bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute kidney injury after transcatheter aortic valve replacement: predictors and prognostic impact from a single, high-volume centre
Authors: De Marzo V , Crimi G , Gil Ad V , Benenati S , Pescetelli F , Della Bona R , Balbi M , Porto I 
Published: November 2020

Abstract

Background
Acute kidney injury (AKI) represents a common complication of transcatheter aortic valve replacement (TAVR), occurring in a variable proportion (from 10% to 30%) and being associated with an increased length of hospital stay and a 2- to 6-fold higher risk of mortality.

Purpose
We sought to identify pre-procedural and procedural variables independently associated with AKI and to analyze AKI impact on 1-month and 1-year all-cause mortality.

Methods
We prospectively collected consecutive patients undergoing TAVR at our centre. AKI was defined according to the Valve Academic Research Consortium (VARC)-2 criteria, as an increase of at least 0.3 mg/dL in serum creatinine or a urine output worsening (&lt;0.5 mL/kg for &lt;12 hours) occurring within 7 days after the procedure.

Results
From 664 consecutive TAVR conducted between January 2010 and December 2018 we excluded 19 (2.9%) patients for unsuccessful procedure according to VARC-2 criteria leading to a population of 645 patients.
The mean follow-up was 9.6±4.3 months, age was 83.2±5.3, 270 (41.9%) were men. AKI complicated TAVR procedure in 141 (21.9%) patients. All-cause mortality occurred in 14 (2.2%) at 1-month and 51 (7.9%) patients at 1-year.
AKI was more likely to complicate TAVR in patients who died within 1-month (4.7% vs. 0.8%, p=0.003) and 1-year (14.1% vs. 5.3%, p&lt;0.001) follow-up period.
Multivariable regression analysis showed that baseline creatinine (OR: 1.46, 95% CI: 1.20–1.78, p&lt;0.001) and VARC-2 bleeding complications (OR: 1.49, 95% CI: 1.04–2.12, p=0.029) were independently associated with AKI incidence, while non-significant covariates were: age, gender, contrast volume, use of self-expandable valve and peri-procedural rapid pacing.
Multivariable analysis adjusted for age and sex showed that AKI (HR: 3.02, 95% CI: 1.03–8.90, p=0.045) and chronic obstructive pulmonary disease (COPD) (HR: 4.12, 95% CI: 1.37–12.40, p=0.012) were independently associated with 1-month all-cause mortality. After 1 month, landmark analysis adjusted for age and sex showed that AKI (HR: 2.41, 95% CI: 1.17–4.96, p=0.017) and peri-procedural myocardial injury (HR: 2.36, 95% CI: 1.05–5.31, p=0.037) were independent predictors of 1-year all-cause mortality, while COPD, non-transfemoral route, and bleeding complications were not independently associated.

Conclusions
In a contemporary cohort of consecutive patients undergoing TAVR, AKI complicated ∼1 out of 5 procedures and is linked with about 4-fold adjusted risk of short-term death at 1-month and about 2-fold adjusted risk of subsequent death events up to 1-year follow-up. Baseline creatinine and bleeding complications, but not contrast volume were independently associated with AKI incidence.
Landmark analysis for 1-year mortality

Funding Acknowledgement
Type of funding source: None
Impact of intervention strategies after failed Mitraclip therapy on mid-term outcome
Authors: Alessandrini H , Geidel S , Wohlmuth P , Meincke F , Hakmi S , Gosau N , Ubben T , Kuck K.H , Willems S 
Published: November 2020

Abstract

Introduction
Procedural failure after MitraClip (MC) therapy has a decisive prognostic influence and Re-treatment after acute procedure failure (APF) remains complex due to the generally high-risk patients. The aim of this work is to analyze the mid-term outcome between the surgical and the percutaneous interventional treatment routes according to APF from our High Volume Center.

Methods
Retrospective analysis of patients (pts.) consecutively treated with MC in the period from 9/2009 - 5/2019 with residual mitral regurgitation (rMR) that is still higher in the case of symptomatic APF (NYHA 3–4). Outcome analysis in primary (PMR) and secondary MR (SMR) with subsequent percutaneous (group Reclip) vs. surgical treatment (group surgery).

Results
Of a total of 824 pts., 63 (73±10 years, 20 women [31,7%]) showed APF (MR&gt;2) peri / postinterventionally. Mitraclip reintervention was performed in 36 pts. (26 SMR, 10 PMR), while 27 (13 SMR, 14 PMR) underwent surgery. Mitral valve replacement (MVR) was surgically performed on 21 pts. (11 PMR, 10 SMR), while reconstruction (MVrec) was performed on n=6 (3 PMR, 3 SMR). The mechanism of the rMR in the surgery group, n=14 (51.9%) was a pure sail injury (LT) or a partial clip detachment (PCD) or a combination of both, n=9 (33.3%) a severe rMI, n=3 (11.1%) device endocarditis and n=1 (3.7%) a technical device problem. In the reclip group n=15 (41.7%) showed an LT and / or a PCD and n=21 (58.3%) a severe rMR. Thirty-day mortality was 13.9% (n=5 deaths) in the ReClip-group (n=4 SMR, n=1 PMR) an 18.5% in the surgical group (n=5 deaths; all SMR patients). In the midterm FU over 18 months (Figure 1), the surgically treated patients with SMR showed a significantly higher mortality rate than in patients with PMR (p=0.002). In the Reclip intervention group, no significant difference between treated PMR and SMR patients can be objectified (p=0.995). The comparison between surgery / reclip in the PMR group shows no significance, whereas a trend (p=0.148) in favor of the reclip can be distinguished between surgery / reclip in SMR in the outcome.

Conclusion
Surgically treated patients after AFP with an SMR as index etiology show a very poor short and medium-term survival both in comparison to the PMR patients and to the two reclip groups. With the combination of AFP and SMR, the reclip treatment can be regarded as the primary treatment option despite the lack of statistical significance compared to surgery. In return, surgery combined with AFP and PMR offers a viable alternative and can be favored over the reclip procedure in younger patients.
Kaplan-Meier plot of the 4 intervention groups

Funding Acknowledgement
Type of funding source: None
Outcomes of transcatheter mitral valve repair from the latest nationwide inpatient sample database 2016–2017
Authors: Mehta H , Kurpad K , Okoh A , Singh S , Berman J , Hawthorne K 
Published: November 2020

Abstract

Background
Transcatheter mitral valve repair (TMVR) is an alternative treatment option for severe mitral regurgitation (severe MR) in patients with high surgical risk. Previous studies have demonstrated safety and efficacy of TMVR. The aim of our study was to assess comorbid and patient outcome data in a nationwide sample.

Methods
From the Nationwide Inpatient Sample (NIS) 2016–2017, all adult patients with mitral valve regurgitation were identified. Patients were divided into two group- TMVR and SMVR (surgical mitral valve repair). Patients requiring surgical valve replacement were excluded. Primary outcomes were inpatient mortality and length of stay. Multivariate analysis was performed to adjust for comorbidities.

Results
A total of 6211 TMVR were performed, while 3789 SMVR were performed. TMVR patients were older (78.34 vs 62.26 years) and had more females (48.86 vs 36.18%). Comorbidities were higher in the TMVR group [heart failure (81.02 vs 46.02%, p&lt;0.001), diabetes mellitus (27.13 vs 15.81%, p&lt;0.001), chronic kidney disease (39.3 vs 13.7%, p&lt;0.001), chronic lung disease (27.13 vs 16.65%, p&lt;0.001). Complications were higher in the SMVR [Cardiogenic shock (3.8 vs 6%, p=0.007), blood transfusion requirement (19.44 vs 4.85%, p=0.001), respiratory failure (10.99 vs 7.37, p=0.012)]. Mean length of stay was higher with SMVR [8.60±0.22 (4.139–5.17) days] compared to TMVR [4.65±0.26 (8.167–9.03) days]. In-patient mortality was lower in TMVR (2.01 vs 2.45%, p-0.02). After adjusting for comorbidities on multivariate analysis, there was no difference in mortality between the groups (adjusted OR=1.081±0.419 (0.506–2.311).

Conclusion
From nationwide data, we report TMVR as a relatively safe treatment modality for severe MR, with comparable inpatient mortality and fewer complications than SMVR, despite having a significantly higher burden of comorbidities.

Funding Acknowledgement
Type of funding source: None
Evaluation of bypass grafts after minimally invasive coronary artery bypass grafting according to the results of MSCT- angiography
Authors: Sichinava L , Payvin A , Denisiuk D , Snegirev M , Khvan N , Drozdova O 
Published: November 2020

Abstract

Background
Minithoracotomy avoids the complications specific to sternotomy access, which in turn creates the conditions for early activation and rehabilitation of patients, especially elderly, with diabetes mellitus, obesity, disorders of the musculo-skeletal system.

Purpose
To assess the patency of grafts after minimally invasive coronary artery bypass grafting (MICS CABG).

Methods
We analyzed the results of 50 MSCT- angiography made to patients with MICS CABG operated between 2014 and 2016 (28,5±13,5 months after surgery). Totally 132 conduits were used, 47 (35.6%) of them – arterial, 85 (64.4%) – venous. In all cases left internal mammary artery (LIMA) was used for revascularization of the left anterior descending artery (LAD). The great saphenous vein was used as a conduit for revascularization of: diagonal branch (DA) – 10 (11.7%) cases, left circumflex artery (LCx) – 44 (51.8%), right coronary artery (RCA) – 12 (14.1%), posterior interventricular branch – 19 (22.4%). Assessment of the patency of grafts were performed: 1–2 years (33 conduits: 13 arterial, 20 venous), after 2–3 years (51 conduits: 19 arterial, 32 venous) and after 3–4 years (48 conduits: 15 arterial, 33 venous).

Results
Assessment of coronary grafts patency in the first period revealed occlusion of 3 (15%) venous conduits. In 2 cases, the venous conduit was anastomosed with the LCx, in 1 case with the RCA. The cumulative patency of the grafts was as follows: arterial – 100%, venous – 85%. In the second point of the study occlusion and stenotic changes of LIMA has not been revealed. Determined occlusion 5 (15,6%) venous grafts. In all cases, the occluded venous conduits revascularized the RCA. Total permeability of conduits: arterial – 100%, venous-84.4%. In the third time interval it was revealed: in 1 case of LIMA occlusion and 7 venous grafts, in 4 cases in the area of the LCx, in 2 – DA and in 1 case – in the area of the RCA. Total patency of grafts: arterial – 93.3%, venous – 78.8%. Total permeability of conduits: arterial – 97.9%, venous – 82.4%.

Conclusion
The analysis shows good long–term results of the functioning of grafts after MICS CABG and their comparability with the results of patency of the conduits after CABG performed by the traditional

Funding Acknowledgement
Type of funding source: None
Comparison of clinical outcomes after transcarotid and transsubclavian versus transfemoral TAVI: a propensity-matched analysis
Authors: Villecourt A , Faroux L , Muneaux A , Tassan-Mangina S , Heroguelle V , Poncet A , Nazeyrollas P , Ruggieri V.G , Metz D 
Published: November 2020

Abstract

Transcarotid (TC) and transsubclavian (TSc) accesses are increasingly used as alternative approaches for TAVI when the transfemoral (TF) access is not suitable. However, concerns remain about the risk of peri-procedural stroke and long-term outcomes following TC or TSc TAVI.
The present study sought to compare early- and long-term outcomes of TC/TSc vs. TF TAVI after propensity-score matching.
260 patients who underwent TAVI through a TF (n=220), TC (n=32) or TSc (n=8) approach at our institution during a 4 years period were identified. A 1:1 matching based on the propensity-score was performed, leading to a population of 40 TF and 40 TC/TSc. Primary endpoints were early complications whereas secondary endpoints were long-term outcomes.
There was no difference in the baseline characteristics. At 30-day post-TAVI, there was no difference in mortality and stroke rates between TF and TC/TSc TAVI (5% vs. 5% mortality, p=1.0 and 2 vs. 1 stroke, p=1.0). After a median follow-up of 21 months, the risk of death (p=0.950), stroke (p=0.817) and myocardial infarction (p=0.155) did not differ between the 2 groups.
After propensity-score matching, no significant difference in early and long-term outcomes was observed between TF and TSc/TSc TAVI. These findings should encourage Heart-Teams to consider a TC or TSc approach when TF access is not available.
Table 1. 30-day and 1-year outcomes according to the arterial access (TF vs. TC/TSc) Variables TF-TAVI (n=40) TC/TSc-TAVI (n=40) p-value 30-day outcomes  All-cause mortality 2 (5.0) 2 (5.0) 1.000  All-stroke 2 (5.0) 1 (2.5) 1.000  Life-threatening bleeding 4 (10.0) 1 (2.5) 0.375  Acute kidney injury stage 2 or 3 2 (5.0) 1 (2.5) 1.000  Major vascular complication 6 (15.0) 6 (15.0) 1.000  Coronary obstruction 0 0 –  Early safety composite endpoint (VARC-2) 10 (25.0) 8 (20.0) 0.804 1-year outcomes  All-cause mortality 6 (15.0) 7 (17.5) 1.000  Cardiovascular mortality 5 (12.5) 3 (7.5) 0.727  Stroke 3 (7.5) 2 (5.0) 1.000  Myocardial infarction 0 (0) 2 (5) 0.500  MACCE 8 (20.0) 9 (22.5) 1.000  Readmission for heart failure 6 (15.0) 2 (5) 0.219
Figure 1

Funding Acknowledgement
Type of funding source: None
Are our patients waiting too long for cardiac surgery?
Authors: Menezes Fernandes R , Mota T.F , Bispo J.S , Costa H , Bento D , Marques N , Mimoso J , Jesus I 
Published: November 2020

Abstract

Introduction
Recommended pre-established waiting periods in patients referred for cardiac surgery aim to improve clinical outcomes.

Purpose
To determine the prognostic impact of the delay until cardiac surgery.

Methods
We conducted a retrospective study encompassing patients referred to cardiac surgery from a Cardiology Department, since January 2016 to December 2018. Clinical characteristics, diagnostic studies and follow-up were analysed. Primary endpoints were global mortality and re-hospitalization rates at follow-up. Independent predictors of clinical outcomes were identified through a binary logistic regression analysis, considering p=0,05.

Results
A total of 591 patients were included, with 71,1% male predominance and a mean age of 68,6±11,36 years old. 55,2% of patients had severe valvular disease (aortic – 38,6%, mitral – 9,6%, mixed valvular disease – 2,9%), and 37,1% had surgical coronary artery disease. The mean left ventricle ejection fraction was 56,1% ± 12,2% and the mean Euroscore II was 3,7%. 120 patients (20,3%) required more than one type of surgical intervention. 360 patients (60,9%) were referred to elective procedures, with a mean waiting time of 129,4 days and only 29,2% of them were operated in a 6-week period. The remaining 39,1% of patients needed urgent/emergent surgery, and the mean time until the intervention was 27,2 days (70,1% operated in 2-weeks). Mean waiting time was higher for valvular patients comparing with coronary patients (110,7 vs 48 days; p&lt;0,001). 9,8% and 4,6% of patients were re-hospitalized or died while waiting for surgery, respectively. In a median follow-up of 520 days since the surgical referral, 25,5% of patients were re-hospitalized and 13,7% died. Waiting time was an independent predictor of global mortality (p=0,018), as well as arterial hypertension (p=0,002), severe valvular disease (p&lt;0,001) and higher Euroscore II values (p=0,023). Waiting for surgery in an out-patient setting (p=0,011) and higher Euroscore II values (p=0,002) were independent predictors of re-hospitalization.

Conclusion
In our study, waiting time until surgery was an independent predictor of global mortality. Efforts should be made to enable referral surgical centres to timely respond to the needs of the population, considering the impact that delaying the appropriate treatment can have on the survival of these patients.

Funding Acknowledgement
Type of funding source: None
Renal sympathetic denervation improves heart rate variability and reduces arrhythmia burden
Authors: Plashchinskaya L , Goncharik D , Barsukevich V , Chasnoits A , Persidskikh Y , Rebeko E , Mrochek A 
Published: November 2020

Abstract

Background
Decreased heart rate variability (HRV) is a strong predictor of mortality (particularly sudden death), not only in high-risk patients. The impact of renal denervation (RDN) on HRV and cardiac arrhythmias has not yet been fully investigated.

Purpose
To assess the effect of RDN on HRV and cardiac arrhythmias in patients with blood pressure (BP) &gt;160/100 mmHg despite 3 full-dose antihypertensive drugs.

Methods
The study included 108 patients (46.3% male) with resistant hypertension (RH), the average age was 50.5±9.0. All patients underwent RDN. Procedure was performed by an experienced electrophysiologist at the renal arteries using specialized electrode Symplicity Flex: ablation power = 8–10 W at 55°C, 4–10 points for each renal artery (including brunch, when was appropriate), 2 minutes per point. Office systolic BP (SBP) and diastolic BP (DBP), 24-hour ambulatory BP monitoring and 24-hour monitoring ECG were measured before, at 6 and 12 months of follow-up.

Results
Baseline SBP and DBP in these groups of patients were −185.6±29 and −110.5±19.3 mm Hg respectively. Office BP significantly decreased by −28.2±21.6 /18.0±16.7 mm Hg (p&lt;0.001 for both) at 12 month. 24-hour SBP and DBP was significantly reduced both at 6 and 12 months after RDN. Twenty-four-hour BP was reduced by 13.2/8.4mmHg (P&lt;0.001). The number and dosage of antihypertensive drugs remained unchanged in all patients. Baseline data of general HRV in this group of patients were low: SDNN – 123.4±41.4 msec. The general HRV increased at 12 month since RDN: SDNN from 123.4±41.4 msec to 155.8±51.4 msec (p&lt;0.05), SDANN-i from 105.3±42.7 msec to 122.1±41.1 msec (p&lt;0.05). There was observed increase in RMSSD, reflecting of parasympathetic activity of autonomic nervous system – from 29.7±43.6 msec to 41.1±33.2 msec (p&lt;0.05). The total number of premature supraventricular and ventricular contractions was also significantly decreased both at 6 and at 12 months after RDN (p&lt;0.05 for both cases). Mean 24-hour monitoring heart rate was reduced by 5.8 bpm (p=0.02) at 12 month after RDN. No pauses or conduction abnormalities were observed either at baseline or after RDN.

Conclusions
Besides the important effect of RDN on heart rate and arrhythmic events, a significant improvement the time domain indexes of HRV was evident in patients with resistant hypertension at 12 month after the RDN-procedure. Our prospective single center study shows that RDN results in substantial BP lowering, significant reduction of mean heart rate and arrhythmia burden and restores autonomic balance in patients with resistant uncontrolled hypertension.

Funding Acknowledgement
Type of funding source: None
Genetic variations of SCNA7 and blood pressure potassium interaction
Authors: Delgado C , Delgado-Lelievre M , Lelievre D , Delgado-Almeida A 
Published: November 2020

Abstract

Introduction
The sodium voltage-gated channel alpha subunit 7 (SCN7A) has been associated to renal Na regulation and hypertension. This study explores the relationship between blood pressure (BP) and urinary overnight Na/K ratio (UONaK) in hypertensives (HT) and normotensive (NT) subjects from from National Heart, Lung and Blood Institute funded, Family Blood Pressure Program (FBPP) that were genotyped for 3 SNPs for SCN7A: CV2161217, CV 356958 and CV433036.

Hypothesis
Genetic variations in the SCNA7 are differently associated to BP and UONaK in HT and NT.

Methods
1,749 subjects genotyped for SCN7A SNPs CV2161217, CV 356958 and CV433036 were analyzed from FBPP. Subjects with diastolic BP (DBP) ≥80 or systolic BP (SBP) ≥130 mmHg were classified HTN; subjects with SBP &lt;130 and DBP &lt;80 mmHg were classified as NT. UONAK was calculated by dividing overnight Na by K concentration. Correlation analysis done with partial variables (use of antihypertensive drug, use of diuretics, overnight urine creatinine).

Results
For the CV2161217, HTN group (n=1,030), 52% had C/C, 39% C/T and 9% T/T. In NT group (n=719), 52% had C/C, 38% C/T and 10% T/T. In the HT group, subjects with CC genotype showed strong correlation between DBP and UONaK (Fig 1a) while no significant correlation with SBP. Those with CT genotype maintained the correlation between SBP and UONaK (r=0.10, p=0.03) with no correlation with SBP. The TT showed no correlation between UONaK and SBP or DBP. In the NT, subjects with TT genotype showed strong correlation between DBP and UONaK (Fig 1b) and with SB (r=0.256, p=0.03). Those with CT or TT genotypes showed no correlation between UONaK and SBP or DBP. Similar finding were obtained for CV356958 SNP; no similar association was observed in the CV433036 SNP.

Conclusions
Subjects with the genetic variations in the SCNA7, such as CV2161217 and CV 356958 SNPs, showed significant correlation between blood pressure and overnight urinary sodium potassium. This finding could have important implications in non dipping status observed in some hypertensive patients.

Funding Acknowledgement
Type of funding source: None
The state of platelets and their functional activity in patients with arterial hypertension in combination with non-alcoholic fatty liver disease
Authors: Netiazhenko V , Bazhenova N 
Published: November 2020

Abstract

Background
According to modern concepts of hypertension (HT) and obesity, the hemostatic system in these diseases is characterized by prothrombogenic changes. Since the liver is the site of the formation of many factors of hemostasis, the concomitant non-alcoholic fatty liver disease (NAFLD), which often accompanies the course of both of these diseases, is an actual problem.

Purpose
To improve the efficiency of early diagnosis of thrombophilic blood changes in hypertensive patients with concomitant obesity and NAFLD by determining the state of platelets and their functional activity.

Materials and methods
We examined 167 patients (80 men and 87 women). The average patient age 55.5 [47.0; 61.0] years. Patients were divided into three groups: I - 46 patients with hypertension without NAFLD, II - 54 patients with NAFLD without hypertension, III group - 52 hypertensive patients with NAFLD. The control group consisted of 15 healthy subjects matched for age and sex. Platelet count and mean platelet volume (MPV) was performed on an automated analyzer, spontaneous and induced platelet aggregation was evaluated by laser aggregometer.

Results
A significant increase in the degree of spontaneous aggregation of platelet has been found in patients in all groups compared to the control group: I group - 2.2-fold increasing in aggregation (p&lt;0.05), II group to 4.2-fold (p&lt;0.05), III group had increasing by 4.1-fold (p&lt;0.05).
ADP-induced platelet aggregation was the same in I group and control, but it was 39% higher (p&lt;0.001) in II cohort and by 22.6% (p&lt;0.01) in III group.
Adrenalin-induced platelet activity increased in all groups versus control: I group – 2.1-fold (p&lt;0.001), II group – 2.3-fold (p&lt;0.001), III group – 1.6-fold (p&lt;0.01) elevation.
Arachidonic acid-induced aggregation elevated by 64,2% (p&lt;0.001) in I group and decreased by 56.3% (p&lt;0.01) in II and by 43% (p&lt;0.05) III cohorts.
Collagen-induced activity had not significant difference between groups.
MPV was increased in both groups with NAFLD by 5.9, but in II group significance level was higher - p&lt;0.01 than in group III - p&lt;0.001. MPV had not significant changes in I group versus control.

Conclusion
Spontaneous platelet aggregation is increased in hypertensive patients and it is significantly enhanced in combination with NAFLD. Thus in patients with isolated NAFLD also observed a statistically significant increase in spontaneous aggregation of platelets. That is possibly explained by an increase in MPV which can be considered as one of the NAFLD risk factors thrombophilic changes in primary hemostasis. An analysis of induced platelet aggregation showed that patients with NAFLD may have a lower sensitivity to acetylsalicylic acid therapy.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Bogomolets National Medical University