bluuebunny/crossref_metadata_2025 huggingface dataset:
Toxicity of GO and rGO suspension against P. acnes: physical puncture and oxidative stress
Authors: Dai Dongfang , Qu Hao , Lv Jianxin , Hu Xueqian , Lv Jian , Ye Qianxu , Lin Zesi , Cai Jinming , Wang Guanlin
Published: February 2021

Acne vulgaris associated with Propionibacterium acnes (P. acnes) remains one of the most common skin diseases, while lacking of effective and non-resistant treatments. Graphene inclusing graphene oxide (GO) and reduced graphene oxide (rGO) have been triggering abundant attentions due to their astonishing performances in multi research areas. Here, the GO and rGO suspensions with different concentrations and sizes against P. acnes were investigated. The higher the concentration while the smaller the size distribution led to the better the antibacterial performance. And the loss of viability of P. acnes can surprisely achieve 72% under a 100 μg 10 000 mesh rGO existed which was induced by physical puncture and oxidative stress. Furthermore, the physiological activities of P. acnes will reduce the GO to rGO which further accelerate its death. This study will provide a rapid, effective and non-resistant method for the treatment of acne.
Materials discovery through machine learning formation energy
Authors: Peterson Gordon G C , Brgoch Jakoah
Published: February 2021

The budding field of materials informatics has coincided with a shift towards artificial intelligence to discover new solid-state compounds. The steady expansion of repositories for crystallographic and computational data has set the stage for developing data-driven models capable of predicting a bevy of physical properties. Machine learning methods, in particular, have already shown the ability to identify materials with near ideal properties for energy-related applications by screening crystal structure databases. However, examples of the data-guided discovery of entirely new, never-before-reported compounds remain limited. The critical step for determining if an unknown compound is synthetically accessible is obtaining the formation energy and constructing the associated convex hull. Fortunately, this information has become widely available through density functional theory (DFT) data repositories to the point that they can be used to develop machine learning models. In this Review, we discuss the specific design choices for developing a machine learning model capable of predicting formation energy, including the thermodynamic quantities governing material stability. We investigate several models presented in the literature that cover various possible architectures and feature sets and find that they have succeeded in uncovering new DFT-stable compounds and directing materials synthesis. To expand access to machine learning models for synthetic solid-state chemists, we additionally present MatLearn. This web-based application is intended to guide the exploration of a composition diagram towards regions likely to contain thermodynamically accessible inorganic compounds. Finally, we discuss the future of machine-learned formation energy and highlight the opportunities for improved predictive power toward the synthetic realization of new energy-related materials.
‘No one blames men in our society’: Indian police officers’ perceptions of female complainants
Authors: Tripathi Saumya , Azhar Sameena
Published: February 2021

The purpose of this study was to identify Indian police officers’ perceptions of female complainants and how these perceptions influenced their handling of cases involving women and girls. Using a phenomenological approach, we conducted a qualitative study involving interviews with 12 police officers who were recruited through purposive and snowball sampling. Patriarchal perceptions regarding gender roles influenced police attitudes regarding female complainants, including scepticism regarding the truthfulness of female complainants. As a result, they often did not file their cases in attempt to prevent women from experiencing shame and social stigma. The study expands our understanding of how the gendered nature of policing has direct implications for the outcomes of complaints made by women in India.
Rheumatologic disorders in patients undergoing esophageal manometry: prevalence, symptom characteristics, and manometric findings
Authors: Qureshi Anam , Jehangir Asad , Malik Zubair , Parkman Henry P
Published: February 2021

Rheumatologic disorders (RDs) can have gastrointestinal (GI) manifestations. Systemic sclerosis (SSc) patients often have upper GI symptoms from absent esophageal contractility (AC). Upper GI symptom characteristics and high-resolution esophageal manometry with impedance (HREMI) findings of other RDs have not been well studied. We aimed to: (i) determine the prevalence of RD in patients undergoing HREMI and (ii) assess the symptom characteristics and manometric findings of these patients. Patients undergoing HREMI (July 2018 to March 2020) rated their GI symptoms’ severity. Healthy volunteers (HVs) also underwent HREMI. Of the 1,003 patients, 90 (9%) had RD (mean age: 55.3 ± 1.4 years, 73.3% females), most commonly SSc (n = 27), rheumatoid arthritis (RA, n = 20), and systemic lupus erythematosus (SLE, n = 11). The most severe upper GI symptoms in patients with RD were heartburn, regurgitation, nausea, and dysphagia, with no significant differences in their severities between SSc, RA, and SLE. RD patients had higher upper esophageal sphincter (UES) pressures, lower distal contractile integral (DCI), lower bolus clearance, and more frequent hiatal hernia (HH) on HREMI (all P < 0.05) than HVs. Over half (61.1%) of patients with RD had esophageal motility disorders, most commonly AC (n = 25), ineffective esophageal motility (IEM; n = 18), and esophagogastric junction (EGJ) obstructive disorders (n = 11). Among patients undergoing HREMI, 9% had RD. Upper GI symptom severities did not distinguish different RDs. Patients with RD had higher UES pressures, weaker DCI, lower bolus clearance, and more frequent HH than HVs. Although AC and IEM were most common motility disorders, a considerable minority (12.2%) of our RD patients had EGJ obstructive disorders.
Exocrine pancreatic insufficiency after esophagectomy: a systematic review of literature
Authors: Blonk L , Wierdsma N J , Jansma E P , Kazemier G , van der Peet D L , Straatman J
Published: February 2021

Complaints of maldigestion, malabsorption, and unintended weight loss after esophagectomy are often attributed to an impaired exocrine pancreatic function. This review systematically summarizes all literature reporting on the presence of exocrine pancreatic insufficiency (EPI) after esophagectomy and the effect of treatment with pancreatic enzymes on gastrointestinal complaints, body weight, and quality of life. Databases of PubMed, Embase, and Wiley/Cochrane Library were searched systematically until July 2020. Studies reporting on EPI and pancreatic enzyme replacement therapy after esophagectomy were included. The Newcastle–Ottawa scale was used to assess study quality. Four studies, including 158 patients, were selected. The maximum score for study quality was six (range 4–6). Exocrine pancreatic function was investigated in three studies, measured by fecal elastase-1 and 72-hour fecal fat excretion. Fecal elastase-1 levels <200 μg/g were reported in 16% of patients at 4 months, 18% at 6 months, and 31% at 18–24 months postoperatively. A decreased fecal fat absorption was noticed in 57% 1 month postoperatively. Treatment with pancreatic enzymes was reported in two studies. In patients with fecal elastase-1 levels <200 μg/g, 90% of patients reported improvement in symptoms and 70% reported improvement in weight. In patients with complaints of steatorrhea, 87% noticed settlement of symptoms. Based on current literature, complaints of maldigestion, malabsorption, and unintended weight loss after esophagectomy are common and can be related to an impaired exocrine pancreatic function. High-quality studies evaluating the presence of EPI and the effect of treatment with pancreatic enzymes after esophagectomy are needed to verify this conclusion.
Left ventricular end-diastolic pressure is associated with left atrial functional measures by echocardiography
Authors: Olsen FJ , Mogelvang R , De Knegt MC , Galatius S , Pedersen S , Modin D , Ravnkilde K , Gislason G , Biering-Sorensen T
Published: February 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation

Background

Assessment of maximal LA volume (LAVmax) is recommended in imaging guidelines but evidence suggests additional value of functional LA measures. How extended measures of LA function associate to left ventricular filling pressure has not been fully explored.

Purpose

To investigate the association between functional LA measures and left ventricular end-diastolic pressure (LVEDP)

Methods

Patients suspected of coronary artery disease referred for angiography had simultaneous left heart catheterization performed for invasive pressure measurements. LVEDP > 12mmHg was considered elevated. LA measurements by echocardiography included: LAVmax, minimal LA volume (LAVmin), total LA emptying fraction (total LAEF), passive LA emptying fraction (passive LAEF), and active LA emptying fraction (active LAEF).

Results

Of 43 patients, 28 (65%) had elevated LVEDP. These patients more frequently had coronary vessel disease (VD) and impaired LA mechanics by all accounts except by LAVmax.

All LA measures except LAVmax were associated with LVEDP in unadjusted linear regression analyses, however, only LA emptying fractions remained associated with LVEDP after adjusting for age and VD (2.6 (1.2-4.0) mmHg increase, p = 0.001, per 5% decrease in total LAEF; 1.4 (0.1-2.8) mmHg increase, p = 0.040, per 5% decrease in active LAEF; 1.8 (0.1-3.4) mmHg increase, p = 0.038, per 5% decrease in passive LAEF).

In logistic regression, passive LAEF was significantly associated with elevated LVEDP (figure), and this was also the case after adjusting for age and VD (OR = 1.11 (1.01-1.21), p = 0.023, per 1% decrease). Similar findings were made in subgroup analyses among patients without dilated LA and patients without conventional indicators of elevated filling pressure.

Conclusion

Left ventricular end-diastolic pressure is significantly associated with LA functional measures but not LA volumes. Additionally, passive LAEF is associated with elevated LVEDP. Future studies examining LA function should include all components of LAEF.

Abstract Figure.
Long-term evolution of echocardiography parameters in Brugada syndrome patients
Authors: Scheirlynck E , Motoc A , De Asmundis C , Sieira J , Koulalis J , Van Malderen S , Chierchia GB , Pappaert G , Haugaa KH , Lie ØH , Cannaerts E , Van Dooren S , Brugada P , Cosyns B , Droogmans S
Published: February 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): ESC Research Grant

Background

Brugada syndrome is a heritable disorder with a high risk of sudden death. Although being a primary electrical disorder, subtle structural changes have repeatedly been described. Little is known about the long-term structural evolution in Brugada syndrome.

Purpose

We aimed to assess the evolution of echocardiographic parameters in Brugada syndrome and the presence of markers of structural evolution.

Methods

Brugada syndrome patients with minimum two complete transthoracic echocardiographic examinations were included. Clinical data were collected retrospectively. We analyzed all available echocardiographic examinations and assessed the evolution of cardiac parameters over time and its association with patient characteristics. 

Results

The study included 113 Brugada syndrome patients [47 (33-55) years, 59 (52%) female, spontaneous type 1 ECG in 26 (23%)], with a total of 258 echocardiographies, collected over a period of 6.8 (6.6-7.1) years. Proximal and distal right ventricular outflow tract and basal right ventricular diameter dilated at a rate of 0.2 (0.1-0.3) mm/year (p = 0.004), 0.4 (0.3-0.5) mm/year (p < 0.001) and 0.6 (0.4-0.8) mm/year (p < 0.001) respectively (Figure). Left ventricular mechanical dispersion increased from 38 (±11) ms to 42 (±12) ms (p = 0.001). Neither male sex, nor presenting a spontaneous type 1 ECG pattern were associated with worse structural evolution.

Conclusion

We observed progressive right ventricular outflow tract and basal right ventricle dilation and an increasing contractile dyssynchrony in Brugada syndrome, potentially indicating a progressive structural affection. Further research is warranted to unravel underlying mechanisms and possible clinical implications of progressive structural changes in Brugada syndrome.

Abstract Figure.
Comparison of two methods to predict CRT-response
Authors: Hubert A , Galard A , Le Rolle V , Galli E , Hernandez A , Donal E
Published: February 2021

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Hospital university of Rennes INSERM - LTSI

Background

Non-invasive estimation of myocardial work by trans-thoracic echocardiography is a novel tool to analyze myocardial contraction efficiency during systole. Two methods are described, on using Left ventricular (LV) strain and a LV pressure estimation, and another with only LV strain integrals. The present study analyzes their utility in prediction of CRT-response.

Methods and results: 243 patients implanted by a CRT according to current recommendations were retrospectively included in hospital university of Rennes. All patients had a complete trans-thoracic echocardiography at implantation and at 6-moths follow-up. Responders were defined as having a 15% decrease in indexed LV end-systolic volume at follow-up compared to baseline. Baseline characteristics are described in table 1. 25.1% were non-responders. In this group, there were more men, more ischemic cardiomyopathies with more dilated LV. Strain signals ware analyzed only in the most informative loop, the apical 4 cavities. Myocardial work estimation with LV pressure estimation was previously described. The 3 different integral of strain signal were represented in figure 1. According to ROC curves, myocardial work (particularly wasted work in septal wall with AUC = 0.718 ± 0.04) estimated with LV pressure estimation is better than strain integrals to predict LV positive remodeling (best AUC 0.631 ± 0.040) after CRT-implantation.

Conclusion

Left ventricular pressure estimation give useful information on top of strain curves for prediction for CRT-response.

Table 1 Responders n = 182 Non-responders n = 61 Men (%) 109 (59.9%) 52 (85%) Ischemic cardiomyopathy (%) 42 (23.1%) 34 (55.7%) LVEF (%) 28 ± 6 28 ± 7 GLS (%) -9 ± 3 -7 ± 3 LVEDD (mm) 62 ± 8 67 ± 7 LVEDVi (ml/m2) 85 ± 34 88 ± 30 LVEF Left ventricular ejection fraction; GLS: global longitudinal strain; LVEDD: left ventricular end-diastolic diameter; LVEDVi: left ventricular end diastolic volume index Abstract Figure 1
Global wasted myocardial is unrelated to conventional markers of systolic and diastolic function in patients with acute heart failure
Authors: Sahiti F , Morbach C , Henneges C , Breunig M , Cejka V , Scholz N , Ertl G , Frantz S , Angermann C , Stoerk S
Published: February 2021

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The AHF Register is supported by an unrestricted grant of Behringer Ingelheim, and grants of the German Ministry of Research and Education within the Comprehensive Heart Failure Center, Würzburg (BMBF 01E01004 and 01E01504)

onbehalf

AHF Registry

Background & Aim Myocardial Work (MyW) analysis quantifies myocardial performance using non-invasively derived pressure-strain loops. It is considered less load-dependent than left ventricular ejection fraction (LVEF) and longitudinal strain, since it integrates blood pressure into the assessment. We assessed associations between MyW indices, natriuretic peptide (NT-proBNP), and conventional markers of systolic and diastolic cardiac function mirroring the hemodynamic changes occurring during hospitalization, in patients hospitalized for acute heart failure (AHF).

Methods Consecutive patients (≥18 years) hospitalized for AHF with serial high-quality pairs of echocardiograms (i.e., early after hospitalization and prior to discharge) were eligible. Exclusion criteria were high output AHF, cardiogenic shock, and being listed for high urgency transplantation. The following MyW measures [definition in brackets] were analyzed from the stored recordings: Global constructive work (GCW) [sum of positive work performed during systolic shortening plus negative work during lengthening in isovolumetric relaxation (IVR)], global wasted work (GWW) [sum of negative work performed during systolic lengthening plus work performed during shortening in IVR], global work efficiency (GWE) [constructive work/(constructive work + wasted work)]; global work index (GWI) [total work performed from mitral valve closure to mitral valve opening]. Associations were determined using scatter plots and Pearson Product-Moment correlation coefficients.

Results N = 126 patients (73 ± 12 years, 37% female) were eligible. GWI and GCW proved significantly correlated with surrogates measured both on admission and at discharge, NT-proBNP, LVEF, and e’ (Table). By contrast, GWW did not correlate with any of these variables. GWE was also correlated with NT-proBNP (and e’ at discharge), but at both time points respective correlations were more pronounced.

Conclusion In patients hospitalized for AHF, GWI, GCW and GWE were associated with conventional parameters of myocardial stress and LV dysfunction. In contrast, GWW was unrelated with any of these established markers. Future studies in larger cohorts and with longer-term follow-up need to clarify to what extent might GWW carry complementary clinical and prognostic significance.

Abstract Figure.
Non-invasive myocardial work normal reference ranges in healthy children
Authors: Sabatino J , Leo I , Borrelli N , Avesani M , La Bella S , Josen M , Paredes J , Sirico D , Piccinelli E , Delle Donne G , Brida M , Indolfi C , Fraisse A , Di Salvo G
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND

Myocardial work (MW) estimation by pressure-strain loops (PSL) allows a non-invasive evaluation of myocardial performance, as recently demonstrated in adult patients.

Aim of this study is to provide the reference values for global myocardial work index (MWI), constructive work (MCW), wasted work (MWW), and work efficiency (MWE) in a group of healthy children.

METHODS

Assessment of MW was performed using a commercially available software package (Echopac, GE). MW was measured from PSLs areas, derived from non-invasive LVP curves combined with strain acquired speckle tracking echocardiography (STE).

After calculating GLS, values of brachial blood pressure were inserted and the time of valvular events by echocardiography were indicated, then the software was able to measure non-invasive PSLs.

RESULTS

Two-dimensional (2D) standard and speckle-tracking echocardiography were performed in 90 healthy children (mean age 9.9 ±4.9 [1-17] years, females: 57%) together with the assessment of MW by means of PSLs.

Mean ± standard deviation, 5° and 95° percentile values for global MWI, MCW, MWW, and MWE in the whole population were 1769 ± 254 mm Hg, (1354-2193); 2201 ± 290 mm Hg, (1657-2658); 78 ± 47 (29-163) mm Hg%; 96 ± 1.8 (92-99)%, respectively.

CONCLUSIONS

The assessment of MW is feasible in healthy children. This study provides useful 2-dimensional echocardiographic reference ranges for novel indices of non-invasive MW.
Myocardial work, combined with arterial stiffness and biomarkers, are able to detect earlier and predict cardiotoxicity in non-Hodgkin lymphoma
Authors: Mihalcea D , Memis H , Cosmulescu G , Balinisteanu A , Vladareanu AM , Vinereanu D
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

CHOP (cyclophosphamide, doxorubicin, oncovin, prednisone) in non-Hodgkin lymphoma (NHL) is limited by risk of cardiotoxicity. Aim. To define new parameters of LV myocardial work, arterial stiffness, and biomarkers for early diagnosis and prediction of cardiotoxicity. Methods. 91 patients (34 men, 57 ± 11 years), with NHL, with LVEF >50%, scheduled for CHOP, were assessed at baseline, and after 4th and 8th cycle (doxorubicin total dose of 341 ± 52 mg). 3D echo was used for LVEF; 2D STE for longitudinal strain (LS) and myocardial work: global constructive work (GCW) as "the positive" work of the heart; global wasted work (GWW) as "the negative" work of the heart; global work efficiency (GWE) by formula GCW/(GCW + GWW), and global work index (GWI) as sum of GCW and GWW; echo-tracking for pulse wave velocity (PWV) and β index. Troponin I and NTproBNP were measured. Cardiotoxicity was defined as LVEF decrease <50%, with >10% from baseline. Results. After 8th cycle, 17 patients (18%) (group I) developed cardiotoxicity (3D LVEF: 63 ± 3 vs. 48 ± 1, p < 0.0001), whereas 74 patients (group II) did not (3D LVEF: 63 ± 2 vs. 57 ± 3, p < 0.0001). There was a significant reduction of LS, GCW and GWE, with an increase of GWW and arterial stiffness, starting with the 4th cycle; changes in group I were higher than in group II (p < 0.001) (table). Univariate analysis showed significant correlation between reduction of 3D LVEF and decrease of LS, GCW, GWE (r = 0.65; r = 0.74; r = 0.54), and increase of GWW, PWV, β index, and troponin level after 4th cycle (r=-0.44; r=-0.38; r=-0.39; r=-0.35; all p < 0.05). Reduction of GCW after the 4th cycle was the best independent predictor of decrease of 3D LVEF after the 8th cycle (R2 = 0.48, p = 0.001). By ROC analysis, decrease of GCW by more than 29% after the 4th cycle predicted development of cardiotoxicity after the 8th cycle of CHOP (Sb 82%, Sp 81%). Conclusion. Assessment of myocardial work, combined with arterial stiffness and biomarkers, are able to detect early chemotherapy-induced cardiotoxicity and to predict further decline of LVEF in non-Hodgkin lymphoma.

Myocardial work and cardiotoxicity CHOP Group I Group II LS(-%) Baseline 4th cycle 8th cycle 22 ± 2 17 ± 1† 13 ± 2† 22 ± 2 19 ± 2† 17 ± 2±† GCW (mmHg%) Baseline 4th cycle 8th cycle 2256 ± 123 1902 ± 133† 1633 ± 167† 2278 ± 168 2104 ± 111† 1937 ± 102† GWW (mmHg%) Baseline 4th cycle 8th cycle 84 ± 4 124 ± 18† 198 ± 24† 85 ± 11 94 ± 21† 113 ± 19† GWE (%) Baseline 4th cycle 8th cycle 98 ± 1 92 ± 2† 86 ± 2† 98 ± 1 95 ± 2 94 ± 1† GWI (mmHg%) Baseline 4th cycle 8th cycle 1982 ± 155 1888 ± 136† 1723 ± 172† 2003 ± 189 1945 ± 111 1873†±102† GCW = global constructive work; GWE = global work efficiency; GWI = global work index; GWW = global waste work; LS = longitudinal strain; † p < 0.001
Characteristics of idiopathic tricuspid regurgitation
Authors: Li LWY , Huang MS , Lee WH , Tsai WC
Published: February 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Science and Technology, Executive Yuan, Taiwan

Background

Tricuspid regurgitation (TR) were traditionally classified as primary and secondary TR. Recently a new category of TR was developed and named as idiopathic TR. However, diagnosis and characteristics of idiopathic TR were not consisted. We tried to identify idiopathic TR by a new systemic approach and studied its characteristics.

Methods

207 consecutive patients (mean age 71.2 ± 14.7 years, 40.6% male) identified as significant TR (moderate and severe) by echocardiography were recruited. We classified TR by a new systemic approach. The classification process started from identified primary TR, then pacemaker related TR, left heart disease related TR, congenital heart related TR, right ventricular (RV) myopathy, pulmonary hypertension and, finally idiopathic TR step by step.

Results

There were 29 (14%) primary TR, 18 (8.7%) pacemaker related, 81 (39.1 %) left heart diseases, 6 (2.9%) congenital heart diseases, 3 (1.4%) RV myopathy, 27 (13%) pulmonary hypertension, and 43 (20.8%) idiopathic TR. Mean age of idiopathic TR was 72.9 ± 11.4 years and 39.5% was male which were not different from other groups. Atrial fibrillation was presented highest in patients with pacemaker related TR (77.8%) and left heart disease (55.6%), lowest in primary TR (24.1%) and pulmonary HT (25.9%), and modest in idiopathic TR (44.2%). Among the echocardiographic characteristics of right heart measurements, idiopathic TR had lowest TR maximal velocity (3.0 ± 0.3 m/s), pulmonary (41.2 ± 8.7 mmHg) and right atrium pressure (5.3 ± 0.3 mmHg; all p <0.001). Idiopathic TR had smallest RV wall thickness (4.5 ± 1.4 mm; p = 0.008), tricuspid annulus diameter (3.2 ± 0.7 cm; p = 0.001), and right atrial area (18.9 ± 8.4 cm2; p <0.001). RV function represented as tricuspid annulus velocity S’ (12.8 ± 3.3 cm/s; p = 0.011) and RV fractional area change FAC (42.6 ± 16.0 %; p <0.001) were best in idiopathic TR. RV dysfunction (FAC < 35%) was lowest (14%) in idiopathic TR.

Conclusions

Idiopathic TR had better RV function then other types of TR. Idiopathic TR can be regarded as a unique disease category in studying TR.
Augmentation index predicts mortality in patients with aortic stenosis. An echo-tracking study
Authors: Vriz O , Palatini P , Mos L , Alsergani H , Grillini G , Alenazy A , Vendramin I , Antonini-Canterin F , Magne J
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Objective. Aortic valve stenosis (AS) shares similarities with the atherosclerotic process  which is known to be responsible od arterial stiffness, but little is known on the direct effect of the mechanical properties of large arteries on the outcome in patients with significant AS and even less is known on the effect of the local stiffness of the large elastic arteries.

The aims of the study were 1) to determine the relationship between indexes of local (carotid) arterial stiffness/compliance and the severity of AS and 2) to identify whether local arterial stiffness is independently associated with mortality.

Methods. 133 patients with severe isolated AS and preserved left ventricular (LV) ejction fraction (EF) were prospectively recruited. Patients underwent  data collection on cardiovascular risk factors and  coronary artery disease, standardized transthoracic echocardiographic examination and local carotid stiffness evaluation by means of high-definition echo-tracking ultrasound system with the calculation of arterial stiffness/comliance and augmentation index (AIx).  All cause death and the requirement of valvular interventions were recorded during the follow-up period until the occurrence of death or censoring. Deaths were confirmed by reviewing the electronic patient records.  

Results. None of the local AS parameters were significantly associated with AS severity. During a mean follow-up of 51.6 ± 39.4 months, 70 patients received aortic valve replacement and 45 died. Patients who died were older (79.2 ± 6.9 vs 73 ± 8.8 years, p < 0.0001), they had higher carotid stiffness (AIx) (21.3 ± 14 vs 16 ± 12%, p = 0.028). In multivariate Cox regression analysis AIx was independently associated with mortality also after the inclusion of age and renal function ((HR 1.048, 95% CI 1.01-1.07, p = 0.001). The Kaplan-Meier survival free event curve showed that  there was an associated with AIx and the curves were statistically different in the group with no surgery (p = 0.016).

Conclusion. In patients with severe AS and normal LVEF,  AIx  measured by means of echo-tracking system was higher in patients who deceased. AIx was independently associated with death and mortality was higher in the group of patients with higher AIx who did not underwent surgery. These data emphasize the importance of arterial stiffness that not only causes an increase in LV afterload but is also a harbinger of a long-term atherosclerotic burden.

Hemodynamic, echocardiographic data
Valvular heart disease in autoimmune diseases in Mexico
Authors: Aceituno Melgar J , Fritche-Salazar JF , Soto-Lopez ME
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

 The autoimmune diseases (AD) have high morbidity and mortality due to their affection to the heart.

Purpose

Our objective was to describe the valvular heart disease (VHD) in patients with AD.

Methods

Patients with systemic lupus erythematous (SLE), rheumatoid arthritis (RA), and systemic sclerosis (SS) diagnosis were included, from January 1st 2008 to December 31th 2018. Prevalence rates of valve involvement were calculated.

Results

A total of 163 patients (57.6% with SLE, 23.3% with RA, 19.0% with SS) were included. The global prevalence of VHD was 5.4% in SLS, 23.6% en RA, and 15.9% in SS. The more affected valve in SLS was the tricuspid valve in 24% (12% with severe tricuspid regurgitation (STR), p = 0.028), in RA was the aortic valve in 26% (13% with severe aortic stenosis (SAS), p = 0.02), and with SS was the tricuspid valve in 48% (29% with moderate tricuspid regurgitation (MTR)). The calcium deposit was present in 66% in RA (37% in aortic valve, p < 0.001). The valve thickening (>5 mm) was higher in RA (50%, p < 0.001), with predominance in mitral valve (26%).

Conclusions

We found significant higher rates of STR in SLE, SAS in RA, and MTR in SS compared with the literature. Moreover, calcification and valve thickening were found more often in RA. Early diagnosis of subclinical VHD is mandatory to improve the long-term prognosis of these patients.

Valvular heart disease. Autoimmune Disease (n = 163) P value* SLE (n = 94) RA (n = 38) ES (n = 31) Demographic characteristics Age, years. Gender, Male / Female, n Body Mass Index (kg/m2) Arterial hypertension, n (%) Diabetes Mellitus, n (%) 38.8 (12.6) 9/85 26.2 (5.9) 21(22.3%) 6 (6.3%) 62.45 (12.3) 7/31 26.6 (7.1) 14(36.8%) 4 (10.5%) 53.8 (13.3) 2/29 25.4 (4.7) 12 (38.7) 5 (16.1%) <0.001 NS NS NS NS Echocardiographic findings. Valve thickening Aortic Mitral 8 (9%) 1 (1%) 7 (7%) 19 (50%) 9 (24%) 10 (26%) 1 (3%) 0 1 (3%) <0.001 Calcium Deposit Aortic Mitral 4 (4%) 2 (2%) 2 (2%) 25 (66%) 14 (37%) 11 (29%) 8 (26%) 4 (12.8%) 4 (12.9%) <0.001 Aortic valve disease 4 (4%) 10 (26%) 0 Aortic stenosis Moderate Severe 0 0 0 7 (18%) 2 (5%) 5 (13%) 0 0 0 0,02 Moderate Aortic Regurgitation 4 (4%) 3 (8%) 0 NS Mitral valve disease 8 (9%) 2 (5%) 2 (6%) Mitral stenosis Moderate Severe 4 (4%) 2 (2%) 2 (2%) 1 (3%) 0 1 (3%) 1 (3%) 0 1 (3%) NS Mitral Regurgitation Moderate Severe 4 (4%) 2 (2%) 2 (2%) 1 (3%) 0 1 (3%) 1 (3%) 0 1 (3%) NS Tricuspid Regurgitation Moderate Severe 22 (24%) 11 (12%) 11 (12%) 8 (21%) 7 (18%) 1 (3%) 15 (48%) 9 (29%) 6 (19%) 0,028 Pulmonic valve disease Moderate Pulmonic Stenosis Moderate Pulmonic Regurgitation 6 (6%) 1 (1%) 5 (5%) 1 (3%) 0 1 (3%) 0 0 0 NS * Not Significant.
Impact on outcome of different etiologies, baseline degree and improvement of mitral regurgitation in patients with aortic stenosis who underwent transcatheter aortic valve replacement
Authors: Melillo F , Putorti F , Ancona F , Stella S , Capogrosso C , Ingallina G , Montorfano M , Colombo A , Agricola E
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background -  Mitral regurgitation (MR) is a frequent finding in patients with aortic stenosis (AS). Moderate or severe MR is present in up to one-third of pts undergoing TAVR and it is a negative prognostic factor as well as the presence of residual MR after TAVR. However, whether different etiologies/mechanisms of MR have different effects on outcome and MR degree changes after TAVR is yet unknown.

Aim – The aim of the study is to evaluate the prognostic impact of baseline MR degree and its changes after TAVR procedures according to different etiologies of MR in patients who underwent TAVR.

Methods - We performed a retrospective observational study on a cohort of patients who underwent TAVR between January 2015 and December 2019. During the index period 947 pts underwent TAVR. To better characterize the mechanism of MR only pts with pre-procedural 3D transesophageal echocardiographic and at least one follow-up available study were included. The final study population consisted of 224 pts. MR severity was evaluated by multiparametric approach and classified in 4 degrees.

The study population was further divided in 4 groups: Group I: fibro-calcific degeneration of the leaflets (78.6% pts); 2. Group II: prolapse or flail (4.4% pts); Group III: functional MR (FMR) due to leaflets tethering (5.6% pts); Group IV: FMR due to annular dysfunction or dilatation (11.3% pts). Primary outcome was all-cause of death.

Results and Discussion – MR was absent in 15 pts (6.7%), mild in 79 pts (35.7%), mild-to-moderate in 109 in pts (49.3%), moderate-to-severe in 7 pts (3.1%) and severe in 11 pts (4.9%). Patients with > moderate MR degree at baseline had a worse outcome than patients with < moderate MR degree (p log rank = 0.029). FMR (groups III and IV) was associated with better outcome than organic MR (groups I and II) (p log rank = 0.035). Moreover, group IV showed a better outcome compared groups I (p log rank = 0.047) and II (p log rank = 0.038). Patients who showed improvement of MR of at least 1 degree post TAVR showed better outcome compared to patients without improvement (p log rank = 0.04). At multivariate analysis, including pre procedural MR > 2+, pre procedural TR > 2+, organic vs functional etiology and MR improvement after TAVR as covariates, only baseline MR > moderate was an independent predictor of mortality (HR 6.3; 95% CI 1.4 -27.0; p < 0.001).

Conclusion - This study confirms the prognostic role of the baseline degree of MR in patients with AS undergoing TAVR. Moreover, this is the first study demonstrating that FMR due to annular dilatation but not due to leaflet tethering is associated with better outcome compared to organic etiologies.
Intraoperative finding of immobile leaflet(s) following freshly implanted bioprosthetic valves: clinical characteristics and impact on outcomes
Authors: Naser J , Pislaru S , Nkomo V , Geske J , Thaden J , Luis A , Crestanello J , Anderson J , Michelena H , Padang R
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND

Detection of immobile leaflets immediately following bioprosthetic valve implantation is a rare but important intraoperative finding. Restriction of leaflet movement can occur in the closed or open position, leading to abnormal prosthesis function. We sought to determine the clinical implications of immobile leaflets seen on intraoperative echocardiography.

METHODS

Patients with immobile leaflets identified on intra-operative/procedure echocardiography immediately post implantation between 2009-2020 were identified from an institutional database. All echocardiograms were reviewed de-novo to confirm immobile leaflets in the immediate post-implantation period. Identified cases were matched 1:2 to controls for age; sex; prosthesis position, model and size; and implantation approach (surgical vs. transcatheter).  Nominal logistic regression and proportional hazards were used to analyze outcomes.

RESULTS

Thirty patients with immobile leaflets immediately post-bioprosthesis implantation were included. Clinical characteristics are summarized in the Table. Immobile leaflets were documented in procedural reports in only 18 (60%) patients. Moderate stenosis was present intraoperatively in 1 patient, none demonstrated ≥moderate regurgitation, and none resulted in immediate corrective action. In 3 (10%), valve re-intervention was required within 30 days due to symptomatic prosthesis dysfunction. Presence of restricted leaflet motion was associated with higher need for post-operative extracorporeal membrane oxygenation use (odds-ratio 7.3, p = 0.02) and composite end-point of death, valve re-replacement, prosthesis thrombosis, or cardiac hospitalizations (risk ratio 2.1, p = 0.03, Figure).

CONCLUSION

Immobile leaflet(s) immediately post-bioprosthetic valve implantation is an uncommon, under-reported, and under-treated phenomenon. Even in the absence of significant prosthetic valve dysfunction, it can be associated with worse post-operative course as well as worse outcomes.

Baseline characteristics Age 76 (67-84) Sex, male 10 (33%) Surgical approach 25 (83%) Aortic 5 (17%) Mitral 12 (40%) Tricuspid 12 (40%) Pulmonary 1 (3%) Re-intervention within 10 days 3 (10%) Numbers are presented as median (interquartile range) or number (percentage). Abstract Figure. Clinical outcome of stuck leaflets
Adapting the concepts of proportionate and disproportionate functional mitral regurgitation to clinical practice
Authors: Lopes P , Albuquerque F , Freitas P , Gama F , Horta E , Reis C , Abecasis J , Trabulo M , Ferreira A , Canada M , Ribeiras R , Mendes M , Andrade MJ
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

  Despite its theoretical appeal, the concept of Proportionate and Disproportionate FMR has been limited by the lack of a simple way to assess it and by the paucity of data showing its prognostic superiority over currently established ways of grading FMR.

Objectives

This study sought to evaluate the prognostic value of a new and individualized method of assessing Functional Mitral Regurgitation (FMR) Proportionality.

Methods

Patients with at least mild FMR and reduced left ventricular ejection fraction (< 50%) under optimal guideline-directed medical therapy were retrospectively identified at a single-center. To determine FMR proportionality status, we used a novel approach where two simple equations establish an individual cut-off of regurgitant volume/effective regurgitant orifice area, categorizing the study population into non-severe, proportionate and disproportionate FMR (Figure 1). The primary endpoint was all-cause mortality.

Results

A total of 572 patients (median age 70 years; 76% male) were included. Median LVEF was 35% (IQR 28-40) and LVEDV was 169 ml (IQR 132-215). Disproportionate FMR was present in 109 patients (19%) with a median EROA of 26 mm2 (IQR 22-31) and a median RegVol of 40 ml (IQR 34-48), proportionate FMR in 148 patients (26%) with a median EROA of 16mm2 (IQR 12-21) and a median RegVol of 26 ml (IQR 19-32). During a median follow-up of 3.8 years (interquartile range: 1.8 to 6.2 years) there were 254 deaths (44%). The unadjusted mortality incidence per 100 persons-year rose as the degree of FMR disproportionality worsened. On multivariable analysis, disproportionate FMR remained independently associated with all-cause mortality (adjusted hazard ratio: 1.785; 95% confidence interval [CI]: 1.249 to 2.550; P = 0.001). The FMR proportionality concept showed greater discriminative power (C-statistic 0.639; 95% CI: 0.597 to 0.680) than the American (C-statistic 0.588; 95% CI: 0.550 to 0.626; P for comparison = .001) and European guidelines (C-statistic 0.563; 95% CI: 0.534 to 0.591; P for comparison < .001). It was also able to increase the net reclassification index (0.167 [P < 0.001] and 0.084 [P = 0.001], respectively).

Conclusions

A new, simplified and individualized method of assessing FMR Proportionality showed that disproportionate FMR is independently associated with all-cause mortality. This approach seems to outperform the risk stratification of current guidelines.

Abstract Figure 1
External validation of the unifying concept for the quantitative assessment of secondary mitral regurgitation
Authors: Albuquerque F , Lopes P , Freitas P , Horta E , Reis C , Abecassis J , Trabulo M , Ferreira A , Canada M , Ribeiras R , Mendes M , Joao Andrade M
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

  A Unifying Concept for the Quantitative Assessment of Secondary Mitral Regurgitation (SMR) was recently proposed in order to provide a solution for the ongoing guideline controversy. However, these data were derived from a single center cohort and lacks external validation. We aimed to validate the proposed algorithm in a different patient population.

Methods

Patients with at least mild SMR and reduced left ventricular ejection fraction (< 50%) under optimal guideline-directed medical therapy were retrospectively identified at a single-center. The cohort was stratified in low-risk (effective regurgitant orifice area [EROA] < 20 mm2 and regurgitant volume [RegVol] < 30 ml), intermediate-risk (EROA 20 to 29 mm2 and RegVol 30 to 44 ml) and high-risk (EROA ≥ 30 mm2 and RegVol ≥ 45ml) according to the defined risk-based thresholds tailored to the pathophysiological concept of SMR. In the intermediate-risk group, patients were further stratified on the basis of the hemodynamic severity of SMR, into intermediate low-risk and intermediate high-risk (regurgitant fraction < 50% or ≥ 50%, respectively). The primary endpoint was all-cause mortality.

Results

A total of 572 patients (median age 70 years; 76% male) were included. Median LVEF was 35% (IQR 28-40) and LVEDV was 169 ml (IQR 132-215). Median measures of SMR severity were EROA of 14 mm2 (IQR 8-22) and RegVol of 23 ml (12-34). During a median follow-up of 3.8 years (interquartile range: 1.8 to 6.2 years) there were 254 deaths (44%). The mortality at 6-years was 38.9% for the low-risk group, 30.7% for the intermediate low-risk, 64.9% in the intermediate high-risk and 63.2% in the high-risk group. On multivariable analysis, the defined thresholds of risk for SMR severity remained independently associated with all-cause mortality (adjusted hazard ratio: 1.164; 95% confidence interval [CI]: 1.020 to 1.327; P = 0.024). The unifying concept showed similar discriminative power (C-statistic 0.588; 95% CI: 0.540 to 0.635) to the American (C-statistic 0.588; 95% CI: 0.541 to 0.635; P for comparison = 1) and European guidelines (C-statistic 0.563; 95% CI: 0.515 to 0.610; P for comparison = 0.458), but it was able to increase the net reclassification index (0.143 [P < .001] and 0.026 [P = .025], respectively).

Conclusions

In this cohort of patients with SMR and LVEF <50%, the proposed unifying concept based on combined assessment of the EROA, the RegVol, and the RegFrac proved to be associated with an increased risk of all-cause mortality and could improve risk prediction of current guidelines.

Abstract Figure.
Prosthesis-patient mismatch after aortic valve in valve procedure: incidence, predictors and clinical outcomes
Authors: Fusini L , Muratori M , Ghulam Ali S , Gripari P , Cefalu" C , Junod D , Fabbiocchi F , Roberto M , Trabattoni P , Agrifoglio M , Bartorelli AL , Alamanni F , Pepi M , Tamborini G
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background. Transcatheter aortic valve-in-valve (TAVI ViV) implantation is an appealing treatment option for patients with degenerated bioprostheses. However, elevated residual gradients after TAVI ViV procedure are very common. These are an unwanted effects of prosthesis-patient mismatch (PPM). Currently, the actual incidenceof PPM, its predictors and its clinical outcomes have not been completely investigated.

Purpose. The aims of this study was to investigate the incidence, predictors and clinical outcome of PPM and therefore of elevated gradients after TAVI ViV.

Methods. 75 patients (age 78 ± 9 years, 36 male), who underwent TAVI-ViV due to failed aortic biological valve (60 stented, 15 stentless), were enrolled. Mechanism of bioprosthetic valve failure was stenosis (34 cases, 45%), regurgitation (24 cases, 32%) or combination (17 cases, 23%). Elevated residual gradients were defined as a mean DP> 20 mmHg. PPM was identified by the indexed effective orifice area (EOAi) measured by echocardiography (moderate PPM if 0.65 < EOAi < 0.85 cm²/m²; severe PPM if EOAi < 0.6 cm²/m²).

Results. ViV TAVI was feasible in all patients, 33 patients (44%) were implanted with a balloon-expandable valve and 42 (56%) with a self-expandable valve. Post-procedural post-ballooning was performed in 16 out of 42 patients (38%) receiving a self-expandable valve. Post-operative mean DP> 20 mmHg was found in 35 patients (48%). Moderate PPM was found in 24 cases (33%) and severe PPM in 15 (20%). A logistic regression analyses identified small size of surgical prosthesis (size < 23 mm) [OR: 6.061(2.127-17.267), p = 0.001] and failed stented valve [OR: 20.727(2.522-170.364), p = 0.005] as independent predictors for the occurrence PPM. Interestingly PPM did not affect early and 1 years mortality (1 years mortality 1.3 %), while mortality was higher in pts with stentless prostheses (9%)

Conclusions. PPM is a frequent finding after ViV procedures. Despite elevated residual gradients, TAVI ViV resolved prosthetic dysfunction and PPM did not affect mortality.  Therefore, this procedure represents a promising new option for patients with failed biological prosthetic valves.
Mitral annulus disjunction: is it a marker of ominous prognosis?
Authors: Cunha NPD , Rigueira J , Santos R , Nunes-Ferreira A , Rodrigues T , Antonio P , Pereira S , Morais P , Silva P , Brito J , Silva B , Placido R , David C , Pinto FJ , Almeida AG
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Mitral annulus disjunction (MAD) has been proposed as a contributing factor for arrythmias and mitral regurgitation in patients with mitral valve prolapse (MVP), however its clinical relevance is still under investigation.

Objective

To evaluate the frequency of MAD in MVP patients, to characterize clinically patients with MAD and assess potential markers for events.

Methods

Single-center retrospective study of consecutive patients with MVP documented in transthoracic echocardiogram between January 2014 and October 2019. MVP was defined according to the 2017 AHA recommendations; MAD was defined as a separation between mitral valve annulus and the left ventricle free wall. Demographic, clinical, echocardiographic, electrocardiographic data were collected. The results were obtained using Chi-square and Mann-Whitney tests; logistic regression was used to find predictors of events.

Results

247 patients were included (mean age 62.9 ± 18 years, 61% males), of these 23 (9.3%) had MAD (mean age 56 ± 20 years, 56.5% males). The maximum diameter of MAD was 10 ± 3mm (range 5-18). 21 patients (92.3%) had mitral regurgitation, and it was at least of moderate severity in 65.2% of patients. Most of the patients (91.3, n = 21) were in sinus rhythm (SR).

During follow-up (FUP) of 29 ± 19 months, 39% (n = 9) of the patients developed symptoms, 22% (n = 5) had atrial fibrillation (AF), 4.3% (n = 1) had acute aortic syndrome (AAS), 4.3% (n = 1) needed ICD, 22% (n = 5) were submitted to mitral valve intervention, 8.7% (n = 2) were admitted to hospital and 8.7% (n = 2) died. None of the patients presented sustained ventricular arrhythmias (SVA) as assessed in regular Holter monitoring.

These patients had more AAS and needed more ICD in FUP compared to patients without MAD (p = 0.007 and p = 0.006, respectively)

Mitral cord rupture (p = 0.04), age (p = 0.044), maximum velocity of tricuspid regurgitation (p = 0.04) and IVS thickness (p = 0.017) were associated with AF in MAD patients. in univariate analysis, interventricular septum thickness was a predictor of AF in this subgroup (OR 4.0, 95%CI 1.1-14.3, p = 0-032) The presence of SR was associated with survival (p = 0.03). There were no predictors of hospital admission or mitral intervention.

Conclusion

Patients with MAD had a relatively benign prognosis with few events during follow-up, although with more AAS and ICD in FUP. In our sample, AF was more common than SVA. Left ventricle hypertrophy was a predictor of AF and sinus rhythm was associated with survival. Larger studies with more patients and other methods of imaging are needed to confirm our results.