bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of concomitant mitral regurgitation in severe aortic stenosis in Japan – from the CURRENT AS registry
Authors: Murai R , Kawase Y , Taniguchi T , Morimoto T , Maruo T , Fuku Y , Kadota K , Kimura T 
Published: November 2020

Abstract

Background
Clinical significance of concomitant mitral regurgitation (MR) in patients with severe aortic stenosis (AS) has not been well-studied.

Purpose
The purpose of this study is to investigate the prognostic impact of concomitant MR in patients with severe AS.

Method
We used the data of 3815 patients from the CURRENT AS registry, a retrospective multicenter registry of severe AS in Japan. We compared the clinical outcomes between patients with moderate/severe MR and with none/mild MR according to the initial treatment strategies (initial aortic valve replacement [AVR] or conservative strategy). The primary outcome measure was a composite of aortic valve-related death and heart failure hospitalisation.

Results
Among the study population, moderate/severe MR were observed in 227/1197 (19%) patients with initial AVR strategy and in 536/2618 (20%) patients with conservative strategy. Among survivors with the initial AVR strategy, moderate/severe MR improved in 61/62 (98%) patients with concomitant mitral procedures. The crude cumulative 5-year incidence of the primary outcome measure was significantly higher in patients with moderate/severe MR than in those with none/mild MR regardless of the treatment strategies (25.2% vs. 14.4%, P&lt;0.001 in the initial AVR strategy; 63.3% vs 40.7%, P&lt;0.001 in the conservative strategy). Multivariate analysis revealed moderate/severe MR at index echocardiography was independently associated with higher risk for the primary outcome measure in conservative strategy (adjusted HR 1.20, 95% CI 1.03–1.40, P=0.023), but not associated in the initial AVR strategy (adjusted HR 1.20, 95% CI 0.82–1.80, P=0.339).

Conclusion
Moderate/severe MR was independently associated with poorer outcome in patients with severe AS who were managed conservatively, but not in those with initial AVR strategy.

Funding Acknowledgement
Type of funding source: None
Cardiac magnetic resonance and B-natriuretic peptide are superior prognostic tools to guideline-based echocardiography in asymptomatic patients with chronic severe aortic regurgitation
Authors: Kockova R , Linkova H , Hlubocka Z , Blaha M , Tuna M , Medilek K , Lupinek P , Sedmera D , Penicka M 
Published: November 2020

Abstract

Background
The optimal timing of intervention in patients with chronic aortic regurgitation (AR) is currently based on patient symptoms and echocardiography derived parameters. The sensitivity of this approach is suboptimal and late operation often results in irreversible myocardial damage.

Purpose
To determine the prognostic value of novel parameters in asymptomatic patients with chronic severe AR in optimal timing of aortic valve surgery.

Methods
Consecutive patients with chronic severe AR not indicated for surgery per the current guidelines were studied in a prospective design in 5 centers. Baseline examination consisted of B-natriuretic peptide (BNP) measurement, comprehensive echocardiography (ECHO) including 3-dimensional (3D) study with vena contracta area (VCA), and complex magnetic resonance (MRI) including regurgitant volume (RV), regurgitant fraction (RF), global myocardial work efficiency (GWE) and extracellular volume (ECV); all analyzed in core lab. All patients were followed every 6 months and the endpoint was disease progression defined as an indication for surgery. The perioperative myocardial biopsy was performed in all surgically treated patients for histological myocardial fibrosis quantification.

Results
In total, 129 patients were enrolled between 2015 and 2019, the endpoint occurred in 35 patients during a mean follow-up of 1044 days. Baseline clinical data did not differ between patients with disease progression (surgical group) and stable patients. Baseline BNP levels were higher in the surgical group (63 vs. 20, P&lt;0.01) and a cut-off value of 30.4 ng/L was predictive of disease progression with AUC 0.75. None of the standard ECHO parameters of left ventricular (LV) size and function was predictive of the endpoint. Novel ECHO parameter 3D VCA was higher in the surgical group (32 vs. 26 mm2, P=0.037). All MRI parameters of LV size and function were predictive of disease progression (all P&lt;0.02), except LV ejection fraction. MRI-derived RV (57 vs. 37 ml, P&lt;0.01) and RF (46 vs. 34%, P&lt;0.01) were identified as the strongest independent predictors of surgery. There was no difference in ECV between the surgical group and stable patients (24 vs. 24, P=0.81) despite a good correlation with histological quantification of myocardial fibrosis.

Conclusions
Standard ECHO parameters cannot reliably predict the need for surgery in asymptomatic aortic regurgitation patients. Baseline BNP levels above 30.4 ng/L predict disease progression. Novel imaging parameters – ECHO-derived 3D VCA and MRI-derived parameters of LV size and AR severity might be useful in optimal timing determination.
Imaging markers and myocardial histology

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Ministry of Health of the Czech Republic
Cardiopulmonary exercise testing as a guideline indicator for mitral valve intervention
Authors: Afoke J , Kanaganayagam G.S , Casula R , Bruno V.D , Howard L , Gibbs J.S.R , Punjabi P 
Published: November 2020

Abstract

Background
Primary mitral regurgitation (MR) is one of the most common heart valvular pathologies. However, optimum timing of surgery remains controversial.

Purpose
To describe changes in cardiopulmonary exercise testing (CPET) parameters after surgery for severe primary MR.

Methods
In a single centre prospective study, patients undergoing surgery under current ESC guidelines for severe primary MR underwent assessment with transthoracic echocardiogram, CPET, cardiac MRI and quality of life questionnaire pre-operatively and at six months after surgery. The primary outcome was a per protocol analysis of impaired post-operative functional capacity (defined as post-operative left ventricular ejection fraction on transthoracic echocardiogram &lt;50% and/or post-operative percentage predicted peak VO2 ≤84%).

Results
43 of the 50 patients recruited between February 2017 and October 2018 were included in the per protocol analysis. Thirty five patients (72.9%) had impaired post-operative functional capacity. In the overall cohort (n=43), there was a significant fall post-operatively in percentage predicted peak VO2 (ppVO2) (81.8±15.7% vs. 76.2±16.2%, p&lt;0.01) and anaerobic threshold (AT) (48.0±11.1% vs. 44.3±10.1%, p=0.01). In patients with a class I indication for surgery (n=30), there was no significant change post-operatively in ppVO2 (79.6±15.7% vs. 75.6±16.7%, p=0.09) or AT (49.9±11.4% vs. 46.4±10.2%, p-0.09). However, in patients with a class II indication for surgery (n=13), there was a significant change post-operatively in ppVO2 (86.9±15.1% vs. 77.4±15.9%, p&lt;0.01), but not in AT (43.5±9.6% vs. 39.5±8.3%, p=0.16).
In the multivariable analysis, pre-operative left ventricular ejection fraction ≤60% (hazard ratio, 1.69; 95% confidence interval, 1.56 to 480.1, p=0.04) and pre-operative percentage predicted peak VO2 ≤84% (hazard ratio, 1.22; 95% confidence interval, 2.13 to 107.1, p&lt;0.01) were independent predictors for impaired post-operative functional capacity.

Conclusions
Pre-operative percentage predicted peak VO2 ≤84% is an independent predictor of impaired post-operative functional capacity. Subject to a confirmatory study, this may help to refine current ESC guidelines for intervention for severe primary MR.
Change in ppVO2 after surgery

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Rosetrees Trust and Friends of Hammersmith Hospital
Determinants and prognostic significance of focal myocardial fibrosis by cardiac magnetic resonance imaging in patients with mitral valve prolapse
Authors: Constant Dit Beaufils A.L , Huttin O , Piriou N , Cueff C , Senage T , Marrec M , Warin-Fresse K , Banasiak C , Sellal J.M , Mandry D , Venner C , Filippetti L , Serfaty J.M , Selton-Suty C , Le Tourneau T 
Published: November 2020

Abstract

Background
Mitral valve prolapse (MVP) is a frequent disease that can be complicated by mitral regurgitation (MR), heart failure, arterial embolism, rhythm disorders and death.

Purpose
We sought to evaluate the correlates of late gadolinium enhancement (LGE), and the prognostic significance of ventricular size, function, and LGE by cardiac magnetic resonance (CMR) imaging on cardiovascular morbi-mortality in patients with MVP

Methods
We included 426 patients (54±15 years, 57% male) with MVP (trace to severe MR) between 2010 and 2019 who underwent a comprehensive echocardiography and CMR imaging. Gadolinium was injected in 411 (96%) patients. The main outcome endpoint was a composite endpoint of cardiovascular death, heart failure, new onset atrial fibrillation or arterial embolism, censored at the time of mitral valve intervention.

Results
Among the 411 patients, LGE+ was found in 118 (29%; 100 myocardial wall including 78 basal inferolateral midwall, 30 papillary muscles) and was more frequent with worse MR volume and LV remodeling. Correlates of LGE in multivariable analysis were LV mass index (OR 1.02, P=0.008), moderate-severe MR (OR 2.15, P=0.017) and coronary artery disease (OR 5.8, P=0.013). At 4 years, survival without cardiovascular events was decreased in patients with LGE+ (50.0±11.9 vs 73.5±6.3%, p&lt;0.0001). In a stepwise multivariable analysis including classical predictors of outcome, grade of MR, LA volume index and the presence of LGE on CMR imaging (HR: 2.15 [1.15–4.02], P=0.017) were associated with impaired event-free survival.

Conclusion
CMR imaging provides additional information to echocardiography in the clinical work-up of MVP. Localized LV myocardial fibrosis is a predictor of cardiovascular event in MVP patients.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): DGOS (PHRCI), Fondation Cœur et Recherche
Prognosis of short- and long-term dialysis in patients with infective endocarditis: a nationwide study
Authors: Petersen J , Jensen A.D , Bruun N.E , Kamper A , Butt J.W , Borgersen E , Pedersen C.T , Chaudry M.S , Kober L , Fosbol E.L , Ostergaard L 
Published: November 2020

Abstract

Background
Infective endocarditis (IE) may be complicated by acute kidney injury, yet data on the use of dialysis and subsequent reversibility are sparse. We set out to examine the prognosis of short- and long-term dialysis in patients with IE.

Methods
Using Danish nationwide registries we identified patients with first-time IE from 2000 to 2017. Dialysis naïve patients were grouped into: those who were treated with dialysis during admission with IE and those who were not. The cumulative incidence of continuous use of dialysis was examined one year post-discharge Multivariable adjusted Cox proportional hazard analysis was used to examine one-year mortality for patients surviving IE based on use of dialysis.

Results
We included 7,307 patients with IE; 416 patients (5.7%) initiated dialysis treatment during admission with IE and these were younger, had more comorbidities and more often underwent cardiac valve surgery during admission with IE compared with non-dialysis patients (47.4% vs. 20.9%). In patients with both surgical intervention and dialysis treatment, 153 (77.7%) initiated dialysis on- or after the date of surgery. The in-hospital mortality was 40.4% and 19.0% for patients with and without dialysis, respectively (p&lt;0.0001). Of those who started dialysis and survived hospitalisation, 78.4% became dialysis-free within one year after discharge. Among those who survived one week subsequent to IE discharge, we identified 5,520 who never had dialysis, 204 patients without continued use of dialysis, and 40 patients with a continued use of dialysis. The corresponding mortality risk at one year was 15.2%, 13.5%, and 41.6% (Figure), respectively. Compared with patients not treated with dialysis, those who became dialysis-free at discharge showed no increased risk of one year mortality in adjusted analysis (HR=1.45, 95% CI: 0.97–2.20), while patients who continued dialysis had an increased associated risk of mortality (HR=2.00, 95% CI: 1.20–3.33).

Conclusion
In dialysis-naïve patients with IE, more than 1 in 20 patients initiated dialysis treatment during admission. Dialysis identified a high-risk group with an in-hospital mortality of 40%–twice as high as their counterparts. In dialysis patients surviving admission with IE, almost 80% became dialysis-free and showed better long-term survival than those who continued dialysis after discharge.
Figure 1

Funding Acknowledgement
Type of funding source: None
Discrepancies between the decisions of an endocarditis team and the modified Duke's Criteria for the diagnosis of infective endocarditis
Authors: Power N , Chick W , Tan A , Gamlin W , Calisti G , Watt V , Price F , Dobson L , Ray S 
Published: November 2020

Abstract

Background/Introduction
The 2015 ESC endocarditis guidelines recommend that a multi-disciplinary endocarditis team should be involved in caring for patients with endocarditis. This approach recognises the heterogeneity of infective endocarditis, and the difficulty in distinguishing endocarditis from other infective and non-infective diseases.

Purpose
This study looks at suspected cases of infective endocarditis discussed at the endocarditis MDT, discrepancies between MDT outcome and the modified Duke's criteria in diagnosing endocarditis, and number of referrals to MDT over time.

Methods
Patients were identified by review of MDT outcome forms. Demographic data, predisposing conditions, imaging findings, microbiology results and final diagnosis were identified by reviewing MDT forms and electronic charts.

Results
234 patients were identified from MDT outcome forms. 118 (50.4%) patients were over 65, 165 (70.5%) were male, and 65 (27.8%) had previous valve surgery. Crosstabulation of MDT decision against outcome by modified Duke's criteria are seen in Table 1. The endocarditis team identified 7 patients with definite or possible endocarditis who were excluded by applying the modified Duke's criteria. 1 of these patients required aortic valve replacement. 2 patients with disseminated Staphylococcal infections without endocarditis were classed as definite endocarditis by the modified Duke's criteria. Referral data and outcomes are included in Figure 1.

Conclusions
The endocarditis team can be used to improve the sensitivity and specificity of the modified Duke's criteria. As the endocarditis team became established the volume of referrals has increased, along with the number of patients who have alternate diagnoses. Practitioners should bear this in mind when establishing endocarditis teams.
Figure 1. Referrals over time by outcome

Funding Acknowledgement
Type of funding source: None
Lifetime mortality associated with hypertrophic cardiomyopathy: 28-year outcome of an historical cohort
Authors: Maurizi N , Cecchi F , Tomberli F , Baldini K , Fumagalli F , Bonacchi G , Marchionni N , Maron B.J , Olivotto I 
Published: November 2020

Abstract

Background
Current understanding of the lifetime mortality of patients with hypertrophic cardiomyopathy (HCM) has been extrapolated from cohorts with 8–10 years follow-up. Real survival rates and long-term burden of HCM are largely unresolved.

Objective
To describe HCM lifetime mortality over 28-years of observation.

Methods
We analyzed clinical/instrumental data of the historic cohort of 202 patients diagnosed from 1970s. ECG, echocardiographic, clinical records until last follow-up were recorded. Reasons for death were classified as HCM related (Sudden Death (SD), Heart Failure related (HF)) and non-HCM related deaths.

Results
Patients were followed-up for 28±6 years (41±17 to 69±14 years), 63% were males. Patients progressively dilated the Left Atrium (40±6 to 50±9mm, p&lt;0.01), depressed ejection fraction (65±9 to 54±12, p&lt;0.01), developed diastolic restrictive pattern and decreased LV wall thickness (23±5 to 19±4mm, p&lt;0.01). One-hundred-eighteen deaths occurred at 66±12 years. HCM accounted for 69 deaths, 53 due to HF-related complications and 16 for SD. Annual HCM mortality rate increased from 0.6% at 10 years following diagnosis to 1.4% during 11–28 years of follow-up (p&lt;0.01): HF yearly burden increased from 0.6% to 1.3%, p&lt;0.01, SD remained similar in the two periods (0.1%, 0.4% respectively).

Conclusions
HCM-related mortality at 10 years significantly underestimated the lifetime rates of HF death, which doubled in the second/third decade of observation. Conversely, SD rates remained constantly low. Real burden of HCM is time dependent and can be appreciated only after prolonged exposure to the disease.

Funding Acknowledgement
Type of funding source: None
Survival analysis in arrhythmogenic/dilated cardiomyopathy caused by pathogenic DSP truncating variants
Authors: Lamounier Junior A , Alonso Garcia D , Fernandez Ferro G , Cardenas Reyes I.J , Salazar-Mendiguchia Y Garcia J , Ochoa J.P , Nicolas Cicerchia M , Pena-Pena M.L , Noel Brogger M , Garcia Hernandez S , Fernandez X , Ortiz M , Barriales-Villa R , Iglesias Monserrat L 
Published: November 2020

Abstract

Background
Desmoplakin (DSP) truncating variants have been associated with arrhythmogenic cardiomyopathy (ACM), which can exclusively affect the left ventricle up to 30% of the cases. Nonetheless, data on prognosis in carriers is still limited.

Purpose
To evaluate survival free of cardiovascular events in carriers of pathogenic DSP truncating variants.

Methods
Clinical and genetic data on families carrying DSP truncating variants (nonsense, frameshift, and splicing-site) in the literature were systematically revised and collected in a dedicated database. Classification of variant pathogenicity was in accordance with ACMG criteria. We evaluated available follow-up data and constructed Kaplan-Meier survival curves free from cardiovascular death (sudden death, appropriate cardiodefibrillator shock, heart failure death, and stroke-related death) or heart transplant based. Long-rank test was used to compare event-free survival time between genders.

Results
707 carriers (336 index cases and 371 relatives; 51.1% were female carriers) were identified carrying 198 variants (90 nonsense, 89 frameshift, 19 splicing-site). 292 had ACM, 136 dilated cardiomyopathy (DCM), eight cases of unexplained sudden death, 120 were unaffected carriers, and no clinical data was reported in 151 carriers. In addition, 73 affected relatives without genetic testing were reported (28 had ACM, 28 DCM, and 17 unexplained sudden deaths).
Survival data was reported for 449 individuals (221 males; 228 females). Eight-one had suffered events: 57 sudden cardiac death (32 males), 10 heart failure deaths (7 males), 7 transplants (5 males), 6 cardiodefibrillator shock (4 females), and one stroke-related death (1 female).
Incidence of cardiovascular death or transplant was higher in males than females (p=0.012), with annual incidence between ages 30–70 of 0.84%/year in males and 0.72%/year in females. Mortality at the age of 50 years was 31% for males and 16% for females.

Conclusion
DSP truncating variants are associated with a relevant risk of cardiovascular death, which is higher in males, especially after age 30. More than 70% of the events were sudden deaths.
DSP truncating variants survival curves

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Health in Code SA
MicroRNA-208b gene expression levels as a biomarkers of left ventricular dysfunction in patients with acute myocarditis
Authors: Marketou M , Kontaraki J , Fragiadakis K , Konstantinou J , Maragkoudakis S , Lempidakis D , Plevritaki A , Plataki M , Papadaki S , Vougia D , Vardas P , Parthenakis F 
Published: November 2020

Abstract

Purpose
MicroRNAs (miRs) play a major role in protein regulation by post-transcriptional gene expression and cell to cell interaction. Recently, they have been emerged as important modulators in cardiovascular development and disease. Our aim was to determine whether cardiac related miRs such as miR-208b was differentially expressed in peripheral blood mononuclear cells from patients with acute myocarditis. We also evaluated their expression levels in peripheral blood mononuclear cells in relation with left ventricular global longitudinal peak strain (GLPS) in those patients.

Methods
We assessed the expression levels of miR-208b in 55 patients with acute myocarditis (48 men, mean age 33±10 years) and 22 healthy individuals (18 men, mean age 33±9 years). Blood samples were taken on admission and miR expression levels in peripheral blood mononuclear cells were quantified by real-time reverse transcription polymerase chain reaction. All patients were also underwent an assessment with standard conventional transthoracic and a two-dimensional speckle tracking echocardiography.

Results
GLPS was significantly reduced in the group of myocarditis compared to healthy individuals (from −13.9±10.9% versus −22.2±6.7%, p&lt;0.05). Myocarditis patients showed significantly higher miR-208b (28.8±16.6 versus 6.40±1.1, p&lt;0.001) expression levels compared to control group. miR-208b gene expression levels at baseline revealed a significant negative correlation with GLPS on admission (r=−0.51, p&lt;0.05). This correlation was independent of the patients' clinical parameters.

Conclusions
Our data reveal that miR-208b gene expression levels are upregulated in peripheral blood mononuclear cells from patients with acute myocarditis relative to healthy individuals. In addition, miR-208b levels have a prognostic value in the deterioration of left ventricular GLPS in those patients. Thus, miR-208b may represent a promising biomarkers in myocarditis or a potential therapeutic target in the future.

Funding Acknowledgement
Type of funding source: None