bluuebunny/crossref_metadata_2025_split huggingface dataset:
Calcified mitro-aortic continuity and mitral regurgitation in patients undergoing transcatheter aortic valve replacement
Authors: Rys M , Szymanski P , Zatorska K , Michalowska I , Witkowski A , Hryniewiecki T 
Published: November 2020

Abstract

Introduction
Calcified aortic stenosis (AS) and mitral annular calcification (MAC) have similar etiology and pathophysiological mechanisms. Half of all patients undergoing transcatheter aortic valve implantation (TAVI) have MAC. Several studies assessed the role of mitral regurgitation (MR) following TAVI but only few examined influence of MAC on its changes after TAVI. MAC frequently coexists with the calcification of mitro-aortic continuity (CMAC).

Purpose
Presence of CMAC may influence the results of TAVI, especially in the case of deeper implantation, protruding to let ventricular outflow tract (LVOT). In the present study we aimed at qualitative and semi-quantitative analysis of calcifications of the mitral complex – MAC and CMAC in multi-slice computed tomography (MSCT) in patients qualified to TAVI, in order to assess their impact on the occurrence and dynamics of MR following aortic valve implantation.

Methods
MAC was assessed quantitatively (Calcium Score) and semi-quantitative scale in depending on the degree of annular involvement. CMAC was evaluated in semi-quantitatively scale in depending on length of calcifications in the largest dimension. Subsequently patients were classified in a dichotomous manner as having non-severe or severe MAC and CMAC. All patients underwent transthoracic echocardiographic examinations prior to the procedure and after TAVI. Changes of MR severity following TAVI were defined as no change, improvement or worsening by at least one degree.

Results
The study group consisted of 94 patients. Fifty six (59.6%) out of 94 patients had MAC and 21 patients (22.3%) had severe MAC. Patients with MAC had higher mean aortic gradients (54.07±13,62 mmHg vs 46.79±14.42 mmHg, p=0.02) and smaller left ventricular diastolic diameter (46.09±6.86 mm vs 51.19±8.42 mm, p=0.002). Almost half of the patients - 46 (48.9%) had CMAC and 12 patients (12.8%) had severe CMAC. Patients with CMAC had higher Calcium Score Aortic Valve (3773.67±1734.02 Hounsfield Units (HU) vs 2875.1±1352.76 HU, p=0.006) and smaller AVA (0.59±0.16 cm2 vs 0.66±0.20 cm2, p=0.052). Before TAVI 35.1% of patients had more than mild MR. MR improved by at least one grade following TAVI in 17 (18.1%) patients and worsened by at least one grade in 7 (7.5%) patients. In multivariable logistic regression analysis MR worsening was associated with higher CMAC [OR 1.092, 95% CI: 1.006–1.185, p=0.035].

Conclusions
The study demonstrated CMAC is prevalent in patients undergoing TAVI. CMAC was associated with MR worsening. This is a novel finding, which may be particular importance in patients with severe AS and coexisting MR in whom arguments for and against surgical repair of concomitant mitral insufficiency are considered, as opposed to isolated aortic valve procedure.

Funding Acknowledgement
Type of funding source: None
Rivaroxaban in patients undergoing surgical mitral valve repair
Authors: Sadeghipour P , Noohi F , Hosseini S , Kordrostami S , Shafe O , Moosavi J , Rokni M , Tashakori Beheshti A , Rezaei Y 
Published: November 2020

Abstract

Background
The role of the non-vitamin K antagonist oral anticoagulants has here been scarcely studied In patients undergoing mitral valve repair (MVre).

Methods
In the present mixed cohort study, the safety and efficacy of rivaroxaban (prospective analysis) were compared with those of warfarin (retrospective analysis) in patients undergoing MVre.

Results
Study flow chart were presented In Figure. Dissimilarities in baseline characteristics necessitated propensity score matching, in which 104 patients in each group were compared. No major bleeding or cerebrovascular accident occurred during the 1-year follow-up. Clinically relevant non-major bleeding was reported in 2 patients in the rivaroxaban group and 4 patients in the warfarin group, a difference non-statistically significant before and after propensity score matching (P=0.371 and P=0.407, respectively). The type of anticoagulation did not predict the 1-year outcome (HR: 2.165, 95% CI: 0.376 to 12.460; P=0.387).

Conclusion
In this mixed cohort study, rivaroxaban was both safe and efficient in patients with MVre. Such preliminary results should prompt larger randomized controlled trials.
Cohort flow chart

Funding Acknowledgement
Type of funding source: None
Myocardial tissue characterization and mortality in transcatheter aortic valve replacement
Authors: Nitsche C , Kammerlander A.K , Koschutnik M.K , Dona C.D , Sinnhuber L.S , Eidenberger A.E , Forutan N.F , Andreas M.A , Hengstenberg C.H , Mascherbauer J.M 
Published: November 2020

Abstract

Background
Cardiac decompensation in severe aortic stenosis involves accumulation of myocardial extracellular matrix and congestion, which can be objectively quantified by cardiac magnetic resonance (CMR) and bioelectrical impedance spectroscopy (BIS). The aim of this study was to determine whether the extent of extracellular matrix pre-intervention correlates with congestion and is associated with adverse outcomes.

Methods
Consecutive patients scheduled for transcatheter aortic valve replacement (TAVR) underwent assessment of volume status using BIS, and CMR, and were prospectively followed. CMR included T1 mapping and extracellular volume (ECV) quantification for the assessement of diffuse myocardial tissue alterations and T2 mapping (n=100) for the assessment of myocardial edema. The combination of all-cause death and heart failure (HF) hospitalization was selected as primary study endpoint.

Results
180 patients (80.6±7.2 y/o, 48.9% female) with valid BIS and CMR data were included. ECV levels≥median was linked to worse ventricular function, more severe pulmonary hypertension and mitral/tricuspid regurgitation (p for all&lt;0.05). Fluid levels significantly correlated with ECV (r=0.403, p&lt;0.001) and T2 (r=0.378, p=0.015), but not T1 relaxation times (p&gt;0.05). Moreover, fluid levels were independently associated with CMR-ECV by multivariate linear regression analysis (p&lt;0.001), alongside with body mass index, left ventricular ejection fraction and hematocrit (p for all&lt;0.05).
In total, 22.9% (39/170) had experienced an event (22 deaths, 17 heart failure) 13.4±7.5 months following TAVR. ECV levels≥median of 27.0% were significantly associated with the combined endpoint by Kaplan Meier estimates (log rank, p&lt;0.001, Figure 1), but also with HF hospitalization (p&lt;0.001) and death (p=0.020), when analyzed separately. Quantitively, every 1% increase in ECV increased event hazard by 11% [hazard ratio 1.111, 95% confidence interval 1.030–1.198, p=0.007]. After multivariate adjustment for important clinical, laboratory and CMR parameters, ECV≥median remained independently associated with outcome (p=0.045), alongside with serum albumin (p&lt;0.001) and body fluid levels (p=0.015) by Cox regression analysis.

Conclusions
Cardiac decompensation in AS involves myocardial ECV expansion and body fluid accumulation. Fluid accumulation seems to impact the amount of ECV, and both parameters are independently associated with adverse outcomes following TAVR.
Figure 1

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Österreichische Kardiologische Gesellschaft
Blood coagulation status after transcatheter aortic valve implantation between the patients with vitamin k antagonist and direct oral anticoagulants
Authors: Katayama T , Yokoyama N , Hirofumi H , Kataoka A , Watanabe Y , Kozuma K 
Published: November 2020

Abstract

Background
Ischemic stroke after transchatheter aortic valve implantation (TAVI) was recognized. Previous study showed that the median time of a stroke was 2.0 days (IQR, 1.0–5.0) after TAVI. One of the main mechanisms for ischemic stroke after TAVI was hyper-coagulation activity associated with TAVI procedure. However, the change of coagulation status in patients with oral anticoagulant (OAC) therapy was not investigated fully.

Purpose
We investigated the difference of blood coagulation parameters between the patients with vitamin K antagonist (VKA) and those with direct oral anticoagulants (DOAC).

Methods
We enrolled 253 patients underwent transfemoral TAVI between February 2017 and March 2019 in our hospital. Of 253 patients, 71 patients (age: 85, male: 20%) took OAC therapy (VKA: 21 patients, DOAC: 50 patients). Patients who took apixaban was 32 patients, rivaroxaban was 7, edoxaban was 11. Prothrombin activation fragment 1+2 (F1+2) as a molecular marker of thrombin generation, thrombin-anti-thrombin complex (TAT) as a marker of thrombin neutralization, soluble fibrin monomer complex (SFMC) as a marker of thrombophilia and fibrin/fibrinogen degradation product (FDP) as a marker of fibrinolysis were measured before and immediately after TAVI, and on 1 and 2 day postoperatively. We also assessed ischemic stroke after TAVI between 2 groups according to BARC-2 criteria.

Results
In patients with VKA, the value of PT-INR the day before TVAI was 1.2 (1.1–1.4). The level of F1+2 in patients with VKA was significantly greater on day 0 postoperatively than those with DOAC [855 pmol/l (595–1135) vs 614 pmol/l (452–774) P=0.003]. The level of SFMC in patients with VKA was significantly greater on day 0 postoperatively than those with DOAC [37.4 μg/ml (17.3–64.5) vs. 15.7 μg/ml (8.8–27.3) P=0.002]. The level of FDP in patients with VKA was significantly greater on day 0 postoperatively than those with DOAC [VKA: 5.8 μg/ml (3.8–7.9), DOAC: 4.0 μg/ml (3.1–5.3) P=0.023]. There were no patients with ischemic stroke among 2 groups.

Conclusion
This study revealed that coagulation activity was increased after TAVI. Furthermore, the coagulation activity in patients with VKA was significantly higher than that with DOAC at especially immediately after TAVI. Careful attention should be paid to hyper-coagulation status after TAVI in patients with VKA.

Funding Acknowledgement
Type of funding source: None
Meta-analysis confirms improvement of hospitalizations and all-cause mortality of transcatheter mitral valve repair in functional mitral regurgitation
Authors: Noutsias M , Matiakis M , Bigalke B , Sedding D , Rigopoulos A 
Published: November 2020

Abstract

Background
Moderate-to-severe or severe functional mitral regurgitation (FMR) is associated with higher rates of hospitalizations and with increased mortality in heart failure (HF). Transcatheter mitral valve repair by MitraClip® implantation (TMVrMC) may effectively reduce severe MR, and is associated with symptomatic improvement. However, the long-term clinical effects of this procedure are not well defined.

Aims
We analyzed outcomes for rehospitalization and survival in HF patients with moderate-to-severe or severe FMR treated by either medical treatment (MT) only versus TMVrMC+MT by meta-analysis.

Methods and results
By systematic search of bibliographic databases, we evaluated publications comparing HF patients with FMR treated by MT only versus treatment by MT combined with TMVrMC. Studies with a minimum of 25 enrolled patients and a follow/up period of at least 12 months were deemed eligible for this meta-analysis. We identified n=7 studies enrolling 2,884 HFrEF patients, divided into two study arms: TMVrMC+MT (n=1,618), versus FMR patients receiving MT only (n=1,266). At 12 months, there was a significant reduction in all-cause mortality favoring TMVrMC+MT (OR: 0.65; CI 95% 0.53–0.79), compared with the MT only patients. At 24 months, a significant reduction of all-cause mortality in the TMVrMC+MT patient group (OR: 0.54; CI: 95%: 0.43–0.67; p&lt;0.001) was calculated. TMVrMC+MT was associated with significantly lower rates of unplanned re-admissions for heart failure compared with MT only at 12 months (OR: 0.69; 95%; CI 0.53–0.89; p&lt;0.001) and at 24 months (OR: 0.53; 95% CI: 0.39–0.71; p&lt;0.001). In one publication, a survival benefit of TMVrMC+MT over MT alone was shown at 5 years post intervention (HR: 0.75; 95% CI: 0.69–0.94; p=0.012) after weighting for propensity score and controlling for age.

Conclusions
This meta-analysis on n=2,884 patients with moderate-to-severe or severe FMR reveals that TMVrMC+MT, as compared with MT alone, is associated with a significant reduction of rehospitalizations and improvement of survival up to 24 months after MitraClip implantation. However, the discordant results of 2 randomized controlled trials (MITRA-FR and COAPT) warrant further clarification, i.e. of the eligible FMR patient profiles who might benefit from TMVrMC+MT in terms of improvement of prognosis. These data imply additional evidence for TMVrMC in eligible HF patients with relevant FMR, which might be important for an update of the corresponding guidelines.

Funding Acknowledgement
Type of funding source: None
Predictors of outcomes in patients with mitral regurgitation undergoing percutaneous valve repair
Authors: Polimeni A 
Published: November 2020

Abstract

Background
Percutaneous mitral valve repairs has been increasingly performed worldwide. The MITRA-UMG registry provides a snapshot of a real-world clinical data and outcomes.

Purpose
We sought to investigate predictors of clinical outcomes in patients with mitral regurgitation undergoing percutaneous valve repair.

Methods
The MITRA-UMG registry retrospectively collected data from consecutive patients with symptomatic moderate-to-severe or severe MR underwent MitraClip implantation. The primary endpoint of interest was the composite of cardiovascular death or rehospitalization for HF.

Results
Between March 2012 and July 2018, a total of 133 consecutive patients admitted to our institution were included. Acute procedural success was obtained in 95.4% of patients, with no intraprocedural death. The composite primary endpoint of cardiovascular death or rehospitalization for heart failure was met in 50 patients (38%) with cumulative incidences of 7%, 25%, at 30 days and 1 year, respectively. In the Cox multivariate model, NYHA functional class IV, left ventricular end-diastolic volume index (LVEDVi), Euroscore II, independently increased the risk of the primary endpoint at long-term follow-up. At Kaplan-Meier analysis, a LVEDVi &gt;92 ml/m2 was associated with an increased incidence of the primary endpoint.

Conclusions
In searching the ideal phenotype of patients who benefit most of percutaneous mitral valve repair, those presenting with severely dilated ventricles (LVEDVi &gt;92 ml/m2), high operative risk (EUROSCORE II &gt;7%) or advanced heart failure symptoms (NYHA IV) at baseline carried the worst prognosis at long-term.

Funding Acknowledgement
Type of funding source: None
Prevalence and prognosis of mitral disease due to mitral annular calcification
Authors: Ahmed A , Cavalcante J.L , Goessl M , Ukaigwe A.C , Schmidt C.W , Du Y , Lopes B.C , Bae R , Sorajja P 
Published: November 2020

Abstract

Background
While mitral annular calcification (MAC) is associated with valvular regurgitation or stenosis, this disease entity remains poorly understood.

Purpose
We sought to evaluate the prevalence and outcomes of patients with MAC.

Methods
Between January 2014 and December 2015, we reviewed all patients who underwent transthoracic echocardiography (TTE), and were identified as having MAC with either mitral regurgitation (MR) or stenosis (MS). Medical records were manually examined for demographics, morbidities, type and severity of mitral disease, and clinical outcomes for this cohort.

Results
Of 41,136 patients who had undergone TTE, MAC was identified in 2,855 (6.9%) patients, including 434 (1.0%) patients who had significant concomitant MR or MS (mean age, 78.9±10.4 years; 63% women). Severe heart failure (NYHA III or IV, 37%), renal failure (mean GFR, 47.3±15.7 ml/min), aortic stenosis (26% with severe stenosis or prior aortic intervention), diabetes (35%), and atrial fibrillation (50%) were common. The mean mitral gradient was 6.2±3.0 mmHg. Fifty-eight patients (13%) underwent surgical or transcatheter mitral valve intervention, with two procedural deaths (3.4%). Overall, the 3-year survival free of all-cause mortality was 53.9%, while freedom from all-cause mortality, hospitalization for heart failure, myocardial infarction and cerebrovascular accident was only 26.5% (Figure 1). Three-year survival free of all-cause mortality for those who had surgery or transcatheter therapy was better in comparison to those treated medically (77.6% vs. 50.3%; p&lt;0.001).

Conclusions
Patients with MAC with MR or MS are common, have severe co-morbidities, and have poor long-term survival. Further study is needed to improve the clinical outcomes of these patients.
KM curves for MAC and MR/MS patients

Funding Acknowledgement
Type of funding source: None
Infective endocarditis in patients with solid organ transplantation. A nationwide study
Authors: Martinez-Selles M , Valerio M , Farinas M.C , Rodriguez-Abella H , Navarro M.L , De Alarcon A , Gutierrez E , Cobo M , Goenaga M.A , Moreno A , Dominguez F , Garcia L , Dominguez L , Munoz P 
Published: November 2020

Abstract

Background
An increase in nosocomial and health care-related infective endocarditis (IE) has been described. Solid organ transplantation (SOT) implies immunosuppression and frequent health care contact. Our aim was to compare characteristics of patients with IE and SOT against those without SOT.

Methods
We used data from the Spanish Collaboration on Endocarditis obtained during the period 2008–2018.

Results
We identified 4794 cases of IE, 85 (1.8%) in SOT (56 kidney, 18 liver, 8 heart, 3 lung). Thirteen patients had other types of transplantation (bone marrow, hematopoietic precursors, and cornea) and were excluded from the analysis. Compared with patients without SOT, patients with SOT had a higher median age (69 vs. 61 years, p&lt;0.001), more comorbidities (mean age-adjusted Charlson index 5.7±2.9 vs. 4.9±2.9, p=0.004), a lower prevalence of native valvular heart disease (29.4 vs. 45.4%, p=0.003), more in-hospital and healthcare-related IE (70.5% vs. 36.3%, p&lt;0.001) and Staphylococcus etiology (57.7% vs. 39.7%, p=0.001). Regarding evolution, patients with SOT had more frequent kidney function worsening (47.1% vs. 34.6%, p=0.02), septic shock (25.9% vs. 12.1%, p&lt;0.001), sepsis (27.1% vs. 17.2%, p=0.02). Surgery indication (54.1% vs 66.3%, p=0.02) and surgery (32.9% vs. 46.3%, p=0.01) were less frequent in patients with SOT. We were unable to find significant differences in mortality: inhospital (30.6% vs. 25.6%, p=0.31), 1-year (38.8% vs. 31.9%, p=0.18).

Conclusion
IE in SOT patients has specific characteristics. Most of the cases are nosocomial and over 70% are hospital-or health care-related. Half have previously normal heart valves and almost 60% are due to Staphylococcus infections.
Figure 1. Kaplan Meier survival curves for patients with and without solid organ transplantation (SOT). SOT: 56 kidney, 18 liver (2 combined with kidney), 8 heart, 3 lung.

Funding Acknowledgement
Type of funding source: None
18F-fluorodeoxyglucose positron emission tomography computed tomography (18F-PET/CT) for the diagnosis of native valve infective endocarditis (NVIE): a prospective study
Authors: Philip M , Delcourt S , Cammilleri S , Gourriet F , Tessonnier L , Casalta J.P , Gardenat A , Gerard H , Riberi A , Hubert S , Habib G 
Published: November 2020

Abstract

Background and objectives
18F-FDG PET/CT has recently been added as a major criterion in the ESC 2015 infective endocarditis (IE) guidelines. We and others have demonstrated that18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) / computed tomography (CT) was useful in patients with suspected prosthetic valve and cardiac device IE. However, the sensitivity and specificity of ESC classification is unknown in patients with native valve endocarditis (NVE) as well as the clinical impact of PET findings.

Purposes
1. Primary objective: To assess the value of the new ESC criteria including 18F-FDG PET/CT in native valve infective endocarditis (NVIE).
2. Secondary objectives:
– to determine the usefulness of PET/CT concerning embolic or neoplastic detection.
– to describe a new PET/CT feature, i.e. the diffuse splenic uptake.

Methods
Between 2012 and 2017, 75 patients with suspected NVIE were prospectively included, after exclusion of patients with uninterpretable or not feasible PET/CT. Using the expert consensus of the Endocarditis Team after a 3-month follow-up as gold standard, 63 IE were confirmed and 12 were rejected. Patients follow-up was scheduled at one and three months after hospitalization.

Results
Significant cardiac uptake by PET/CT (major criterion) was observed in 11 among 63 patients with definite NVIE and no patients with rejected IE (sensitivity 18%, specificity 100%). Among the 63 patients with a final diagnosis of NVE, a peripheral embolism or mycotic aneurysm was observed in 20 cases (32%). Considering this, the ESC 2015 classification increased the sensitivity of Duke criteria from 64 to 70% (p&lt;0.001) without no change on specificity (p&lt;0.001). Twenty-four patients (38%) were diagnosed with secondary infectious sites or infectious portal of entry. A diffuse splenic uptake was observed in 39 (52%) patients, including 37 (59%) of patients with a final diagnosis of NVE (specificity 83%).

Conclusion
1. The value of 18F-FDG PET/CT in NVE diagnosis is poor (18% sensitivity)
2. Usefulness of PET/CT remains high when concerning embolic or neoplastic detection.
3. Our study describes for the first time in NVE a new potential endocarditis criterion, i.e. the presence of a diffuse splenic uptake on 18F-FDG PET/CT
Diffuse splenic uptake

Funding Acknowledgement
Type of funding source: None