), compared to the 53% of patients with stable cognition (0.29±0.45 ml) and the 36% of patients with improved cognition (0.31±0.91 ml), (p=0.06). WMH lesions did not exhibit distribution patterns across various locations within the groups characterized by declined, stable, or improved cognition (Figure 1). WMH volumes were higher in patients who experienced postprocedural delirium than in patients without delirium (27.1±14.0 vs 15.0±12.5 mL, p<0.001).

In this study, patients with severe symptomatic aortic valve stenosis undergoing TAVI, there was an overall increase of white matter hyperintensity volume between baseline and 3-month follow-up. Up to 12% of patients had cognitive decline, which was associated with new white matter hyperintensities on MRI.
Generalizability of SELECT to a contemporary cohort of cardiac surgical patients: analysis of the TRICS III Randomized Trial
Authors: Dhingra N , Verma R , Mazer C D , Verma S
Published: October 2024

Background

The SELECT trial reported a significant reduction in cardiovascular (CV) outcomes with semaglutide amongst patients without diabetes who had pre-existing CV disease and a body-mass index (BMI) of 27 or greater. Patients undergoing cardiac surgery represent a high-risk subset of those with established CV disease, and may benefit from treatment with semaglutide.

Purpose

This study evaluated the generalizability of SELECT to a contemporary international cohort of cardiac surgical patients, and assessed whether differences between SELECT-eligible and non-eligible patients translated to altered risks of CV outcomes.

Methods

Present data was gathered from the TRICS III trial, a multicentre, randomized trial of restrictive versus liberal red-cell transfusion thresholds amongst 5243 cardiac surgical patients with a EuroSCORE I of ≥6. The proportion of cardiac surgical patients eligible for SELECT was determined by applying its selection criteria to the TRICS III cohort. Finally, baseline characteristics and outcomes stratified by SELECT eligibility were compared.

Results

A total of 4887 patients from the TRICS III cohort had available data for analysis, of which 452 (9.2%) were deemed to have been eligible for the SELECT trial. A comparison of baseline characteristics between SELECT-eligible and non-eligible patients are presented in Table 1; while SELECT-eligible patients were more likely to have preserved left ventricular function (71.7% vs. 61.0%), EuroSCORE I values were comparable between the two groups (7.8±2.1 vs. 7.9±1.9). The rate of a 3-point MACCE of Death, MI or stroke in the present cohort of SELECT-eligible patients undergoing cardiac surgery (16.6%) was numerically higher than those enrolled in SELECT receiving semaglutide (8.1%) or placebo (10.0%), despite the shorter follow-up (6 months vs. 39.8 months). Six month outcomes following cardiac surgery were similar regardless of SELECT eligibility (Figure 1); no difference in risk of outcomes was documented for the 3-point MACCE [SELECT Eligible vs. Non-eligible – 16.6% vs. 14.5%; OR 1.17 (0.9-1.53); P=0.24] and the TRICS III primary composite of Death, MI, Stroke, or New-Onset Renal Failure with Dialysis [17.0% vs. 17.0%; OR 1.0 (0.77-1.29); P=0.98]. There was a trend towards higher rates of MI at 6 months amongst SELECT-eligible patients, but this difference failed to reach statistical significance [8.5% vs. 6.3%; OR 2.0 (0.96-1.39); P=0.08).

Conclusions

In this large international cohort of contemporary cardiac surgical patients, nearly 10% would have met eligibility for SELECT. SELECT-eligible patients undergoing cardiac surgery in TRICS III had a numerically higher rate of MACCE than those enrolled in SELECT, highlighting the high risk nature of this patient subgroup. However, amongst SELECT-eligible and non-eligible patients undergoing cardiac surgery, no significant difference in CV outcomes was uncovered.
Association of R2-CHA2DS2-VASc score and clinical outcomes after bioprosthetic valve replacement: Subanalysis from BPV-AF registry
Authors: Sano M , Toyota T , Taniguchi T , Kim K , Kobori A , Ehara N , Kinoshita M , Takegami M , Nishimura K , Miyake M , Koyama T , Fujita T , Kitai T , Izumi C , Furukawa Y
Published: October 2024

Background

Although bioprosthetic valve (BPV) replacements are becoming more common, there are limited studies about prognostic prediction method for patients after BPV replacement. R2-CHA2DS2-VASc score is modified CHA2DS2-VASc score by adding reduced estimated glomerular filtration rate (eGFR < 60 mL/min/1.73m2). It is increasingly used for the prediction of cardiovascular (CV) events in patients with atrial fibrillation (AF), device implantation, and acute coronary syndrome.

Purpose

We aimed to evaluate the predictive value of R2-CHA2DS2-VASc score for future CV events in patients after BPV replacement.

Methods

BPV-AF, an observational, multicenter, prospective registry, enrolled AF patients that underwent BPV replacement. Patients were stratified into three risk groups according to their R2-CHA2DS2-VASc score as follows; low (scores, 0–1), moderate (scores, 2–4), and high (scores, 5–11). The primary outcome measure was a composite of stroke, systemic embolism, CV events including heart failure hospitalization, and cardiac death.

Results

A total of 766 patients were included in the analysis. The mean age was 80.3 years and 419 patients (54.7%) were female. Mean R2-CHA2DS2-VASc score was 4.1±1.5. Low, moderate, and high R2-CHA2DS2-VASc score groups consisted of 12 (1.6%), 178 (23.2%), and 576 (75.2%) patients, respectively. Median follow up period was 491 (interquartile range: 393-561) days. Kaplan-Meier analysis showed higher incidence of the composite CV events in high R2-CHA2DS2-VASc score group (Log rank test; p<0.01). Multivariate Cox proportional hazards regression analysis revealed that the R2CHA2DS2-VASc score as a continuous variable was an independent predictor of CV events (hazard ratio 1.33, 95% confidence interval 1.18 to 1.51, p<0.01).

Conclusion

The R2-CHA2DS2-VASc score is useful for CV risk stratification in AF patients after BPV replacement.Cumulative Incidence for Composite CV Ev
Interventional treatment of patients with hypertrophic obstructive cardiomyopathy: the immediate and long-term results
Authors: Sieraia A , Nevmerzhytska L , Lazoryshynets V , Rudenko K , Romanyak V , Fanta S
Published: October 2024

Background

Alcohol septal ablation (ASA) is a widely accepted and effective procedure for reducing septal thickness in patients with symptomatic hypertrophic obstructive cardiomyopathy (HOCM) who do not respond to medical treatment and have significant outflow tract gradients. Despite numerous studies confirming its safety and efficacy, as well as current guidelines from 2020 recommending ASA as a class 1 treatment option alongside surgical myectomy[1], the decision between these methods is still a subject of debate.

Methods

From 2009 to 2022 154 ASA performed in 145 patients (91 males, 54 females) with HOCM at our centre. Mean age of pts. was 42 [6;77] years. All pts. had right ventricle pacing lead with pacemaker backup and myocardial contrast ECHO(MCE) before procedure. Mean peak pressure gradient (PG) on LVOT was 93,5 ± 8,2 mm. Hg. Mitral valve regurgitation (MR) from moderate to severe was in all pts. Mean interventricular septum thickness was 2,5сm [1,6; 3,8].

Results

Mean PG on LVOT decreased from 93,5 ± 8,2 mmHg to 31,7±4,3 mmHg. The grade of MR reduced from at least moderate to mild or even trivial. The procedure – related mortality was 1,3%. In 3 cases (2%) the procedure was aborted by he MCE data. Mean follow up for 145pts (100%)was 91±4,6 months. 112(77,3%) pts had PG reduction (to ≤30 mtmHg) – regarded as good result of procedure. 19 (13,1%) pts had PG > 30mmHg, but significant improvement in symptoms. Long term mortality in ASA pts. was 2.7%. 10(6.9%) pts needed redo procedure due to residual LVOTO, which was effective. 13(8,9%) patients had complete AV block and required permanent pacemaker. Mean interventricular wall thickness decreased from 2,5±0,3сm to 1,8±0,2cm. MR decreased from at least moderate to mild or complete disappearance. NYHA class reduced from 2,9 to 1,2.

Conclusions

ASA is effective and safe method of HOCM treatment. Accumulation of the experience can lead to a reduction in procedure time, a decrease in the number of complications, and an overall improvement in the outcomes of interventional HOCM treatment.
The importance of taste salt sensitivity in the development of kidney damage in patients with high-risked arterial hypertension
Authors: Khamidullaeva G , Ataniyazov K H , Jabbarova N , Fayzullaeva S H , Fozilov K H
Published: October 2024

Purpose of the study

to evaluate the diagnostic significance of determining taste salt sensitivity in kidney damage development in patients with high-risked arterial hypertension.

Material and methods

The study included 1021 patients with arterial hypertension (AH), 60% women, 40% men, aged 58.05±7.95 years. All patients underwent the R.Henkin test to determine the threshold of taste sensitivity to table salt in the family polyclinics of Aral Sea region. All patients underwent a complete blood count, a complete urinalysis, biochemical tests, determination of serum creatinine with calculation of glomerular filtration rate, microalbuminuria, urine albumin-to-creatinine ratio and uric acid level.

Results

Low and medium thresholds of taste salt sensitivity were determined in 149 patients (14.6%, group 1), the average NaCl concentration was 0.15±0.02%. A high threshold of taste salt sensitivity was detected in 872 patients (85.4%, group 2), the average NaCl concentration was 0.64±0.57% (p=0.0001). Patients of the 1st and 2nd groups differed in the level of systolic and diastolic blood pressure (SBP and DBP): 150.8±10.0 mmHg. versus 172.0±16.7 mmHg. p=0.0001 for SBP, 91.4±3.8 mmHg versus 100.7±10.13 mmHg, p=0.0001 for DBP in the 1st and 2nd groups respectively. At the same time, there was a noticeable direct correlation between hemodynamic parameters – SBP / DBP and NaCl concentration in the test for determining the taste sensitivity to table salt threshold (r = 0.646; r = 0.610, respectively). As a result, were detected significantly differences in GFR: 97.22±11.42 versus 70.33±16.56 (p=0.0001); MAU: 58.64±35.45 vs. 215.9±126.65 (p=0.0001); albumin to creatinine ratio: 47.88±42.73 vs. 268.46±261.05 (p=0.0001); uric acid: 227.67±43.75 vs. 337.17±86.52 (p=0.0001), for 1st and 2nd groups respectively.

Conclusion

A high threshold of taste salt sensitivity, determined by the R.Henken method, is associated with the level of SBP, DBP, markers of kidney damage and the level of uric acid, which increases the diagnostic significance of determining taste salt sensitivity in patients with hypertension.
Neutrophil-to-lymphocyte ratio can predict the clinical prognosis of patients with primary adosteronism
Authors: Guo X , Liu C , Hu S , Chen K
Published: October 2024

Background

Excess aldosterone-mediated inflammatory response is thought to be a factor in the high risk of cardiovascular events in patients with primary aldosteronism (PA). Leucocyte related inflammatory parameters, especially NLR, were significantly independent of aldosterone (PAC) in PA patients. However, the impact of NLR on the long-term prognosis of PA patients is unclear.

Objective

To explore the predictive value of neutrophil-to-lymphocyte ratio (NLR) on the long-term prognosis of patients with primary aldosteronism (PA).

Methods

The data for this study were derived from the Tianjin Health and Medical Big Data Super platform, comprising a retrospective cohort of patients discharged from 72 hospitals in our city from 2010 to 2023. According to the inclusion and exclusion criteria, 570 patients were ultimately included in the statistical analysis. Each patient had laboratory measurements, including blood cell counts, taken after admission and before interventional treatment. The primary endpoint was major cardiovascular events (MACEs), defined as cardiovascular death, nonfatal myocardial infarction (MI), and nonfatal stroke.

Results

During a mean follow-up period of 5 years, 125（21.9%）MACEs were recorded. ROC curve analysis displayed that the best cut-off value of NLR for predicting MACEs was 4.87. The MACEs of the high NLR group at 1 year, 3 years, and 5 years were higher than those of the low NLR group（25.0% vs 9.4%，40.3% vs17.1% 和 40.3% vs 19.3%；P＜0.05).Kaplan-Meier survival curve analysis showed that the survival rate of the low NLR group was higher than that of the high NLR group (P<0.001). The results of multivariate Cox proportional hazards regression analysis showed that NLR was an independent risk factor affecting the prognosis of PA patients, and the difference was statistically significant (P<0.05).

Conclusions

Elevated NLR is associated with adverse prognosis in patients with PA. NLR can serve as a simple and practical indicator to evaluate the long-term prognosis of PA patients. These findings warrant external validation, preferably in a prospective design.