bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic value of global myocardial constructive work in patients with secondary mitral regurgitation
Authors: Yedidya I , Lustosa R.P , Fortuni F , Van Der Bijl P , Namazi F , Vo N.M , Ajmone Marsan N , Delgado V , Bax J 
Published: November 2020

Abstract

Background
Left ventricular (LV) myocardial contractility evaluation is of crucial importance in patients with secondary mitral regurgitation (SMR). The most widespread echocardiographic tool, left ventricular ejection fraction (LVEF), might overestimate LV function, since it calculates the volume changes regardless of the flow direction. Global myocardial constructive work (GMCW) might be a more suitable tool, as LV myocardial work derived from pressure-strain loops obtained with speckle tracking echocardiography incorporates non-invasive blood pressure measurements.

Purpose
To evaluate the prognostic value of LV GMCW in patients with SMR.

Methods
378 patients (72% men, median age 68 [range 60 to 74 years]) with various grades of SMR were retrospectively analysed. LV global myocardial constructive work, wasted work and work efficiency were measured with speckle tracking echocardiography.

Results
There were 145 patients with mild SMR, 130 with moderate SMR and 103 with severe SMR. Patients with severe SMR had larger LV volumes, lower LVEF and more impaired LV GLS. GMCW was more impaired in patients with severe SMR, compared with mild MR (678 mmHg% vs. 845 mmHg% p&lt;0.001 respectively). After a mean follow-up of 59±37 months, 162 patients died. When dividing the population according to prognostically relevant cut offs derived by spline curve analysis, patients with a GMCW≤700 mmHg% had a worse prognosis, compared with their counterparts (Figure 1).

Conclusion
Global myocardial constructive work ≤700 mmHg% is associated with worse long-term survival in patients with SMR.
Kaplan-Meier survival curves

Funding Acknowledgement
Type of funding source: None
The importance of comorbidities for long-term outcome after aortic valve intervention in patients with preserved left ventricular ejection fraction, a nation-wide register study
Authors: Thilen M , James S , Lindhagen L , Stahle E , Christersson C 
Published: November 2020

Abstract

Background
In Aortic stenosis (AS) cardiovascular comorbidities as well as left ventricular ejection fraction (LVEF) have an impact on postoperative outcome among patients undergoing aortic valve replacement (AVR). The prevalence of heart failure (HF) based on LVEF in patients with severe AS varies. Lately HF with preserved LVEF has gained more attention. The aim is to describe the prevalence and prognostic impact of cardiovascular comorbidities, including HF, in relation to LVEF before AVR in a national cohort of patients with AS.

Methods
Patients &gt;18 years, undergoing AVR due to AS 2008–2014 were identified in the national register for heart diseases, SWEDEHEART. Preoperative LVEF and comorbidities were collected from the register and enriched with data from national patient registries. The outcome events were all cause mortality and hospitalization for HF as the main diagnosis. The cohort was separated by preoperative LVEF status; preserved (&gt;50%) or reduced (≤50%). Outcome events were analysed by Cox regression.

Results
10406 patients, median age 73 (18–96) years whereof 3817 (36.7%) women, were included with a median follow-up of 35 months. In the cohort 15.9%, 73.9% and 10.2% received a mechanical, surgical biological and trans-catheter biological valve prosthesis, respectively. Preserved LVEF was present in 7512 (72.2%). Comorbidities were more frequent in the group with reduced LVEF (p&lt;0.001). Irrespective of LVEF HF influenced outcome negatively (see table).

Conclusion
In patients planned for AVR a history of HF irrespective of LVEF worsen postoperative prognosis and a history of HF seems at least as important as LVEF when predicting long-term outcome. When stratifying patients for AVR with preserved LVEF, comorbidities such as HF and atrial fibrillation should be highlighted, and further research to identify risk factors for a negative postoperative outcome in this group seems important in optimizing the follow-up after AVR.

Funding Acknowledgement
Type of funding source: None
Favorable course of tricuspid regurgitation after percutaneous mitral valve repair is associated with improved survival and clinical outcome
Authors: Meijerink F , Baan J , Bouma B.J 
Published: November 2020

Abstract

Background
Tricuspid Regurgitation (TR) is often present in patients with mitral regurgitation (MR) and is associated with increased mortality and morbidity after percutaneous mitral valve repair (PMVR) using the MitraClip (Abbott Vascular). It is unclear to what extent TR is reduced after PMVR and whether the reduction of TR is related to survival and functional outcome.

Purpose
The aim of this study was to determine (1) the TR course after PMVR and (2) if this was related to survival and clinical outcome.

Methods
Patients who underwent PMVR and had complete echocardiographic data at baseline and follow-up were included. TR severity was graded as none, mild, moderate or severe (according to current guidelines) and was determined before treatment and at 6-months of follow up. Favorable TR course was defined as improvement of ≥1 grade or ≤ mild TR at 6-months. Clinical endpoints were all-cause mortality during 1-year of follow-up and improvement in New York Heart Association (NYHA) functional class after 6 months.

Results
A total of 67 patients were included (mean age 76 years, 57% male, 81% NYHA class ≥3 and 69% baseline TR ≥ moderate). Favorable TR course was achieved in 31 patients (46%) (figure 1A). All-cause mortality at 1 year was 7.5%, and was lower in the favorable TR course group (0% vs. 13.9%, p=0.057) (figure 1B). Improvement in NYHA class at 6-months was seen in 45% of patients without vs. 81% of patients with favorable TR course (p=0.01) (figure 1C).

Conclusion
A favorable TR course is achieved in 46% of PMVR patients and is associated with improved survival and improvement of NYHA class. The relatively high rate of an unfavorable TR course at 6-months, indicates that interventional treatment of the tricuspid valve might benefit these patients.
TR course (A) and NYHA improvement (B)

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Abbott
Postoperative prognostic impact of replacement fibrosis in patients with aortic valve stenosis
Authors: Igual Munoz B , Blanco Herrera O , Perez Bosca J.L , Forner Giner J , Barber Hueso C , Berenguer Jofresa A , Oscar Gil Albaroya O , Ruiz Sauri A , Montero Argudo A , Paya Serrano R 
Published: November 2020

Abstract

Nowadays, risk assessment in patients undergoing aortic valve replacement (AVR) is mainly performed using Euroscore II risk model. Nevertheless other imaging findings as presence of replacement myocardial fibrosis (RMF) assessed by magnetic resonance imaging (MRI) is reported to be a potent risk marker. Our objective is to assess the prognostic value of RMF in patients undergoing surgical AVR and its value using as reference Euroscore II model.

Methods
121 patients without any coronary or additional valve disease undergoing surgical aortic valve replacement were included. All of them have a preoperative MRI study including b-SSFP short axis sequences to assess left ventricular mass, volume and ejection fraction and IR-FGRE sequences to assess replacement fibrosis and also clinical follow up for a median time of 40 months. The postoperative risk of events was also estimated using Euroscore II model. The impact of fibrosis on survival free of cardiovascular events was estimated using the Kaplan-Meier test and its value against reference parameters was estimated using a multivariate Cox model.

Results
121 consecutive patients, 50% males with a mean age of 72 years (SD 10) with an average Euroscore value of 1.55 (SD 1) undergoing AVR, 100 (78%) with a biological prosthesis. Patients with replacement fibrosis had significantly decreased survival (p&lt;0.05). Furthemore multivariate analysis showed Euroscore II and replacement fibrosis as the most potent predictors (HR: 1.5, p=0.01 and HR: 1.8, p=0.09 respectively) and furthermore to include replacement fibrosis in the model significantly improves prediction of postoperative MACE.

Conclusions
1. Patients with replacement fibrosis had significantly decreased postoperative survival free of MACE.
2. To Include replacement fibrosis in the preoperative risk assessment significantly improves prediction of postoperative MACE.
Survival plots regarding fibrosis

Funding Acknowledgement
Type of funding source: None
Totally endoscopic aortic valve replacement: technique and first experience
Authors: Van Genechten S , Claessens J , Kaya A , Yilmaz A 
Published: November 2020

Abstract

Background
Cardiac surgery is still looking for new minimally invasive techniques with less trauma and better cosmetic results. In the field of aortic valve replacement, several types of less invasive procedures were introduced, allowing a reduction in blood loss, infections, ventilation times, morbidity and mortality. The most common technique for minimally invasive aortic valve replacement is the mini-sternotomy approach. In this report, the initial experience with a non-sternotomy approach for aortic valve replacement by means of a totally endoscopic surgical technique is presented.

Methods
The totally endoscopic aortic valve replacement was carried out in 201 patients (59,7% males, mean age: 71.6±11.7 years) from October 2017 until October 2019. Severe aortic valve stenosis was the surgical indication for all patients, who had a mean EuroSCORE II of 2.35±3.82. The surgery was carried out with the patient in supine position and a standard zero-degree optics was used. A 20 mm working port in the 2nd right intercostal space and two 5 mm trocars gained access to the aorta. After groin cannulation, cardiopulmonary bypass was initiated. Transthoracic aortic cross-clamping followed by antegrade administration of a single shot cold mixed-blood cardioplegia was assessed. The aortotomy was followed by the excision of the stenotic aortic valve and the aortic valve prosthesis was implanted in supra-annular position. After the closure of the aorta, an external pacemaker wire was placed.

Results
Mean cross-clamp and cardiopulmonary bypass times were 62±14 and 94±25 minutes, respectively. No conversion to a sternotomy was needed. The mean length of stay at the intensive care unit was 69.4±149.6 hours while patients spend 9.6±10 days at the hospital. Due to our new fast track protocol, the mean hospital stay in the last two months was 6.1 days (26 patients, 12.9%). The average postoperative blood loss (24h) was 251±298 mL and the patients were ventilated for 6.9±9 hours. In 10 patients (4.9%), re-exploration in an endoscopic way was needed. None of them had a surgical bleeding focus. No paravalvular leakages were detected at discharge. 69 patients (34.7%) developed atrial fibrillation after surgery. In addition, 10 patients (4.9%) underwent a pacemaker implantation postoperatively whereas 4 patients (1.9%) suffered from a CVA. Finally, the 30-day mortality was 2.0%.

Conclusion
These results concerning the feasibility and safety of totally endoscopic aortic valve replacement are promising. The aortic cross clamping times are acceptable, and the morbidity and mortality rates are low. Long term results are needed to confirm these initial findings.

Funding Acknowledgement
Type of funding source: Private hospital(s). Main funding source(s): Jessa Hospital
Clinical and echocardiographic outcomes of patients with moderate to severe aortic stenosis and preserved, mid-range and reduced ejection fraction
Authors: Chew N , Ngiam N , Tan B.Y.Q , Sia C.H , Sim H.W , Kong W.K.F , Tay E.L.W , Yeo T.C , Poh K.K 
Published: November 2020

Abstract

Background
Left ventricular ejection fraction (EF) plays an important role in risk stratifying and guiding therapy for patients with aortic stenosis (AS). This study aims to describe the clinical and echocardiographic outcomes of AS patients with preserved (ASpEF), mid-range (ASmrEF) and reduced (ASrEF) EF.

Methods
713 consecutive patients with index echocardiographic diagnosis of moderate-severe AS (aortic valve area &lt;1.5cm2) were allocated according to the EF into three groups: ASrEF (EF&lt;40%), ASmrEF (EF 40–50%), and ASpEF (EF&gt;50%). The study outcomes were defined as 5-year all-cause mortality, heart failure admissions, and aortic valve replacement (AVR).

Results
In comparison to patients with ASpEF, those with ASrEF were more frequently male, and systolic blood pressure was significantly lower on enrolment (p&lt;0.001). Diabetes, ischemic heart disease and atrial fibrillation were more commonly seen in the ASrEF and ASmrEF groups, compared to ASpEF group. All-cause mortality rates were 30.5% for ASpEF, 50.8% for ASmrEF, 55.0% for ASrEF groups (p&lt;0.001). Increased rates of heart failure admissions were seen in the ASmrEF and ASrEF groups (30.5% and 33.9%, respectively, vs. 14.9% in ASpEF group). Patients with ASrEF had significantly higher rates of AVR as compared to those in the ASmrEF and ASpEF groups (p=0.032).

Conclusion
Echocardiographic and clinical outcomes of ASmrEF patients resembled those of ASrEF more closely than the ASpEF patients. Stratifying AS patients according to the different EF groups may improve risk assessment and treatment strategies.
Figure 1

Funding Acknowledgement
Type of funding source: None
The prevalence and natural history of mitral annulus calcification
Authors: Kato N , Guerrero M , Scott C.G , Lee A.T , Eleid M.F , Alkhouli M.A , Nkomo V.T , Crestanello J.A , Rihal C.S , Pislaru S.V , Pellikka P.A 
Published: November 2020

Abstract

Background
There is a paucity of data about the prevalence and natural history of mitral annular calcification (MAC).

Purposes
In a large cohort of patients undergoing clinically-indicated echocardiography, we aimed to evaluate the prevalence and the natural history of MAC, and the frequency of associated mitral valve dysfunction (MVD).

Methods
Retrospective review of all patients who underwent echocardiographic evaluation at our institution between January 1st and December 31st 2015. The patients were stratified into 3 groups: MAC with MVD, MAC without MVD, no MAC. MVD was defined as moderate or greater mitral regurgitation (MR) or stenosis (MS). The 3 groups were compared for baseline clinical and echocardiographic characteristics and all-cause mortality during follow-up.

Results
Of 24,415 evaluated patients, 5478 (22%) had MAC. Patients with MAC were older (75±10 vs. 60±16 years, p&lt;0.01) and more often female (46% vs. 43%, p&lt;0.01). MVD was more frequently observed in patients with MAC (16% vs. 7%, p&lt;0.01); moderate or greater MR was found in 10% of patients with MAC vs. 6% without MAC (p&lt;0.01) and MS in 7% vs. 0.5% (p&lt;0.01). In patients with MAC, those with MVD were more often female and more frequently had creatinine ≥2mg/dl and moderate or greater aortic stenosis (AS) than those without MVD (Fig. A). Kaplan-Meier survivals at 1 year were 75% in patients with MAC and MVD, 87% in those with MAC without MVD, and 92% in those without MAC (Fig B). Adjusted for age, sex, diabetes, creatinine ≥2 mg/dl, coronary artery disease, left ventricular ejection fraction &lt;50%, and AS, MAC was associated with higher all-cause mortality (adjusted hazard ratio1.4, 95% confidence interval: 1.3–1.5, p&lt;0.01); combined MAC and MVD was associated with the highest mortality during follow-up of 2.5±1.8 years.

Conclusion
In a large cohort of patients undergoing echocardiographic evaluation, the prevalence of MAC was 22%. MV dysfunction was more than twice as prevalent in patients with MAC as without. Patients with MAC had higher all-cause mortality than patients without MAC. Among patients with MAC and mitral valvular dysfunction, adjusted mortality was two-fold higher compared to those without MAC.

Funding Acknowledgement
Type of funding source: None
The 3 noes right-sided infective endocarditis: a unrecognized type of right-sided endocarditis
Authors: Lopez Diaz J , Vilacosta I , Habib G , Miro J.M , Olmos C , Sarria C , Gonzalez-Juanatey C , Gonzalez-Juanatey J.C , Cuervo G , Cabezon G , Garcia-Granja P.E , Gomez I , San Roman J.A 
Published: November 2020

Abstract

Introduction
The “3 noes right-sided infective endocarditis” (3no-RSIE: no left-sided, no drug users, no cardiac devices) was depicted for the first time more than a decade ago. We describe the largest series to date to characterize its clinical, microbiological, echocardiographic and prognostic profile.

Methods
Eight tertiary centers with surgical facilities participated in this study. Patients with right-sided endocarditis without left involvement, absence of antecedents of drug use and no intracardiac electronic devices were retrospectively included in a multipurpose database. A total of 53 variables were analysed in every patient. We performed a univariate analysis of in-hospital mortality to determine variables associated with worse prognosis.

Results
A total of 100 patients (mean age 54.1±20 years, 65% male) with definite 3no-RSIE were included (16.7% of all the right-sided endocarditis of the series). Most of the episodes were community-acquired (72%), congenital cardiopathies were frequent, fever was the main manifestation at admission (85%). The microbiological profile is led by Staphylococci spp. Vegetations were detected in 92% of the patients. Global in-hospital mortality was 19% (5.7% in patients operated and 26% in patients who received only medical treatment, p&lt;0.001). Non community-acquired infection, diabetes mellitus, right heart failure, septic shock and acute renal failure were more common in patients who died.

Conclusions
The clinical profile of 3no-RSIE is closer to other types of RSIE than to LSIE, but mortality is higher than that reported on for other types of RSIE. Surgery plays an important role in improving outcome.

Funding Acknowledgement
Type of funding source: None
Diagnosis and management of coronary artery disease in early surgical treatment of acute infective endocarditis of the aortic valve
Authors: Knol W.G , Wahadat A.W , Roos-Hesselink J.W , Tanis W , Hirsch A , Van Mieghem N.M , Bogers A.J.J.C , Budde R.P.J 
Published: November 2020

Abstract

Background
The need to routinely screen for coronary artery disease (CAD) in asymptomatic patients undergoing surgery for acute aortic valve infective endocarditis (IE) is debated. There is concern about the risk of embolization during invasive coronary angiography (ICA), especially in patients with vegetations. Coronary computed tomography angiography (cCTA) is a non-invasive alternative.

Purpose
To evaluate the prevalence of CAD in patients with acute aortic valve IE, the safety and feasibility of ICA and cCTA for diagnosis of CAD, and CAD related postoperative outcomes.

Methods
In this single center retrospective cohort study, all patients with acute infective aortic valve endocarditis between 2009–2019 undergoing surgery were selected. Outcomes were embolization after preoperative ICA, in-hospital mortality, perioperative myocardial infarction or unplanned revascularization.

Results
159 patients (mean age 58±15, 81% male) underwent surgery. No CAD screening was done in 46/145, a cCTA was performed in 54/145 patients and an ICA in 52/145 patients. In 1 of the 52 patients undergoing preoperative ICA a cerebral embolism occurred. cCTA was not assessable on a patient level in 2 patients and 7 patients underwent both cCTA and ICA. Significant CAD was found in about 20% of patients both after cCTA and ICA. Even though just a minority of patients with CAD was treated with concomitant CABG, only 1 patient with known but untreated CAD needed unplanned revascularization postoperatively. The rate of perioperative myocardial infarction or unplanned revascularization in patients not screened for CAD was 5% (3 patients).

Conclusion
In patients with acute aortic valve IE the prevalence of CAD is low (14%). The risk of embolism after preoperative ICA is not negligible and should be carefully weighed against the estimated risk of CAD-related perioperative complications. cCTA might serve as a gatekeeper for ICA in many patients with acute aortic IE.

Funding Acknowledgement
Type of funding source: None
Age-related characteristics of infective endocarditis: prospective data from the Euro-Endo registry
Authors: Pazdernik M , Selton-Suty C , Lancellotti P , Kong W.K.F , Srdanovic I , Yamada H , Riezebos R.K , De Martino A , Pierard L , Nunes M , Haertel Miglioranza M , Magne J , Mutlu B , Habib G , Iung B 
Published: November 2020

Abstract

Introduction
The profile of infective endocarditis (IE) is continuously evolving over time, and this may probably be partly due to increasing age of the patients.

Methods
All data were collected from the EURO-ENDO registry, which is a one-year prospective international multicentre observational survey on patients with definite or possible IE included between 2016 and 2018. Subjects were stratified into 3 groups according to their age at index hospitalization.

Results
Among the 3113 patients included, 1670 patients (54%, Young group) were &lt;65, 1068 (34%, Medium group) between 65 and 80 and 375 (12%, Old group) ≥80 years old. The most striking age-related differences were (old group vs others) (table 1) 1) the higher comorbidity burden and Charlson index; 2) the lower rate of embolic events on admission and under therapy; 3) the higher rate of Enterocci and digestive streptococci; 4) the lower rate of surgery during acute IE despite a theoretical indication; 5) the higher in-hospital and 1-year mortality. With regards to surgery, young and medium age were predictive of more frequent performance of surgery as compared to old age (Young: OR 4.33, 95% CI [3.09–6.06], Medium: 3.62, [2.57–5.10], p&lt;0.001). In multivariable analysis, age per se was not predictive of in-hospital and 1yr FU mortality, but lack of surgical procedures when indicated (27% of the old group), was strongly predictive.

Conclusion
This is the largest contemporary registry showing the strong influence of age on the demographic, clinical, therapeutic, and prognostic profile of IE. Non-performance of surgical procedures when indicated is frequent in old patients and is a strong predictor of mortality while age per se is not. Endocarditis Teams should take these results into account when considering surgery in elderly patients.

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): EORP grant