bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tricuspid regurgitation: long-term management, morbidity and mortality
Authors: Marquez Camas P , Rodriguez Capitan J , Chaparro Munoz M , Lopez Haldon J , Manovel Sanchez A , Becerra Munoz V.M , Doncel Abad V , Melgar Melgar A , Robles Mezcua A , Jimenez Navarro M 
Published: November 2020

Abstract

Introduction
The natural history of tricuspid regurgitation (TR) is poorly known and its morbi-mortality has been rarely described.

Objectives
Several causes lead to the appearance of TR. The aim of our study was to assess the prognosis of our patients taking into account the etiology and severity of their valvulopathy. We also wanted to evaluate the income-free survival.

Methods
We designed a bi-centre (including a tertiary-level hospital and a secondary hospital), descriptive and retrospective study that included 745 patients with at least moderate-to-severe TR who had not had any previous cardiac surgery for this pathology. Once patients were selected, clinical characteristics (age, sex, cardiovascular risk factors) as well as associated pathology, readmissions because of heart failure and mortality were evaluated.

Results
745 patiens were included in the study (70.7% women) from the year 2002 to the 2017. The age average was 72.28 years old (in a range of 16–97). The obtained frequency of primary TR (caused by an abnormality of any of the components of the TV apparatus) was 6.4%, secondary TR (due left-sided valvular and myocardial diseas, Pulmonary hypertension or increased RV afterload) was 67.6%, related to AF 19% and isolated TR 7%. After a long follow-up (global median survival 51.51 months) only 62 patients received surgical treatment. Figures 1–4 show survival curves depending on etiology. Figure 5 compares survival curves depending on sex characteristics.

Conclusions
TR (moderate-to-severe or more) was associated with poor outcomes from the beginning of the follow-up. This poor clinical prognosis was observed in all ethiological groups analyzed and in both genders.
Survival curves Tricuspid Regurgitation

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Sociedad Andaluza de Cardiología
Hemoglobin level at stabilization is associated with long-term all-cause mortality in patients with left-sided endocarditis, a POET substudy
Authors: Pries-Heje M , Hasselbalch R.B , Ihleman N , Gill S , Bruun N.E , Elming H , Jensen K , Oestergaard L , Helweg-Larsen J , Fosboel E.L , Koeber L , Toender N , Moser C , Iversen K , Bundgaard H 
Published: November 2020

Abstract

Background
Left-sided infectious endocarditis (IE) has a high 1-year mortality. Anemia is a common finding in patients with IE, yet little is known about frequency, severity, and associated outcomes in this setting.

Purpose
To examine the relationship between Hemoglobin (Hgb) level measured at IE stabilization (time of randomization) in the Partial Oral versus intravenous Antibiotic Treatment of Endocarditis (POET) trial - and long-term all-cause mortality.

Methods
In the POET trial, 400 patients with left-sided IE were randomized, after medical and/or surgical stabilization, to conventional antibiotic treatment or partial oral treatment. Only non-surgically treated patients were considered in this study. Patients were divided by quartiles into four groups based on Hgb level at randomization.

Results
We examined 248 patients with non-surgically treated IE. Median time from diagnosis of IE to randomization was 14 days (IQ 12–19). At long-term follow-up (median 3.2 years, IQ 2.18–4.60), 71 patients had died (28.6%). Patients in the lowest quantile (Hgb ≤6.0 mmol) had a HR of 4.17 (95% CI 1.81–9.61, p&lt;0.001) for death compared to patients in the highest quantile (Hgb &gt;7.5 mmol/L). This association remained significant after multivariable adjustment for age, sex, renal disease, C-Reactive Protein, and Prosthetic heart valve (HR 2.69, 95% CI 1.11–6.50); p=0.028).

Conclusion
Low Hemoglobin level at stabilization in patients with IE was associated with an increased risk of long-term mortality. Whether intensified treatment of anemia in patients with IE could improve long-term outcome requires investigation.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): The Danish Heart Foundation, The Capital Regions Research Council
Age differences in mortality in patients undergoing surgery for infective endocarditis
Authors: Ostergaard L , Smerup M.H , Iversen K , Jensen A.D , Dahl A , Chamat S , Eske Bruun N , Butt J.H , Bundgaard H , Torp-Pedersen C , Kober L , Fosbol E.L 
Published: November 2020

Abstract

Background
Infective endocarditis (IE) is associated with high mortality. Surgery may improve survival, but the intercept between benefit and harm is hard to balance and may be closely related to age.

Purpose
To examine the in-hospital and 90-day mortality in patients undergoing surgery for IE and to identify differences between age groups and type of valvular intervention.

Methods
By crosslinking nationwide Danish registries we identified patients with first-time IE undergoing surgical treatment in the period from 2000 to 2017. The study population was grouped in patients &lt;60 years, 60–75 years, and ≥75 years of age. High-risk subgroups by age and surgical valve intervention (mitral vs aortic vs mitral+aortic) during IE admission were examined. Kaplan Meier estimates was used to identify 90-day mortality by age groups and multivariable adjusted Cox proportional hazard analysis was used to examine factors associated with 90-day mortality.

Results
We included 1,767 patients with IE undergoing surgery, 735 patients &lt;60 years (24.1% female), 766 patients 60–75 years (25.8% female), and 266 patients &gt;75 years (36.1% female). The proportion of patients with IE undergoing surgery was 35.3%, 26.9%, and 9.1% for patients &lt;60 years, 60–75 years, and &gt;75 years, respectively. For patients with IE undergoing surgery, the in-hospital mortality was 6.4%, 13.6%, and 20.3% for patients &lt;60 years, 60–75 years, and ≥75 years of age, respectively and mortality at 90 days were 7.5%, 13.9%, and 22.3%, respectively. Factors associated with an increased risk 90-day mortality were: mitral valve surgery and a combination of mitral and aortic valve surgery as compared with isolated aortic valve surgery, patients 60–75 years and &gt;75 years as compared with patients aged &lt;60 years, prosthetic heart valve prior to IE admission, and diabetes, Figure. Patients &gt;75 years undergoing a combination of mitral and aortic valve surgery had an in-hospital mortality of 36.3%.

Conclusion
In patients undergoing surgery for IE, a stepwise increase in 90-day mortality was seen for age groups, highest among patients &gt;75 years with a 90-day mortality of more than 20%. Patients undergoing mitral and combined mitral and aortic valve surgery as compared to isolated aortic valve surgery were associated with a higher mortality. These findings may be of importance for the management strategy of patients with IE.
Mortality risk

Funding Acknowledgement
Type of funding source: None
SHARPEN score accurately predict in-hospital mortality in infective endocarditis: a real-world validation study
Authors: Alves S.G , Filippini F.B , Dannenhauer G.P , Seroiska G , Birk L.F.S , Terra D.H , Pivatto Jr F , Miglioranza M 
Published: November 2020

Abstract

Background
Infective Endocarditis (IE) has impressive 30-day mortality of up to 30%. Prompt recognition of high-risk patients is required in order to optimize management and outcomes. The SHARPEN score was recently developed to predict intrahospital mortality in patients admitted due to IE, regardless of the need to undergo cardiac surgery. We aimed to evaluate the accuracy of the SHARPEN score to predict in-hospital mortality in comparison to Charlson Comorbidity Index (CCI).

Methods
Retrospective cohort of all consecutive adult admissions between 2000 and 2016 with diagnosis of definitive IE according to the Modified Duke Criteria. The SHARPEN score was applied comprising: Systolic blood pressure at presentation, Heart failure, Age, Raised creatinine, Pneumonia, Elevated peak CRP and Non-intravenous drug abuser. The CCI was applied to assess comorbidities. Accuracy in predict mortality was estimated with C-statistic. DeLong test was used to compare the areas under the curve (AUC). Survival probabilities were estimated by Kaplan-Meier method and differences between survival curves analyzed using the log-rank test. Multivariate analysis using Poisson Regression with robust variation was performed to determine independent predictors of in-hospital mortality.

Results
179 cases of IE were registered (70% male; 55±17 years-old) with an in-hospital mortality of 22%. Cardiac surgery was required in 68 (38%) of the patients. Calculated SHARPEM and CCI scores were 9 (7–11) and 3 (1–6) points respectively. SHARPEN was able to predict in-hospital mortality with an AUC of 0.76 (95% CI 0.7–0.8; p&lt;0.001) and cut-off &gt;10 points (Sen=69%; Sp=71%; PPV=40%; NPV=89%). Mortality was significant higher (40% vs 11%; p&lt;0.001) in patients with SHARPEN &gt;10 points (FIGURE). CCI had a similar AUC of 0.7 (95% CI 0.6 - 0.8; p&lt;0.001) with SHARPEN (p=0.32). However, in a multivariate analysis, SHARPEN score &gt;10 points a stronger predictor related with in-hospital mortality (OR 2.3; 95% CI 1.1 - 4.8; p=0.03) in comparison to CCI &gt;3 points (OR 1.4; 95% CI 0.7–2.8; p=0.3).

Conclusion
SHARPEN score demonstrated a good accuracy in predict in-hospital mortality independently of other variables, with a high negative predictive value. These findings suggest that SHARPEN score may be useful to stratify high-risk IE patients in a clinical setting.

Funding Acknowledgement
Type of funding source: None
Prognostic benefit of urgent cardiac surgery in left-sided infective endocarditis
Authors: Garcia Granja P.E , Lopez J.A , Ladron R , Cabezon G , Vilacosta I , Dominguez F , Olmos C , Sarria C , Lopez I , Carrasco M , Garcia-Pavia P , San Roman A 
Published: November 2020

Abstract

Background
Cardiac surgery is required in approximately 50% of patients with left-sided infective endocarditis (IE) being a high-risk procedure specially during active phase of the disease.

Purpose
To evaluate the impact of cardiac surgery in the in-hospital mortality of left-sided IE.

Methods
We used a prospective cohort of consecutive patients with definite left-sided IE between 2000 and 2017 (n=1002). A predictive model of in-hospital mortality was derived by adding the variable cardiac surgery to the already published ENDOVAL score. The benefit of cardiac surgery was calculated with the mean difference between the risk of in-hospital mortality considering urgent surgery and considering no surgery for each patient.

Results
The predictive model showed good discriminative capacity with an area under the ROC curve of 0.861 (95% CI: 0.830 - 0.891) and a good calibration (p-value in the Hosmer-Lemeshow test of 0.353). Figure shows the in-hospital mortality prediction of each patient in case of no-surgery (orange), urgent surgery (yellow) or real decision (blue). Mean reduction of in-hospital mortality risk in case of surgery for patients with a theoretical risk of in-hospital mortality between 0–20% in absence of surgery was 3.2±1.6%. For patients with a theoretical risk between 20–40% in absence of surgery the mean reduction was 8.1±1.1%. For patients with a theoretical risk between 40–60% in absence of surgery the mean reduction was 10.7±0.3%. For patients with a theoretical risk between 60–80% in absence of surgery the mean reduction was 9.7±0.9%. For patients with a theoretical risk between 80–100% in absence of surgery the mean reduction was 4.6±2.1%.

Conclusion
Urgent cardiac surgery is a protective factor of in-hospital mortality for all patients with left-sided IE but especially for those with intermediate risk.
Figure 1

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Gerencia Regional de Salud, Junta de Castilla y Leόn
Two common echocardiographic variables to diagnose cardiac amyloidosis: the AMYLoidosis Index (AMYLI) score
Authors: Aimo A , Chubuchny V , Vergaro G , Fontana M , Nicol M , Cohen-Solal A , Castiglione V , Spini V , Giannoni A , Taddei C , Pasanisi E , Passino C , Emdin M 
Published: November 2020

Abstract

Background
Early diagnosis of cardiac amyloidosis (CA) is warranted to initiate specific treatment and improve outcome. The amyloid light chain (AL) and inferior wall thickness (IWT) scores have been proposed to assess patients referred by hematologists or with unexplained left ventricular (LV) hypertrophy, respectively. These scores are composed of 4 or 5 variables, respectively, including strain data, and no decisional cut-offs were introduced.

Methods
Based on 2 variables common to the AL and IWT scores, we defined a simple score named AMYLoidosis Index (AMYLI) as the product of relative wall thickness (RWT) and E/e' ratio, and assessed its diagnostic performance. Optimal rule-out cut-offs were searched as those with negative likelihood ratio (LR−) &lt;0.1.

Results
In the derivation cohort (n=251), CA was ultimately diagnosed in 111 patients (44%). The 2.22 score value was selected as rule-out cut-off (LR- 0.0). In the hematology subset, AL CA was finally diagnosed in 32 patients (48%), with 2.36 as rule-out cut-off (LR− 0.0). In the hypertrophy subset, ATTR CA was diagnosed in 79 patients (43%), with 2.22 as best rule-out cut-off (LR− 0.0). In the validation cohort (n=691), where more patients were diagnosed with CA (94% and 68% in the hematology and in the hypertrophy subsets, respectively), the 2.22 rule-out cut-off had a LR− = ∞ (as no patient scoring &lt;2.22 had CA). In the hematology and hypertrophy subsets, the 2.36 and 2.22 cut-offs were effective for ruling-out CA, with both LR− = ∞ (as no patient scoring &lt;2.36 or 2.22, respectively, had CA).

Conclusions
The AMYLI score (RWT* E/e') is simpler than those proposed and similarly accurate. A 2.22 cut-off value excludes CA diagnosis in patients undergoing a diagnostic screening for CA, while a &lt;2.36 and a &lt;2.22 value may be better considered in the subsets with either blood dyscrasia or unexplained hypertrophy, respectively.

Funding Acknowledgement
Type of funding source: None
Clinical features, risk factors, and prognosis of anthracycline-induced cardiotoxicity in patients with malignant lymphoma who received a CHOP like regimen
Authors: Nakayama T , Oshima Y , Kusumoto S , Osaga S , Yamamoto J , Wakami K , Goto T , Sugiura T , Seo Y , Iida S , Ohte N 
Published: November 2020

Abstract

Background
Anthracycline-induced cardiotoxicity is a serious complication in patients with malignant lymphoma (ML) who received chemotherapy, which threatens life prognosis and quality of life of patients. However, incidence and risk factors of cardiotoxicity in patients with ML who undergo intensive chemotherapy which aims complete remission is not clarified. Furthermore, prognosis after cardiotoxicity and that after recovery from cardiotoxicity have not been elucidated.

Method
We screened 443 ML patients who received either rituximab (R)-CHOP or CHOP regimen between January 2008 and December 2017 at Nagoya City University Hospital. Two handled forty-four patients who underwent echocardiography before and after chemotherapy were enrolled and data were analyzed retrospectively. Cardiotoxicity was defined as a decline in left ventricular ejection fraction (LVEF) of 10% or greater and an LVEF was below 50%. Partial recovery was defined as a 5% or more of increase in LVEF and an LVEF was ≥50% after cardiotoxicity. Complete recovery was defined as an increase in LVEF became more than 95% of the baseline value. Patient's basic characteristics, chemotherapeutic regimen, laboratory data, echocardiographic data, and prognosis were collected from the medical records by two cardiologists and two hematologists.

Result
At baseline, the median age was 71 years, the median cumulative dose of doxorubicin was 302 mg/m2 and the median LVEF was 69%. During the follow-up period, cardiotoxicity was observed in 52 out of 244 patients (21%), 30 patients (12%) had a symptomatic heart failure, and 5 patients died from cardiovascular cause. Thirty-five patients developed cardiotoxicity during the first year of chemotherapy. Multivariate analysis identified that only the baseline LVEF (HR 0.949, 95% CI 0.919–0.981, p=0.002) was an independent risk factor for cardiotoxicity. In our study, patients who received more than 200 mg/m2 of doxorubicin developed cardiotoxicity frequently. Among 52 patients who experienced cardiotoxicity, partial recovery and full recovery were observed in 18 (35%) and 4 (8%) patients, respectively. Four patients without recovery died due to heart failure and 1 patient with partial recovery died suddenly. Six out of 18 patients with partial recovery developed re-cardiotoxicity.

Conclusion
ML patients who undergo more than 200 mg/m2 of doxorubicin need a watchful follow-up. Only a baseline LVEF was an independent risk factor for cardiotoxicity. one third of patients with partial recovery developed re-cardiotoxicity.

Funding Acknowledgement
Type of funding source: None
Procalcitonin in myocarditis patients: role in aetiology identification and risk stratification
Authors: Peretto G , Villatore A , Sala S , Riccio A , Ripa M , Basso C , Della Bella P 
Published: November 2020

Abstract

Background
Procalcitonin (PCT) is an established predictor of bacterial infections and sepsis. However, PCT involvement in cardiovascular diseases has been scarcely investigated so far. In particular, no studies at all ever addressed the role of PCT in myocarditis patients.
We aimed at evaluating PCT in myocarditis patients, as a potential biomarker of: a) aetiologic diagnosis; b) prognosis.

Methods
A cohort of 130 consecutive patients with a novel diagnosis of myocarditis confirmed by both endomyocardial biopsy and cardiac magnetic resonance were included in the study. Patients with known bacterial infections or bacterial myocarditis were excluded (n=5). PCT concentration was measured on admission in all patients. Prospective follow-up (FU) was performed every 6 months up to 5 years.

Results
Of 125 patients analyzed (mean age 45±15 years, males 62%, mean LVEF 48±15%), 22 (18%) had fulminant myocarditis (FM). The remaining 103 cases had non-fulminant myocarditis (NFM), including infarct-like presentation and non-malignant arrhythmias. Aetiology was viral or virus-negative in 23 and 102 patients, respectively.
The mean PCT value was 0.44±0.18 mcg/ml, with no significant differences between viral and virus-negative myocarditis (0.43±0.19 vs. 0.44±0.18 mcg/ml, p=0.90).
Baseline PCT concentration was significantly higher in FM patients (0.69±0.21 vs. 0.39±0.16 mcg/ml, p=0.07). Consistently, PCT was higher in patients with LVEF &lt;60% (0.51±0.20 vs. 0.30±0.14 mcg/ml, p=0.03) and in those with elevated (&gt;400 pg/mL) NT-proBNP (0.55±0.19 vs. 0.36±0.17 mcg/ml, p=0.03). As for inflammatory biomarkers, patients with high ESR (&gt;20 mm/h) had also higher PCT values (0.56±0.20 vs. 0.37±0.16 mcg/ml, p=0.03). By converse, no association was found between PCT and CRP abnormal values (p&gt;0.05).
At univariate analysis, high PCT (≥0.20 mcg/ml) was predictive of heart failure recurrence (OR 2.77, 95% CI 1.18–6.48, p=0.02) or arrhythmic cardiac arrest (OR 3.22, 95% CI 1.19–8.71, p=0.02) by discharge, with overall hospitalization prolonged by 10±4 days (p&lt;0.05). Furthermore, patients with high PCT were more prone to myocarditis recurrences (13/80 vs. 4/45, p=0.03) by 5-year FU.

Conclusions
In myocarditis patients, elevated PCT values at presentation are not associated with myocarditis aetiology. Nonetheless, PCT suggests a worse short-term clinical outcome, and also a higher risk of myocarditis recurrences at long-term FU.

Funding Acknowledgement
Type of funding source: None
Treatment of virus negative chronic myocarditis: long term follow-up of TIMIC trial
Authors: Chimenti C , Russo M.A , Frustaci A 
Published: November 2020

Abstract

Background
The TIMIC trial demonstrated the short term efficacy of immunosuppression (IMS) in virus-negative inflammatory cardiomyopathy. However long term outcome of patients responsive to this treatment is still unclear.

Purpose
To assess the long term outcome of patients enrolled in the TIMIC trial.

Methods
The 85 (51 M, 34 F, 42.7±14.7 years) patients with endomyocardial biopsy proven virus-negative chronic inflammatory cardiomyopathy, enrolled in the TIMIC trial and treated either with prednisone and azathioprine (prednisone 1mg kg–1 day–1 for 4 weeks followed by 0.33 mg kg–1 day–1 for 5 months and azathioprine 2 mg kg–1 day–1 for 6 months) or placebo for 6 months, were evaluated in a long-term follow-up of up to 18 years (mean 15.2±2.0 SD, range 12–18 ys). Patients treated with placebo at the end of the 6-month enrollment because of the lack of improvement received IMS for further 6 months.

Results
At 6 months' follow-up 89% patients showed a significant improvement of left ventricular ejection fraction compared to baseline (LVEF rising from 27.0±5.7 to 46.2±6.4, % p&lt;0.001).
This improvement was maintained in the long term follow-up (LVEF 51.1±6.4%, p&lt;0.001). Importantly, the 42 patients initially on placebo showed an improvement comparable to the branch on IMS either on short (EF from 27.7% to 46.8±6.2%) and on long term follow up (LVEF from 27.7% to 50.6±5.6%, p&lt;0.001). Nine patients (11%) did not show a significant improvement of LVEF either at short and long term follow-up and among them 4 died and 2 had a cardiac transplantation. Five patients (5.8%) had a relapse of the cardiac inflammatory process that promptly responded to a new TIMIC dose treatment. Four of them (4F, 41.2±9.4 ys age) had concomitant autoimmune diseases and the relapse was within the first 2 years after IMS discontinuation. One patient (M, 56 ys) had a relapse after 10 years following a flu-like syndrome.

Conclusion
Immunosuppressive therapy of virus negative inflammatory cardiomyopathy warrants in susceptible patients a long term recovery of heart function with very low incidence of recurrences, that respond to a new TIMIC protocol dose treatment.
Long term efficacy of TIMIC-IMS therapy

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): AIFA