bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of bisphosphonate and calcium carbonate on normal aortic valve and cholecalciferol induced in vivo rabbit aortic stenosis model
Authors: Okutucu S , Sabanoglu C , Saglam Ayhan A , Tulumen E , Aksoy H , Oto A 
Published: November 2020

Abstract

Background
Calcific aortic valve disease (CAVD) is the most common valvular heart disease. Bisphosphonates are stable analogs of pyrophosphates and commonly prescribed in the treatment of osteoporosis. The effects of bisphosphonate treatment on CAVD are not clearly known and there are inconsistent results. Similarly, the effect of calcium supplementation on CAVD remains controversial.

Purpose
The aim of this study was to assess the effects of bisphosphonate therapy on the normal aortic valve and vitamin D induced in vivo rabbit aortic stenosis (AS) model.

Methods
The impact of calcium supplementation on the rabbit AS model was also evaluated. A total of 30 New Zealand white rabbits were divided into five equal groups: no treatment (Group I); 25,000 IU/day vitamin D3 (cholecalciferol) (Group II, rabbit AS model); 25,000 IU/day cholecalciferol plus 2500 mg/day calcium carbonate (Group III); 20 μg/kg/week intravenous alendronate (Group IV) and 25,000 IU/day cholecalciferol plus 2500 mg/day calcium carbonate plus 20μg/kg/week alendronate (Group V). Echocardiography was performed at baseline and after 12 weeks of treatment. The left ventricular mass index (LVMI), aortic valve area (AVA), transvalvular velocities and gradients were recorded. Radiologic and histopathologic examination was performed at the end of the 12th week. Control animals displayed no abnormalities of the aortic valve.

Results
There was no echocardiographic change in Group IV. In Groups II, III and V, there was a significant decrease in AVA and increases in transvalvular velocities and gradients. However, these stenotic changes were significantly prominent in Group V (p=0.001 for all, via repeated measures ANOVA). Moreover, LVMI was only increased in Group V (p&lt;0.05). Calcification of aortic valvar complex was detected in 14 (46.7%) cases by radiologic imaging and 10 (33.3%) cases by histopathologic examination. Most frequent calcification was found in Group V (5 for each method, 83.3%). Agatston, volume and equivalent mass scores of calcific foci in Group V were significantly higher than other groups (p&lt;0.05 for all). There was no significant difference between groups regarding with presence of osteoclasts in calcific foci.

Conclusion
Calcium supplementation has no effect on the in vivo rabbit AS model. Alendronate treatment aggravates the stenosis and increases the calcification in the rabbit AS model. Alendronate treatment has no effect on the normal valve in which there was no osteogenesis and osteoclastogenesis. Based on these findings, in patients with CAVD, alendronate treatment should be given with regular echocardiographic follow-up or may not be preferred.
Central figure

Funding Acknowledgement
Type of funding source: None
Predictors of adverse prognosis in patients with infective endocarditis in a surgical referral center
Authors: Scheggi V , Olivotto I , Ceschia N , Merilli I , Andrei V , Alterini B , Stefano P.L 
Published: November 2020

Abstract

Background
Despite optimal medical and surgical treatment, mortality in infective endocarditis (IE) remains high. Aim of this study was to identify predictors of long term mortality for any cause, adverse event rate, relapse rate and valvular dysfunction at follow-up, in a high-volume surgical center.

Methods
We retrospectively analyzed 358 consecutive patients (127 women) admitted to our department with definite diagnosis of IE not device-related. IE occurred on native valves in 224 patients (63%); the infection involved the aortic valve in 192 (54%), mitral valve in 139 (39%) and tricuspid valve in 26 (7%). Overall 285 (80%) patients underwent surgery and 73 (20%) were treated conservatively, 38 due to absence of surgical indication and 35 due to refusal or prohibitive surgical risk. Long-term follow-up was obtained by structured telephone interviews. Primary endpoints were all-cause mortality, freedom from recurrent endocarditis, postoperative incidence of major adverse events (hospitalization for any cause, pace-maker implantation, new onset of atrial fibrillation, sternal dehiscence), worsening of left ventricular ejection fraction (LVEF) and valvular dysfunction.

Results
Mean age was 65 years (SD 15.2). Mean vegetation length was 8.9 mm (SD 7.6). Endocarditis was left-sided in 332 (93%). Average follow-up was 6 months. At univariable analysis, mortality was associated with female gender (p=0.031), age (p&lt;0.001), higher EuroSCORE 2 (p&lt;0.001), chronic renal failure (p&lt;0.001), diabetes (p=0.002), brain embolism on presentation (p=0.05), double valve infection (p=0.008), low ejection fraction (p&lt;0.001), paravalvular extension (p=0.031), prosthetic infection (p=0.018), exclusion from surgery if indicated (p&lt;0.001), high procalcitonin levels (p=0.035); factors associated with a significantly lower mortality were streptococcal infection (p=0.04; OR 0.34) and early surgery (p=0.009, OR 0.55). At multivariable analysis independent predictors of all-cause mortality were lower EF, EuroSCORE2, procalcitonin levels and diabetes. Non-fatal adverse events were associated with renal failure (p 0.035, OR 2.8). Relapse rate was associated with S aureus infection (p=0.005, OR 3.8), right-sided endocarditis (p&lt;0.001, OR 6.7) and drug abuse (p&lt;0.001, OR 9.4).

Conclusions
The present study shows that low EF, EuroSCORE2, procalcitonin levels and diabetes are independent predictors of death in patients with IE. Non-fatal adverse events are more frequent in patients with renal failure. Relapse rate is higher in drug abusers. These informations may help personalize follow-up strategies after acute admission for IE.

Funding Acknowledgement
Type of funding source: None
Proof of concept study on the utility of integrated transthoracic and transesophageal echocardiography aortic stenosis assessment
Authors: Schwartzenberg S , Sagie A , Kazum S , Yedidya I , Monakier D , Ofek H , Vaturi M , Kornowski R , Shapira Y 
Published: November 2020

Abstract

Background
Integrated echo method (IEM) combining transthoracic and transesophageal echocardiography (TTE/TEE) data can provide accurate aortic stenosis (AS) assessment. Our objectives were to evaluate the impact of IEM classification on mortality in AS patients.

Methods
Between 2016–2017, 63 out of 81 consecutive patients with at least moderate AS underwent comprehensive sequential TTE and TEE. AS types were determined by TTE and IEM (utilizing TEE planimetry of left ventricular outflow tract and highest Doppler spectral signals from both TTE and TEE). Based on conservative vs actionable implication, AS types were dichotomized into Group A, comprising moderate and Normal-Flow Low-Gradient (NFLG), and Group B, comprising High-Gradient (HG), Low ejection fraction Low-Flow Low-Gradient (Low EF LFLG), and Paradoxical Low-Flow Low-Gradient (PLFLG) AS. Survival under medical therapy was determined.

Results
Dichotomous classification was discordant in 15.9% of the patients with the two methods, with a relative risk of 1.55 of A to B Group re-classification with IEM (p&lt;0.001). The optimal cut-off value of TTE-determined AVA for AS classification was 0.82 cm2 (75% sensitivity and 87% specificity) vs an IEM-determined optimal AVA cut-off value of 0.92 cm2 (84.4% sensitivity and 76% specificity). During a median time of 9 months (quartiles 2.4–22 months) of follow-up under medical treatment, Group B patients had a worse survival under medical therapy than Group A patients, with additional independent prognostic value for Group A/B dichotomization by IEM in Group A (non-actionable) TTE-defined patients after multivariable adjustment (hazard ratio 5.3, confidence interval 1.39–20.3, p value=0.015).

Conclusions
IEM in patients with ambiguous AS severity can improve detection of patients who may benefit from early invasive therapy.
Graphical Abstract

Funding Acknowledgement
Type of funding source: None
Impact of pericoronary inflammation assessed by coronary computed tomography angiography on the progression of aortic valve calcification
Authors: Misawa T , Sugiyama T , Kanaji Y , Hoshino M , Yamaguchi M , Hada M , Sumino Y , Ueno H , Nogami K , Kakuta T 
Published: November 2020

Abstract

Background
Aortic valve calcification (AVC) has been known as an independent predictor for adverse cardiovascular events and all-cause mortality. Previous studies demonstrated that AVC was associated with aortic valve inflammation and atherosclerosis. However, the relationship between the progression of AVC and pericoronary inflammation remains undetermined.

Purpose
The purpose of this study was to evaluate the impact of the pericoronary inflammation on the progression of AVC.

Methods
A total of 107 patients with suspected or known chronic coronary syndromes who underwent clinically indicated serial 320-slice coronary computed tomography angiography (CTA) at Tsuchiura Kyodo General Hospital from January 2011 to June 2019 were retrospectively studied. Pericoronary inflammation was assessed by pericoronary adipose tissue attenuation (PCATA) defined as the mean CT attenuation value of PCATA (−190 to −30 Hounsfield units [HU]) on proximal 40 mm segments of coronary arteries. AVC was quantified by Agatston score on CTA. The mean aortic attenuation (HU Aorta) and the standard deviation (SD) in the region of interest at the level of the sinotubular junction was measured. AVC was defined as the threshold for calcium detection (mean HU Aorta + 2SD). AVC index was calculated as follows: (follow-up/baseline) AVC divided by follow-up period. AVC progression was defined as newly-developed AVC at follow-up or an increased AVC index during follow-up. All patients were divided into two groups according to the presence or absence of AVC progression, and clinical characteristics and CT findings were compared between these two groups.

Results
AVC progression was observed in 26 patients (24.3%) between 2 serial CT examinations (median, 34 months). There was no significant difference in age, gender and the prevalence of other cardiovascular risk factors between the 2 groups. Patients in AVC progression group were associated with higher prevalence of elevated PCATA-LAD, higher LV mass index at baseline and the initial AVC presence. Receiver-operating characteristic curve analysis revealed that the optimal cut off value of PCATA-LAD for predicting AVC progression was −68.26 HU (area under the curve 0.605; 95% confidence interval [CI], 0.465–0.745). Multivariable logistic regression analysis revealed that baseline PCATA-LAD ≥−68.26 HU (odds ratio [OR], 3.12; 95% CI, 1.04–9.35, p=0.042) and the presence of baseline positive AVC (OR, 6.84; 95% CI, 2.34–20.0, p=0.0004) were independent predictors of AVC progression.

Conclusions
The increased pericoronary inflammation and the presence of AVC may help identify patients with high risk for future AVC progression.

Funding Acknowledgement
Type of funding source: None
Mechanism of transcatheter heart valve deployment for right ventricular outflow tract insufficiency after surgical reconstruction in childhood as assessed with intravascular ultrasound
Authors: Kalinczuk L , Rynkiewicz K , Skotarczak W , Mintz G.S , Zielinski K , Swierczewski M , Michalowska I , Biernacka K , Ruzyllo W , Demkow M 
Published: November 2020

Abstract

Introduction
Transcatheter heart valve (THV) deployment can be used to treat right ventricular outflow tract (RVOT) insufficiency.

Purpose
To study deployment mechanism of a balloon expandable THV (Melody or Edwards SAPIEN [ES] 3) implanted for pulmonary homograft insufficiency using intravascular ultrasound (IVUS) with Visions PV.035 Digital Catheter (Philips) offering an imaging field of 60mm.

Methods
Sequential (baseline and post-THV) IVUS was performed in 6 pts (median age 33 [20–44] yrs, 3 ♀, all with Tetralogy of Fallot) who had undergone prior corrective surgery (4 transannular patch, 1 bioprosthetic valve or 1 pulmonary homograft), but who presented with significant RVOT insufficiency. IVUS-visualized homograft cross-sections were perpendicular to its long axis and were obtained along the entire homograft length (Fig. 1). Volumetric measurements included the native pulmonary homograft (inner lumen and outer dimension) and the corresponding inner-stent/inner-THV cross-sections post-THV for a total of 16 evenly spaced cross-sections per analyzed region. Each THV (1 Melody [Ø 22mm, 28mm nominal length] and 5 ES3 [Ø 23mm, 18mm height; 4 Ø 29mm, 22.5mm height]) was implanted after pre-stenting using stents of 36, 39, or 48mm length, deployed on a 24mm (n=1) or 30mm (n=4) balloon-in-balloon catheter.

Results
Overall, there were 96 paired cross-sections. There was significant increase in average lumen dimension after THV deployment (Δ of 97.5mm2) accompanied by the similar increase in outer pulmonary homograft dimensions (Δ of 84.0mm2) (Table 1). Whereas the maximal lumen diameter was unchanged, the minimal lumen diameter increased significantly resulting in substantial decrease in the ratio of max/min lumen diameter of 1.41±0.20 vs 1.16±0.13 (p&lt;0.001) representing a reduction in lumen eccentricity.

Conclusions
During balloon-expandable THV implantation to treat RVOT insufficiency, there is a significant increase in baseline lumen dimensions accompanied by a substantial outer RVOT dimension increase to normalize lumen eccentricity.
Figure 1. IVUS intraprocedural visualisation

Funding Acknowledgement
Type of funding source: None
Pressure constrained mitral annular dysfunction determines severity of regurgitation in Barlow's disease – a 3D echocardiographic study
Authors: Dumont K.A , Persson R , Kvitting J.P , Lundblad R , Haaverstad R , Fiane A , Urheim S 
Published: November 2020

Abstract

Background
Barlow's disease provides both diagnostic and therapeutic challenges. The impact of systemic blood-pressure on severity of regurgitation is still unclear.

Purpose
We hypothesized that mitral annulus behaves passively with enlargement during ventricular systole, and secondly, we tested the hypothesis that severity of regurgitation correlates to systemic blood-pressure (BP) of the patient.

Methods
Ten patients with Barlow's disease were compared with 10 healthy controls. Brachial blood-pressure was measured according to guidelines. Transthoracic 3D echo was obtained from an apical view (38.6±8.2 frames per second). Data was analyzed using a holographic display. We measured commissure width (CW), septallateral length (SL) and mitral annular surface area throughout the cardiac cycle. Aortic flow ejection time was derived from continuous Doppler across the aortic valve. Timing of aortic valve closure was visually assessed by 3D echo. Onset and end of mitral regurgitation was derived from continuous wave Doppler of transmitral flow.

Results
Systolic BP in controls and patients were 122±5 and 133±12 mmHg, respectively (p&lt;0.05). Enddiastolic volume was 87±7 ml/m2 (controls) and 100±14 ml/m2 (Barlow), p&lt;0.02. Left ventricular EF in controls and patients were 59±5 and 62±5%, respectively, p=NS. Barlow patients had moderate or severe late systolic regurgitation with mean regurgitation volume of 51±18 ml. Annular surface area, CW and SL behaved passively with enlargement during ventricular systole (Figure 1). Peak systolic surface area, CW and SL in healthy controls and Barlow patients were 8.7±0.5 vs 20.7±3.2 cm2 (p&lt;0.001), 30.1±1.5 vs 49.5±4.9 mm (p&lt;0.001) and 30.9±1.5 vs 44.9±3.3 mm (p&lt;0.001). Peak annular surface area and regurgitation volume in patients showed a positive correlation with systolic BP (y = 0.156x − 0.077, r=0.60 and y = 1.136x − 99.7, r=0.80, respectively).

Conclusions
We have demonstrated pressure constrained mitral annular dysfunction in Barlow's disease, indicating that systemic blood pressure may modify the severity of regurgitation. The study provides novel insights into mechanisms of mitral regurgitation and potential therapeutic actions in the future.
Figure 1

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Grieg Foundation
Transcatheter echo guided mitral valve repair with neochord implantation for posterior leaflet disease
Authors: Mahia P , Cobiella J , Enriquez D , Carnero M , Maroto L , Perez De Isla L , Macaya C 
Published: November 2020

Abstract

Background/Introduction
Transapical off-pump mitral valve repair with NeoChord implantation (TOP-MINI) has become applied for patients presenting with severe mitral regurgitation (MR) due to posterior leaflet (PML) prolapse or flail. The procedure is performed under real-time 2D- and 3D-transesophageal echocardiography for both implantation and neochordae tension adjustment allowing real-time monitoring of hemodynamic recovery.

Purpose
This prospective study sought to evaluate acute safety and efficacy of this innovative, minimally invasive, transcatheter mitral valve repair approach.

Methods
33 symptomatic patients patients with severe MR secondary to PML flail/prolapse (March 2017-Dec 2019) were included. Patients were stratified on the basis of the preoperative 3D transesophageal echocardiography assessment of MV morphology: type A, isolated central PML prolapse/flail (25 patients); type B, posterior multisegment prolapse/flail (3 patients); type C and D, anterior or bileaflet prolapse/flail or paracommissural prolapse/flail or any type of disease with the presence of significant leaflet/annular calcifications (5 patients). Type A was considered the more favorable morphology.

Results
Median age was 67.7±13.4 y. Median EuroSCORE-II 2.7%±1.91. Procedural success was achieved in 28 patients (84,9%). 5 patients, 2 type A and 3 type D, underwent conversion to open surgery for immediate failure. The median number of chords implanted was 3.1±0.6. 1 high-risk patient considered inoperable because of severe comorbidities and extensive annular calcifications died before discharge. Postoperative length of stay was 4.25±1 days. At 12.3±4.9 months median follow-up, MR≤moderate was present in 25 (90%). Overall 1-year survival was 100%. Freedom from reintervention was 97% for overall population. Transthoracic echocardiography at 1 year revealed ventricular reverse remodeling, with a significant decrease in indexed left ventricular end- end-systolic volumes (25.3±6.4 to 21.6±8.2 mL/m2, P&lt;0.001). 92.9% were in New York Heart Association class I.

Conclusions
TOP-MINI procedure is a feasible, low-risk technique that allows safely repair degenerative mitral valve failure secondary to prolapse/flail valvular and its efficacy is maintained up to 1-year.

Funding Acknowledgement
Type of funding source: None
Transcatheter versus surgical aortic valve replacement: an updated systematic review and meta-analysis with a focus on outcomes by sex
Authors: Dagan M , Yeung T , Stehli J , Stub D , Walton A.S , Duffy S.J 
Published: November 2020

Abstract

Background and purpose
Women at increased surgical risk have been shown to have better outcomes with transcatheter aortic valve implantation (TAVI) as compared to surgical valve replacement (SAVR). With the scope of TAVI moving into low-surgical risk patients we aimed to update the current literature to include the new low-risk randomized controlled trial data in investigating outcomes by sex.

Methods
We systematically searched MedlineOVID, PubMed, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and reference lists for relevant randomised controlled trials (RCTs) comparing TAVI to SAVR published prior to October 7th 2019. Data extraction was performed by two independent authors and included trial design details, baseline characteristics and outcome data stratified by sex. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Quantitative synthesis of pooled data was performed using Mantel-Haenszel fixed or random effects model. Q-statistic and the I2 test were used for assessment of heterogeneity.

Results
Our search yielded eight RCTs included in the final quantitative synthesis. The overall pooled cohort was 8,040, of whom 41.4% were female. Women had significantly lower rates of one-year all-cause mortality and one-year composite endpoint with TAVI as compared to SAVR. The selective mortality benefit with TAVI over SAVR in women did not persist to five-years. At 30-days, women demonstrated lower rates of major bleeding and acute kidney injury following TAVI compared to SAVR. For men, these outcomes were similar regardless of type of intervention. Both sexes were at increased risk of major vascular complications with TAVI as compared to SAVR, however women demonstrated nearly double the odds of major vascular complication with TAVI compared to men.

Conclusion
Our updated meta-analysis demonstrates that at one-year women undergoing TAVI have significantly lower mortality and better safety outcomes compared to those undergoing SAVR. These benefits are not seen in men. In the new low-risk era, these results are ever more important for guiding appropriate patient selection.
Composite endpoint at one-year

Funding Acknowledgement
Type of funding source: None
Doppler echocardiographic predictors of low mitral valve area after implantation of one MitraClip: time for a paradigm shift?
Authors: Kassar M , Brugger N , Seiler C , Windecker S , Praz F 
Published: November 2020

Abstract

Introduction
During edge-to-edge therapy using MitraClip (MC) for severe mitral regurgitation (MR) the interventional cardiologists usually rely on the mean transmitral gradient to decide if they “go for” a second clip in case of suboptimal MR reduction or to stabilise the first MC in the context of prolapse or flail leaflet. The value of this parameter to detect low mitral valve area (MVA) is unknown.

Method
During each intervention of the last two years, high quality volumes focused on the MV were acquired. Using a dedicated 3-D analysis software and a new planimetry method, we measured the MVA before and after the implantation of one MC (each orifice was evaluate independently on the most optimal plane). The usual transmitral CW-Doppler parameters (mean gradient (MG), VTI, PHT) were evaluated.

Results
We included 120 patients, 69 primary (PMR) and 51 secondary (SMR) mitral regurgitation. For all the parameters, the best model for the curve fitting was y = a + b / x and the two parameters who best correlated with the MVA after MC were PHT (R2 0.67, p=0.0001) and MG (R2 0.28, p. 0001). Looking at SMR, the correlation with PHT was even better but there was no correlation with MG. In PMR, the correlation with MG was good but still lower than with PHT (Figure 1). The ROC analysis for PHT showed an AUC of 0.948 and defined an optimal cut-off of 127ms with sensibility and specificity 91% to detect a MVA &lt;2 cm2 after one MC.

Conclusion
The transmitral MG appears as a poor parameter to predict low MVA after the implantation of one MC, especially in SMR probably because in this population the MG depends more on the flow than on the MVA. In the contrary PHT appears as a robust parameter.
Figure 1

Funding Acknowledgement
Type of funding source: None