bluuebunny/crossref_metadata_2025_split huggingface dataset:
Post-surgical outcomes in infective endocarditis patients with liver disease: nationwide propensity-match analysis
Authors: Ludhwani D.L , Vemireddy L.V , Patel R.P , Jhaveri K.J , Zaidi A.Z 
Published: November 2020

Abstract

Introduction
Surgery remains the definitive treatment for persistent infective endocarditis (IE). Age, renal dysfunction and diabetes mellitus are few amongst the many associated with increased post-surgical mortality. Liver dysfunction is a common entity seen in patients with IE. Data on post-surgical sequelae in patients with IE and liver disease is lacking.

Method
We performed a retrospective cross-sectional analysis of all adult (age&gt;18 years) admissions with a discharge diagnosis of acute or sub-acute IE using the 2016 National Inpatient Sample (NIS). IE patients undergoing valve replacement or repair were identified and divided into two groups based on the presence or absence of liver disease. Propensity score matching was performed to control for confounders such as diabetes, age, smoking among others. Odds of in-hospital mortality, cardiogenic shock, and acute kidney injury were calculated using multivariate logistic regression analysis. IE patients without liver disease undergoing valve surgery were selected as the reference population.

Results
We identified a total of 9,822 IE related admissions in the 2016 NIS. Amongst all IE admissions, 11.7% (n=1,158) had either valve replacement or repair surgery performed. After using propensity scores for 1 to 1 matching 16.8% of patients (n=195) who had concomitant liver disease were compared with 195 patients without liver disease. In-hospital mortality was significantly higher in patients with hepatic impairment (14.3% vs 0.51%, p=0.004). Patients with liver disease also had higher odds of concurrent cardiogenic shock (OR=9.35, 95% CI=3.01–29.15, p=0.001), acute kidney injury (OR=2.13, 95% CI=1.15–3.93, p=0.01), and thrombocytopenia (OR=2.29, 95% CI=1.13–4.61, p=0.02).

Discussion
The presence of liver disease in the setting of IE, in patients undergoing valvular surgery significantly increases the morbidity and mortality post-operatively. Functional status of the liver should be considered in addition to the commonly used tools for cardiac operative risk evaluation.

Funding Acknowledgement
Type of funding source: None
Early safety outcome in patients requiring conversion to general anesthesia during transfemoral transcatheter aortic valve replacement
Authors: Mayr P , Pellegrini C , Rheude T , Trenkwalder T , Alvarez-Covarrubias H , Xhepa E , Wiesner G , Schunkert H , Tassani-Prell P , Joner M 
Published: November 2020

Abstract

Background
Transfemoral TAVR (tf-TAVR) has become an established therapy. Conscious sedation (CS) is a alternative to general anesthesia (GA). So far, the outcome of patients undergoing unplanned conversion from CS to GA has not been investigated.

Methods
All patients undergoing tf-TAVR in CS between 2014 and 2019 were included. Primary endpoint was early safety at 30 days according to VARC-2 criteria. The reasons for conversion and length of ICU-/ hospital-stay were further analyzed.

Results
Of 1058 patients 35 (3.3%) required a conversion. Baseline characteristics were similar among groups. The combined VARC-2 endpoint was documented in 13 (37%) of the converted and 110 (11%) of non-converted patients (p&lt;0.001). Four major sub-groups were underlying causes: unrest in 11/35, procedural complications in 10/35, respiratory distress in 8/35 and cardiovascular decompensation in 6/35 patients. An univariable analysis was performed to identify risk factors for unplanned conversion due to respiratory distress or cardiovascular decompensation (Table). Compared to the group without conversion (Median [IQR], 4 [4–5] days), length of hospital stay was longest in the group with procedural complications (6 [1–11] days) followed by cardiovascular decompensation (5 [4–7] days).

Conclusions
The conversion rate to general anesthesia was overall low but associated with a higher observation of the composite endpoint. Hospital stay was longer dependent on the reason for conversion. A thorough understanding of the frequency, causal factors and clinical significance of unplanned conversion to general anesthesia is of utmost clinical relevance taking a general trend towards a minimalist approach into consideration.

Funding Acknowledgement
Type of funding source: None
Anatomical changes in tricuspid annulus and tricuspid regurgitation reduction after Cardioband implantation
Authors: Garcia Martin A , Fernandez-Golfin C , Sanchez Recalde A , Salido-Tahoces L , Lorente Ros A , Hinojar Baydes R , Gonzalez-Gomez A , Jimenez Nacher J.J , Zamorano J.L 
Published: November 2020

Abstract

Introduction
Isolated tricuspid regurgitation (TR) is an entity of high prevalence and associated with poor prognosis. Traditionally, treatment options have been limited because high surgery mortality. In this context, new percutaneous therapeutic options have appeared. The objective of this study is to describe the anatomical changes in tricuspid annulus (TA) and the immediate response in the TR severity after implantation of the Cardioband tricuspid system as well as the safety of the procedure.

Methods
Patients undergoing Cardioband implantation in our center where included. The diameter and area of the TA were measured by 2D and 3D transesophageal echocardiography (TEE) before and immediate after the implantation. TR severity was evaluated by the vena contracta width (VC) in 0 and 90 degrees by 2D TEE.

Results
Six patients (81.3 (79–85) years, 66.3% females) were included. The etiology of TR was dilatation of the ring in two cases, secondary to left valvulopathy in three cases and secondary to type III pulmonary hypertension in other case. Four patients presented basal severe TR, and two patients massive TR.
A significant reduction in TA diameters (reduction TA diameter 0°: 10.6 mm; 90°: 12.2 mm) and 3D TA area (4.5 mm2) was observed immediately after the procedure as well as a reduction in the VC width (reduction VC 0°: 4.8 mm; 90°: 3.9 mm). Table 1 shows the measurements before and after the procedure.
The success of the procedure was 84% (Five patients reduced one-degree TR severity, and one reduced two degrees TR severity). One patient was partial success because the complete implant of all anchors could not be performed. There was 0% intraprocedural mortality or major complications. There were two minor complications, one related to vascular access and the other related to an intra-atrial thrombus, both resolved.

Conclusions
The new percutaneous techniques to treat TR are a reality, and preliminary results seem to indicate that they are a safe and effective alternative, reducing the size of the ring and the severity of valvulopathy. Further studies and longer clinical follow-up will lead to the generalization of these new techniques.

Funding Acknowledgement
Type of funding source: None
Meta-analysis and meta-regression of early aortic valve replacement versus watchful waiting in asymptomatic severe aortic stenosis: a 2020 boost of evidence
Authors: Costa G , Oliveiros B , Goncalves L , Teixeira R 
Published: November 2020

Abstract

Background
Current guidelines recommend aortic-valve replacement (AVR) as the only effective therapy for severe symptomatic aortic stenosis (AS) patients. Nevertheless, management and timing of intervention in asymptomatic AS remains a controversial topic, with sparse evidence to support the recommendations (level C).

Purpose
To assess an early-AVR strategy in asymptomatic severe AS, comparing it with a watchful waiting (WW) strategy

Methods
We systematically searched PubMed, Embase and Cochrane databases, in February 2020, for both interventional or observational studies comparing early-AVR with WW in the treatment of asymptomatic severe AS. Random-effects meta-analysis for early-AVR and WW were performed. Meta-regression was used to assess the influence of study characteristics on the outcome.

Results
Eight studies were included (seven registry-based or unrandomized studies and one randomized clinical trial) providing a total of 3985 patients, and 1232 pooled all-cause deaths (172 in early-AVR and 1060 in watchful waiting). Meta-analysis showed a significantly lower all-cause mortality for the early-AVR compared with WW group (pooled OR 0.24 [0.17, 0.32], P&lt;0.01) although with a moderate amount of heterogeneity between studies in the magnitude of effect (I2=57%, P=0.02). The early-AVR patients also displayed a lower cardiovascular mortality (pooled OR 0.27 [0.15, 0.48], P&lt;0.01) plus a lower heart failure hospitalization rate (pooled OR 0.27 [0.06, 0.65], P&lt;0.007). No difference in clinical thromboembolic event rate (stroke or myocardial infarction) was noted.
The meta-regression for all cause mortality based on possible confounders such as time of follow-up, age, gender, diabetes mellitus, coronary artery disease, left ventricular ejection fraction, and mean peak aortic jet velocity showed that effect sizes reported by the individual studies seem to be independent from the covariates considered (P&gt;0.05).

Conclusions
Our 2020 pooled data reinforces the previous evidence suggesting the benefit of early-AVR in asymptomatic patients with severe AS.
Early AVR vs WW, All-cause death

Funding Acknowledgement
Type of funding source: None
Bicuspid aortic valve: prompt identification of high-risk groups in a heterogeneous disease
Authors: Carrero M.C , Constantin I , Masson G , Mezzadra M , Ruano M , Diaz Babio G , Pessio C , De Stefano L , Lopez Rosetti M , San Miguel J , Espinosa E , Stutzbach P 
Published: November 2020

Abstract

Background
Bicuspid aortic valve (BAV) is a congenital heart disease that can be associated with aortic and/or valve complications. Although most BAV are predisposed to progressive calcification, little is known on variables related to significant valvular dysfunction. BAV is a heterogeneous disease, therefore it is important to identify high-risk groups for a closer follow- up and timely intervention.

Objective
Identify the main determinants of primary cardiovascular events (aortic valve replacement, aortic surgery and death) in a cohort of adults with BAV.

Methods
We included 325 consecutive patients with non-syndromatic BAV (2010–2019) referred to our hospital (3rd level). Clinical information was prospectively collected. All patients underwent serial echocardiograms and Cardiac CT was available in 125 patients (38%). We performed univariate and multivariate analyses and Kaplan-Meyer survival analysis with log-rank test. A p-value &lt;0.05 was considered significant.

Results
325 patients (44.4±15.3 years, 73% men), right–left coronary cusp fusion (RL) in 79%,and presence of raphe in 77%. 100 patients (31.2%) had significant aortic valve dysfunction and 103 (31.7%) had aortic dialatation (&gt;40mm) at the onset of the follow-up. Twenty-nine patients required cardiac surgery (8.9%, mainly symptomatic severe aortic stenosis with aortic valve replacement)and 3 died (1%) during a follow-up of 6.3±1.2 years. Patients with at least 2 of the following determinants at baseline: aortic valve prolapse, aortic valve calcification &gt;1, age &gt;50 years and/or aorta &gt;45mm had higher risk of major cardiovascular events during follow-up (Chi2 for log rank test=27,229 p=0,000005).

Conclusions
In this study population of young adults with BAV we observed a high incidence of events related to the BAV. Age&gt;50 years, aortic valve calcification, aortic valve prolapse and aortic dilatation were independently associated with primary cardiac events. Despite significant BAV heterogeneity, the identification of risk factors may help to stratify the risk of valvular dysfunction, aortic dilatation and major cardiovascular events.
BAV: Risk factors for cardiac surgery

Funding Acknowledgement
Type of funding source: None
Plasma lipids and risk of aortic valve stenosis: a Mendelian randomization study
Authors: Nazarzadeh M , Pinho-Gomes A.-C , Bidel Z , Dehghan A , Canoy D , Hassaine A , Solares R.-A , Salimi-Khorshidi G.H , Smith G.D , Otto C.M , Rahimi K 
Published: November 2020

Abstract

Background
Aortic valve stenosis is commonly considered a degenerative disorder with no recommended preventive intervention, with only valve replacement surgery or catheter intervention as treatment options.

Purpose
We sought to assess the causal association between exposure to lipid levels and risk of aortic stenosis.

Methods
Causality of association was assessed using two-sample Mendelian Randomization (MR) framework through different statistical methods. MR approach uses instrumental variable analysis to mimic the randomization process that underpins causal inference in clinical trials. It takes advantage of the naturally-occurring random allocation of alleles inherited by offspring from their parents during the formation of the zygote. We retrieved summary estimations of 157 genetic variants that have been shown to be associated with plasma lipid levels in the Global Lipids Genetics Consortium that included 188,577 participants, mostly European ancestry, and genetic association with aortic stenosis as the main outcome from a total of 432,173 participants in the UK Biobank. Secondary negative control outcomes included aortic regurgitation and mitral regurgitation.

Results
The odds ratio (OR) for developing aortic stenosis per unit increase in lipid parameter was 1.52 (95% confidence interval [CI], 1.22 to 1.90; per 0.98 mmol/L) for low-density lipoprotein (LDL) cholesterol, 1.03 (95% CI, 0.80 to 1.31; per 0.41 mmol/L) for high-density lipoprotein (HDL) cholesterol, and 1.38 (95% CI 0.92 to 2.07; per 1 mmol/L) for triglycerides. There was no evidence of a causal association between any of the lipid parameters and aortic or mitral regurgitation.

Conclusion
Lifelong exposure to high LDL-cholesterol increases the risk of symptomatic aortic stenosis, suggesting that LDL-lowering treatment may be effective in its prevention.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): British Heart Foundation
The impact of frailty in an endocarditis cohort: association with length of stay and mortality
Authors: Primus C.P , Bvekerwa I , McCue M , Menezes L , Serafino-Wani R , Das S , Wong K , Uppal R , Ambekar S , Bhatacharyya S , Woldman S , Davies L.C 
Published: November 2020

Abstract

Introduction
Predictors of poor outcome are well established in Endocarditis (IE). “Frailty” refers to a syndrome of physiological decline associated with adverse health outcomes. Gilbert et al.(Lancet, 2018) developed a Hospital Frailty Risk Score (HFRS) that predicts 30-day mortality and length of stay (LOS).

Aim
Identify impact of an abbreviated HFRS (aHFRS) on in-hospital survival and LOS in IE given high morbidity and mortality.

Methods
Retrospective analysis of prospectively collected cases (Jan 2018–date). aHFRS score was calculated with key IE, cardiac, respiratory, oncology & frailty diagnoses. Univariate regression was applied overall and in key “cohorts” (native & prosthetic IE, medical & surgical management) for survival and LOS.

Results
Of 334 cases, LOS data were available in 317; mean age 57.8y (range 17–91, male 74%). Table 1 describes key cohorts. Mortality was 10.1% (medical, 11.9%; surgical, 8.3%). Mean LOS was 31.2 days (range 0–224).
Mean aHFRS was 5.38diagnoses (SD 2.61, range 0–14); 1.65 pre-IE and 3.73 attributed to IE alone, consistent across cohorts. Regression analyses highlight increasing LOS with increasing aHFRS (r2=0.06, Figure 1). Table 1 summarises the modest impact of aHFRS on LOS, and a trend to worse outcome in medical management (r2=0.02).

Discussion
Higher aHFRS is associated with longer LOS and a trend to higher mortality in medically managed IE. IE itself is associated with a number of frailty diagnoses. To improve outlook and provide holistic care, the IE Team may need to include experts in frailty. Satisfactory outcomes may require intensive post-IE rehabilitation.

Funding Acknowledgement
Type of funding source: None
Infective endocarditis in patients who use IV drugs: a single centre cohort
Authors: Alraddadi H , Alsagheir A , Gao S , An K , Hronyecz H , Parry D , Whitlock R.P , Belley-Cote E 
Published: November 2020

Abstract

Background
Managing endocarditis in intravenous drug use (IVDU) patients is challenging: unless patients successfully quit IVDU, the risk of re-infection is high. Clinicians often raise concerns with ethical and resource allocation principles when considering valve replacement surgery in this patient population. To help inform practice, we sought to determine the long-term outcomes of IVDU patients with endocarditis who underwent valve surgery in our center.

Method
After research ethics board approval, infective endocarditis cases managed surgically at our General Hospital between 2009 and 2018 were identified through the Cardiac Care Network. We reviewed patients' charts and included those with a history of IVDU in this study. We abstracted data on baseline characteristics, peri-operative course, short- and long-term outcomes. We report results using descriptive statistics.

Results
We identified 124 IVDU patients with surgically managed endocarditis. Mean age was 37 years (SD 11), 61% were females and 8% had redo surgery. During admission, 45% (n=56) of the patients had an embolic event: 63% pulmonary, 30% cerebral, 18% peripheral and 11% mesenteric. Causative organisms included Methicillin-Sensitive Staphylococcus Aureus (51%, n=63), Methicillin-Resistant Staphylococcus Aureus (15%, n=19), Streptococcus Viridans (2%, n=2), and others (31%, n=38). Emergency cardiac surgery was performed for 42% of patients (n=52). Most patients (84%) had single valve intervention: 53% tricuspid, 18% aortic and 13% mitral. Double valve interventions occurred in 15% (n=18). Overall, bioprosthetic replacement was most commonly chosen (79%, n=98). In-hospital mortality was 7% (n=8). Median length of stay in hospital was 13 days (IQR 8,21) and ICU 2 days (IQR 1,6). Mortality at longest available follow-up was 24% (n=30), with a median follow-up of 129 days (IQR 15,416). Valve reintervention rate was 11% (n=13) and readmission rate was 14% (n=17) at a median of 275 days (IQR 54,502).

Conclusion
Despite their critical condition, IVDU patients with endocarditis have good intra-hospital outcomes. Challenges occur after hospital discharge with loss of follow-up and high short-term mortality. IVDU relapse likely accounts for some of these issues. In-hospital and community comprehensive addiction management may improve these patients' outcomes beyond the surgical procedure.
Annual rate 2009–2018

Funding Acknowledgement
Type of funding source: None
Diphosphonate single-photon emission computed tomography in cardiac transthyretin amyloidosis
Authors: Aimo A , Grigoratos C , Rapezzi C , Genovesi D , Barison A , Aquaro G.D , Vergaro G , Pucci A , Passino C , Marzullo P , Gimelli A , Emdin M 
Published: November 2020

Abstract

Background
Planar diphosphonate scintigraphy is an established diagnostic tool for amyloid transthyretin (ATTR) cardiomyopathy. Characterization of the amyloid burden up to the segmental level by single photon emission computed tomography (SPECT) has not been evaluated so far.

Methods
Data from consecutive patients undergoing cardiac 99mTc-hydroxymethylene diphosphonate (99mTc-HMDP) SPECT and diagnosed with ATTR cardiomyopathy at a tertiary referral center from June 2016 to April 2019 were collected.

Results
Thirty-eight patients were included (median age 81 years, 79% men, 92% with wild-type ATTR). In patients with Perugini score 1, the most intense diphosphonate regional uptake was found in septal segments, particularly in infero-septal segments. Among patients scoring 2, the amyloid burden in the septum became more significant, and extended to inferior and apical segments. Finally, patients scoring 3 displayed an intense and widespread tracer uptake. All patients with Perugini score 1 had LGE in at least one antero-septal, one infero-septal, and one infero-lateral segment. All patients with score 2 displayed LGE in infero-septal, inferior, and infero-lateral segments. LGE became extensive in patients scoring 3, with all patients having at least one LGE-positive segment in each region.

Conclusions
When assimilating different Perugini grades to evolutive stages of the disease, amyloid deposition seem to progress from the septum to the inferior wall and then to the other regions and from the basis to the apex. The potential of segmental analysis might be particularly relevant in patients with very limited cardiac uptake at planar scintigraphy (Perugini score 1).

Funding Acknowledgement
Type of funding source: None
Circumferential deformation in diagnosis and risk assessment of patients with left ventricular non-compaction
Authors: Anwer S , Heiniger P.S , Rogler S , Cassani D , Rebellius L , Kuzo N , Gotschy A , Erhart L , Kebernik J , Schmid D , Pazhenkottil A.P , Meyer M , Schoenenberger-Berzins R , Gruner C , Tanner F.C 
Published: November 2020

Abstract

Introduction
Echocardiography-based deformation analysis is used for studying left ventricular (LV) mechanics and have an emerging role in the diagnosis of cardiomyopathies. Left ventricular non-compaction (LVNC) is a rare cardiomyopathy characterised by a two-layered LV myocardium with prominent trabeculae separated by deep recesses perfused from the LV cavity. Left ventricular hypertrabeculation (LVHT) may be difficult to differentiate from LVNC. In this study, we aim to develop a diagnostic algorithm based on the circumferential deformation (CD) of LVNC, LVHT and controls; and find their associations with LVNC outcomes.

Methods
We compared 45 LVNC patients, 45 LVHT individuals, and 45 matched healthy controls. LVNC was diagnosed according to current echocardiographic criteria. LVHT was defined as presence of three or more trabeculae in the LV apex visualised in both parasternal short axis and apical views. Controls had a normal echocardiographic examination and no evidence of cardiovascular disease. Strain analysis was performed using TomTec Image-Arena (version 4.6).

Results
Receiver observer characteristics curve (ROC) analyses revealed that GCS &lt;22.3% differentiated LVNC from control or LVHT. In individuals with global circumferential strain (GCS) below 22.3%, an apical peak circumferential strain (PCS) cut-off value of 18.4% differentiated LVNC [&lt;18.4%] and LVHT [≥18.4%] (fig. 1). An independent echocardiographer (Table 1) performed blind validation of diagnosis on 32 subjects from each group.
Combined endpoint of cardiovascular events in LVNC (CVE) is described in figure 2. Multi-variate regression analyses have shown that GCS was associated with 11-fold increased risk of CVE independent of LVEF and NC:C ratio, while global longitudinal strain (GLS) displayed only 2-fold increased risk. Regional basal and apical peak circumferential or longitudinal strain, left ventricular twist, basal-apical rotation ratio have shown significant associations (Fig. 3).

Conclusions
A diagnostic algorithm with GCS and aPCS (threshold value 18.4%) differentiates LVNC from LVHT and control with very high sensitivity and specificity independent of additional echocardiographic or clinical information. Circumferential strain derived parameters exhibit a very strong association with outcomes independent of LVEF and NC:C ratio. Absence of CVE in LVHT provides further evidence on the distinct nature of LVNC and LVHT.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): 2018 research grant from the Swiss Heart Foundation