bluuebunny/crossref_metadata_2025_split huggingface dataset:
The GRACE scale in the prognosis of patients with Takotsubo syndrome
Authors: Zalewska-Adamiec M , Kuzma L , Dobrzycki S , Bachorzewska-Gajewska H 
Published: November 2020

Abstract

Background
The prognosis of Takotsubo syndrome (TTS) is comparable to that of the non-ST-elevation myocardial infarction (NSTEMI). The GRACE scale is used to assess the risk of premature and long-term mortality in patients with NSTEMI in order to select the most favorable treatment strategy.

Methods
101 patients with TTS were hospitalized in 4 centers of invasive cardiology in Podlaskie Voivodeship during the period 2008–2012 were included in the study. The patients were divided into 2 groups: I – 52 patients (GRACE ≤140 points) and II – 49 patients (GRACE &gt;140 points).

Results
The mean GRACE score in study group was 138.66. The course of Takotsubo in the patients with higher GRACE scores was associated with higher incidence of pneumonia (36,7% vs 7,69%, p=0,0004), rhythm abnormalities (17,3% vs 3,85%, p=0,026) and serious complications (cardiogenic shock, pulmonary edema, and sudden cardiac arrest) (30,6% vs 5,77%, p=0,001).
The mean observation period was 7.2 years. A significantly higher risk of 6-month (18,37% vs 3,85%, p=0,019),1-year (22,45 vs 3,85%, p=0,005), 3-year (40,82 vs 3,85%, p&lt;0,0001), 5-year (42,86% vs 3,85%, p&lt;0,0001) and 7-year mortality (53,06% vs 9,62%, p&lt;0,0001) was observed in the group of patients with a GRACE score ≥140. The death risk factors in the multivariate analysis performed were low BMI, low eGFR, and a higher GRACE score
The ROC curve presents the discriminatory scores of the GRACE scale for the follow-up prognosis. The area under ROC curve (AUC) for the GRACE scale was 0.805 (95% CI - 0.718–0.892, p&lt;0.001), with a cut-off value of 153 points, sensitivity of 74%, and specificity of 77% for TTS.

Conclusion
The GRACE scale is highly valuable for the prognosis of death risk in patients with TTS in the early and follow-up period.

Funding Acknowledgement
Type of funding source: None
Longitudinal strain in patients with severe aortic regurgitation: superiority to ejection fraction for detection of myocardial dysfunction
Authors: Reil J.C , Reil G.-H , Necker N , Borer J , Sievers H.H , Ensminger S , Marquetand C , Stierle U , Schaefers H.J , Langer H.F , Aboud A 
Published: November 2020

Abstract

Objectives
The aim of the study was to analyse LV systolic function and mechanical energetics in asymptomatic patients with severe aortic regurgitation (AR) to seek a new hemodynamic concept for timing for surgery.

Background
Current guidelines suggest surgery for patients with severe AR including clinical symptoms, subnormal LV ejection fraction (EF), or markedly abnormal left ventricular dimensions. However, the optimal measure to detect intrinsic myocardial systolic dysfunction in the presence of normal LVEF remains elusive.

Methods
Strain and echo-derived single beat pressure-volume analyses were performed in cohorts with severe AR without indication for surgery (ARNS; LVEDD &lt;70mm, EF &gt;50%, n=41), with indication for surgery (ARS; n=19) and in healthy, age-matched controls (C; n=20). Additionally, end-systolic elastance (Ees=LV contractility), stroke work (SW) and total energy (PVA) were calculated.

Results
Patients with ARNS demonstrated significant depression of LV contractility vs. C: Ees (1.5mmHg/ml ±0.7 vs. 2.25mmHg/ml ±0.7; p&lt;0.001), despite comparable ejection fractions (EF: 0.56±0.05 vs. 0.60±0.07; p=0.10). Accordingly, global longitudinal strain (GLS) was decreased (−16.0±2.5% vs. −21.5±2%; p&lt;0.001), end-diastolic volume markedly enlarged (236ml ±90 vs. 136ml ±30; p&lt;0.001), as were PVA and SW indicating waste of energy. The correlation of GLS vs. Ees was good (r=−0.68; p&lt;0.001). Results of ARS-patients were consistently worse.

Conclusion
Patients with severe AR and normal LVEF showed depressed LV contractility and waste of energy when assessed by Ees and GLS, both correlating well with each other. Hence, GLS may outperform LV dimensions for predicting timing for surgery and clinical outcomes in AR patients.

Funding Acknowledgement
Type of funding source: None
Invasive exercise hemodynamics in patients with severe primary mitral regurgitation and preserved ejection fraction predicts future valve surgery
Authors: Hein M , Neu J.N , Dorfs S.D , Doerken S.D , Zeh W.Z , Neumann N.J , Minners J.M , Jander N.J 
Published: November 2020

Abstract

Background
The role of invasive exercise hemodynamics in the management of asymptomatic patients with severe primary mitral regurgitation (MR) is unclear.

Methods and results
We compared the predictive power of parameters of invasive exercise testing for future valve surgery to guideline-defined non-invasive criteria. Maximal pulmonary capillary wedge pressure (PCWP), PCWP normalized to workload and weight (PCWL), and invasive maximal systolic pulmonary artery pressure (SPAP) were assessed in 113 asymptomatic patients with severe primary MR between 1996 and 2012. Mean age was 52±11 years, 16% were female, ejection fraction was ≥55% in all patients. During a median follow up of 4.5 years (IQR2.0; 8.3) 54 patients (48%) underwent valve surgery. In univariate analysis PCWP (P&lt;0.001), PCWL (P&lt;0.001), and maximal SPAP (P=0.009) were significantly associated with future mitral valve surgery. In multivariate analysis maximum PCWP and PCWL predicted future mitral valve surgery (HR 2.1 (1.44–3.10), P=0.005 and HR 1.31 (1.14–1.52), P&lt;0.001, respectively) whereas SPAP did not. Adding maximum PCWP &gt;25mmHg to a Cox regression model based on non-invasive guideline criteria resulted in a significant increase in the area under the curve (0.61 to 0.68, P=0.02).

Conclusion
In asymptomatic patients with severe primary mitral regurgitation and preserved left ventricular function invasive exercise hemodynamics improves information derived from current non-invasive guideline criteria.
Figure 1

Funding Acknowledgement
Type of funding source: None
Early single center experience with a novel transcatheter anuloplasty system for the treatment of functional tricuspid regurgitation
Authors: Landendinger M , Smolka S , Marwan M , Troebs M , Anneken L , Gaede L , Achenbach S , Arnold M 
Published: November 2020

Abstract

Background
Functional tricuspid regurgitation (TR) is increasingly recognized as relevant, but undertreated clinical entity. Since surgical repair or replacement of the tricuspid valve is associated with high mortality, many patients with with severe tricuspid regurgitation are not referred to surgery. Transcatheter anuloplasty is a new interventional treatment option for tricuspid regurgitation. We report the outcome of a consecutive single-center series of 11 patients treated with this technique.

Methods
Clinical and procedural data as well as mid-term outcome of a series comprising 11 consecutive patients (9 female, mean age 80±5 years, mean LV-EF 53±7, mean PAP 27±4 mmHg) who underwent transcatheter tricuspid anuloplasty for secondary tricuspid regurgitation in a 12-month period (Octover 2018–October 2019) were systematically collected, including pre- and post-procedural transthoracic/transesophageal echocardiogryphy (TTE/TEE). Patients were selected for the procedure based on clinical, echocardiographic and CT findings. All patients were treated using the Cardioband® system (Hersteller, Ort) in general anesthesia under 4D-TEE guidance.

Results
Mean procedural duration was 259±46 min across all 11 patients. Device success was 91%. In one patient extensive tricuspid annular excursions prevented anuloplasty band implantation. The mean grade of TR severity was reduced from 3.5 to 2.1, p=0,00016 (vena contracta decreased from 11±4 to 6±3 mm, p=0,0047).73% of all patients achieved pos-procedure TR severity ≤2. Procedural complications were infrequent: one patient required coronary stent implantation to the RCA kinking and in an further patient, transient 3rd degree AV bock occurred during the procedure. No patient died during the index hospital stay or during the follow up period (median follow up of 4 months). The NYHA classification improved from a median of III before the procedure to a median of II at follow-up (p=0,00022).

Conclusion
Transcatheter tricuspid annuloplasty permits effective treatment of functional tricuspid regurgitation with a low complication rate and sustained symptomatic improvement.

Funding Acknowledgement
Type of funding source: None
Safety and feasibility of retrograde inoue balloon for balloon aortic valvuloplasty without rapid ventricular pacing during transcatheter aortic valve implantation
Authors: Ninomiya R , Ishida M , Tosaka K , Kanehama N , Ishikawa Y , Fusazaki T , Kin H , Morino Y 
Published: November 2020

Abstract

Background
Although rapid ventricular pacing (RVP) is commonly performed for preparation of transcatheter aortic valve implantation (TAVI). It has been reported that multiple and / or prolonged RVP is associated with adverse clinical outcomes of TAVI. Retrograde Inoue-Balloon was designed for balloon aortic valvuloplasty (BAV) without RVP to prevent slip of balloon by way of central waist during biphasic inflation.

Purpose
The purpose of this study was to evaluate safety and feasibility of Retrograde Inoue-Balloon for TAVI preparation.

Methods
From December 2013 to December 2019, 427 consecutive patients who performed TAVI for severe aortic valve stenosis, were retrospectively enrolled in Iwate Medical University. Of them, 227 (53%) patients (mean age 83±5 years, male 41%), underwent retrograde BAV before prosthetic valve implantation, comprised this study population. Retrograde BAV procedures were divided into two groups; patients used Inoue-Balloon without RVP and those did conventional balloon with RVP. The primary endpoint was defined as combined adverse events of 30-day mortality, cerebral infarction, and critical complications after BAV (aortic dissection, aortic rupture and cardiopulmonary arrest). The secondary endpoint was set as prolonged hypotension after BAV.

Result
Inoue-Balloon (IB) and conventional balloon (CB) were used for 73 patients (32%) and 154 (68%) patients, respectively. Both balloons were succeeded to through and expand of aortic valve in all cases. In the CB group, cardiopulmonary arrest occurred in 2.0% after BAV, cerebral infarction was observed in 3.9%, and 30-day death in 3.3%. On the other hand, no major complications were observed except one aortic dissection in the IB group. In logistic regression analysis adjusted by sex and age, the incidence of combined adverse events was significantly lower in the IB group (OR 0.17, 95% CI 0.009–0.917, P=0.037). Furthermore, the IB group had significantly a lower incidence of prolonged hypotension following BAV compared with CB group (4.1% vs 19.5%, p=0.002).

Conclusion
Balloon aortic valvuloplasty using retrograde Inoue-balloon without rapid ventricular pacing is safe and feasible, and may improve clinical outcomes of TAVI.

Funding Acknowledgement
Type of funding source: None
MIDA mortality risk score in patients undergoing percutaneous edge-to-edge mitral repair
Authors: Kavsur R , Iliadis C , Metze C , Spieker M , Tiyerili V , Horn P , Baldus S , Kelm M , Nickenig G , Pfister R , Westenfeld R , Becher M.U 
Published: November 2020

Abstract

Background
Recent studies indicate that careful patient selection is key for the percutaneous edge-to-edge repair via MitraClip procedure. The MIDA Score represents a useful tool for patient selection and is validated in patients with degenerative mitral regurgitation (MR).

Aim
We here assessed the potential benefit of the MIDA Score for patients with functional or degenerative MR undergoing edge-to-edge mitral valve repair via the MitraClip procedure.

Methods
In the present study, we retrospectively included 520 patients from three Heart Centers undergoing MitraClip implantation for MR. All parameters of the MIDA Score were available in these patients, consisting of the 7 variables age, symptoms, atrial fibrillation, left atrial diameter, right ventricular systolic pressure, left-ventricular end-systolic diameter, left ventricular ejection fraction. According to the median MIDA-Score of 9 points, patients were stratified in to a high and a low MIDA Score group and association with all-cause mortality was evaluated. Moreover, MR was assessed in echocardiographic controls in 370 patients at discharge, 279 patients at 3-months and 222 patients at 12 months after MitraClip implantation.

Results
During 2-years follow-up after MitraClip implantation, 69 of 291 (24%) patients with a high MIDA Score and 25 of 229 (11%) patients with a low MIDA Score died. Kaplan-Meier analysis and log rank test showed inferior rates of death in patients with a low score (p&lt;0.001) and multivariate cox regression revealed an odds ratio of 0.54 (0.31–0.95; p=0.032) regarding 2-year survival in this group. Moreover, one point increase in the MIDA Score was associated with a 1.18-fold increase in the risk for mortality (1.02–1.36; p=0.025). Comparing patients with a high MIDA Score and patients with a low score, post-procedural residual moderate/severe MR tended to be more frequent in patients with a high MIDA Score at discharge (53% vs 43%; p=0.061), 3-months (50% vs 40%; p=0.091) and significantly at 12-months follow-up (52% vs 37%; p=0.029).

Conclusion
The MIDA Mortality Risk Score remained its predictive ability in patients with degenerative or function MR undergoing transcatheter edge-to-edge mitral valve repair. Moreover, a high MIDA score was associated with a higher frequency of post-procedural residual moderate/severe MR, indicating a lower effectiveness of this procedure in these patients.

Funding Acknowledgement
Type of funding source: None
Higher acceleration ejection time ratio predicts impaired prognosis in mild to moderate aortic stenosis
Authors: Einarsen E , Cramariuc D , Bahlmann E , Midtboe H , Chambers J.B , Rossebo A.B , Gerdts E 
Published: November 2020

Abstract

Introduction
Acceleration/ejection time (AT/ET) ratio is a marker of aortic stenosis (AS) severity, and a predictor of outcome in severe AS. The importance of ejection dynamics in mild and moderate AS has been less investigated.

Purpose
To investigate the impact of increased AT/ET ratio on prognosis in patients with mild-moderate AS.

Methods
Data from 1635 patients with asymptomatic mild-moderate AS with preserved ejection fraction enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis study was analysed. Covariates of higher AT/ET ratio was identified in linear regression analysis. Outcome was assessed in Cox regression analyses and reported as hazard ratio (HR) and 95% confidence interval (CI) per 1 standard deviation (SD) higher AT/ET ratio. Median follow-up time was 4 years.

Results
The total study population included 38% female, mean age 67 years and average peak aortic jet velocity was 3.02 m/s. Higher AT/ET ratio was significantly associated with lower ejection fraction, higher LV mass, higher aortic jet velocity, lower systolic blood pressure, low stroke volume index and lower stress-corrected midwall shortening (all p&lt;0.05). In Cox regression analyses, adjusting for these confounders including age and gender, 1 SD higher AT/ET ratio predicted a 29% increase in hazard for major cardiovascular events, 25% for cardiovascular death and hospitalization for heart failure and 23% increase in hazards for all-cause mortality (Table).

Conclusion
In asymptomatic mild-moderate AS patients free from diabetes and known cardiovascular disease, higher AT/ET ratio was associated with increased risk for major cardiovascular events, cardiovascular death and hospitalization for heart failure and all-cause mortality independent of traditional risk markers.

Funding Acknowledgement
Type of funding source: None
Is Isolated tricuspid regurgitation different from functional tricuspid regurgitation?
Authors: Vieitez Florez J.M , Monteagudo J.M , Mahia P , Marco I , Gonzalez T , Sitges M , Bouzas A , Gonzalez V , Alonso D , Carrasco F , Adeba A , Hinojar R , Fernandez-Golfin C , Zamorano J.L 
Published: November 2020

Abstract

Introduction
Isolated tricuspid regurgitation (TR) prevalence is increasing in the last decades. Its presence is associated with a worse prognosis when EROA is &gt;40 mm2. Because of high surgery risk and increasing incidence, isolated TR is a challenge in modern cardiology.

Purpose
To evaluate the prevalence and characteristics of isolated TR compared to other TR aetiologies in a large cohort of patients.

Methods
Prospective study where consecutive patients undergoing an echocardiographic study within a three-month period were included. All studies with at least moderate TR were selected. Isolated TR was defined as TR with no likely pulmonary hypertension (&gt;50 mmHg), no overt TR cause (no intrinsic tricuspid disease, LVEF ≥50%, no pacemaker/defibrillator wire across the tricuspid, no other significant valve disease, no disease that may cause TR, no congenital or pericardial heart disease); and no previous valve surgery. Patients with isolated TR and other aetiologies were compared.

Results
2121 patients with at least moderate TR were included. Isolated TR was found in 398 patients (18.8%). Basal characteristics are shown in table 1. Patients with isolated TR did not have a higher prevalence of AF (47.5% vs. 48.6% p=0.362). Isolated TR was less severe (20.5% vs. 32.1% of patients with severe TR; p&lt;0.001) and less symptomatic (NYHA ≥ II in 27.8% of patients vs. 69.3%; p&lt;0.001).
After selecting patients with at least severe TR, patients with isolated TR were also less symptomatic (NYHA≥II in 47.8% of patients vs. 70.7%; p&lt;0.001) and they had better RV function (TAPSE &lt;17 mm in 13.4% vs. 35.6%; p=0.001).
We found that patients with isolated severe TR had a larger tricuspid annulus diameter (25.4±0.8 mm/m2 vs. 24.0±0.3 mm/m2; p=0.047).

Conclusions
In this large prospective study, isolated TR is present in 18.8% of significant TR. Isolated TR was less severe, was associated with less RV dilatation (but with larger tricuspid annulus diameter) and patients had a better functional class compared to other TR aetiologies.
Differeces in NYHA and RV function

Funding Acknowledgement
Type of funding source: None
3-Dimensional echocardiographic evaluation of right ventricular function in pediatric sickle cell disease population
Authors: Karsenty C , Guitarte Vidaure A.G.V , Hadeed K , Dulac Y.D , Acar P.A , Blanc A.B 
Published: November 2020

Abstract

Introduction
Sickle cell disease (SCD) is characterized by chronic hemolytic anemia and intermittent vaso-occlusive events associated with cardiac abnormalities.

Aim
To assess 3 dimensional (3D) echocardiographic of right ventricle (RV) volumes and function in a pediatric SCD population.

Methods
Eighteen patients with SCD aged 4 to 17 years old (mean age: 8.0±4 years, 56% male, body surface area (BSA) 1.0±0.35) and 18 healthy controls matched for age, gender and BSA were prospectively included and compared. Echocardiograms were performed using a commercially available ultrasound Philipps EPIQ 9 system using matrix X5–1 transducer. 3D indexed RV volumes and ejection fraction (3D- RVEF) were obtained using full volume acquisitions. RV free wall strain, tricuspid S-wave, tricuspid annular plane systolic excursion (TAPSE), indexed cardiac output, systolic pulmonary pressure (sPAP) and hemoglobin were assessed. Data were analyzed with TomtecArena© software (v2.3, Germany).

Results
Cardiac output was significantly higher in SCD children (4.5 vs 3.6 l/min/m2, p=0.025), as sPAP (24.9 vs 21.9 mmHg, p=0.015), 3D-RV diastolic volume (58.1 vs 47.5 ml/m2, p=0.025) and 3D-RV systolic volume (28.8 vs 21.4 ml/m2, p=0.005). 3D-RVEF and RV free wall strain were significantly lower in SCD compared to control population (respectively 51.9 vs 56.3%, p=0.018; −28.6 vs −32, p=0.017). There were no difference regarding TAPSE and doppler S-wave. Mean hemoglobin in SCD population was 9.6±1.7 g/dl.

Conclusions
Despite normal RV systolic function parameters, 3D-RVEF and RV free wall strain are lower in children with SCD. Chronic anemia generating volume overload and vaso-occlusive events could explain these findings.
3D sickle cell

Funding Acknowledgement
Type of funding source: None
Determinants of pulmonary vascular resistance reduction with upfront oral therapy in idiopathic pulmonary arterial hypertension: relevance in risk assessment
Authors: Badagliacca R , D'Alto M , Ghio S , Greco A , Papa S , Romeo E , Casu G , Corda M , Paciocco P , D'Agostino C , Galgano G , Stolfo D , Correale M , Naeije R , Vizza C.D 
Published: November 2020

Abstract

Background
In pulmonary arterial hypertension (PAH) upfront oral therapy represents the standard of care for naive patients at low and intermediate risk. However little is known about associated changes in risk assessment and prediction of low risk status achievement.

Purpose
To evaluate determinants of PVR reduction in patients treated with upfront oral therapy and to create a score to predict PVR reduction after upfront oral treatment and compared its additive value on top of the European and REVEAL scoring system in predicting treatment response.

Methods
One-hundred-eighty-one consecutive naive PAH patients treated with upfront therapy at 11 italian centers were retrospectively evaluated. Evaluation included clinical, hemodynamic and simple echocardiographic parameters, together with European and REVEAL 2.0 risk scores.

Results
At the time of diagnosis, the majority of the patients was idiopathic PAH (80.6%), female (66.3%), at intermediate risk, 71.8% and 55.2%, respectively, according to the European (average method) and the REVEAL 2.0 risk scores. Ambrisentan-Tadalafil was the most frequent combination used (62%). The median PVR reduction obtained after 180 days (IQR 79–394) was −40.4% (IQR −25.8; −45.3).
Age ≥60 years, male-sex, baseline mPAP 48 mmHg associated with low CI (&lt;2.5 l/min/m2), and RV/LV ratio &gt;1 associated with low TAPSE (&lt;18 mm) emerged as independent predictors of poor PVR reduction, defined as the lower tertile of PVR changes (−25.8%). A treatment response score was created deriving weighted integers from the beta coefficient.
At second evaluation 78 (43.1%) patients achieved or remained at European-derived low risk status, while 63 (34.8%) considering the REVEAL 2.0 score.
Multivariate analysis for the prediction of treatment failure, defined as the absence of low-risk status at follow-up, demonstrated the incremental prognostic power of the models incorporating the treatment response score (≥3) on top of the European and REVEAL 2.0 scores, improving risk discrimination by 63.2% (IDI index 0.056) and 36.8% (IDI index 0.080), respectively.

Conclusions
A significant proportion of PAH patients treated with upfront oral combination are not able to achieve a low-risk status. The treatment response score helps clinicians in predicting treatment failure at the time of diagnosis.

Funding Acknowledgement
Type of funding source: None