bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spondylodiscitis and endocarditis, the strange couple
Authors: Scheggi V , Del Pace S , Virgili G , Stefano P.L 
Published: November 2020

Abstract

Background
The association between spondylodiscitis and infective endocarditis (IE) was first reported in 1965 but only a few data are available in the literature about this clinical picture. Early diagnosis of infective endocarditis as the source of spondylodiscitis is often difficult. The aim of this study was to evaluate the proportion of spondylodiscitis in patients with IE and to determine its clinical features.

Methods
We retrospectively analyzed 355 consecutive patients (127 women) admitted to our department with definite diagnosis of IE. Mean age was 65 years (SD 15.3). IE occurred on native valves in 223 patients (63%) and it involved the aortic valve in 191 cases (54%), mitral valve in 138 cases (39%) and tricuspid valve in 26 (7%). Spondylodiscitis occurred in 24 patients (7%). The diagnosis of spondylodiscitis was made on the basis of typical clinical and radiologic signs. Long-term follow-up was obtained by structured telephone interviews. Average duration of follow-up was three years. Primary endpoint was to establish clinical features of patients with IE complicated by spondylodiscitis.

Results
At univariable analysis spondylodiscitis was associated with male sex (p=0.043), diabetes (p=0.049), drug abuse (p=0.017) and enterococcus infection (p=0.043). At multivariable analysis diabetes (p=0.014) and drug abuse (p=0.006) were independently correlated with the presence of spondylodiscitis. Other clinical features were not associated with the presence of spondylodiscitis (age, BMI, chronic renal failure, paravalvular extension of infection, vegetation length, EuroScore 2, PCR and procalcitonin levels, type of valve infected). Mortality was similar between patients with and without spondylodiscitis.

Conclusions
The association of spondylodiscitis and infectious endocarditis should always be suspected, expecially in patients with a high risk profile. Hence, patients with spondylodiscitis should be submitted to echocardiography, mainly when the infective organism is an Enterococcus. Conversely, patients with IE should undergo screening for methasthatic infection.

Funding Acknowledgement
Type of funding source: None
Prognostic value and reversibility of liver stiffness in patients undergoing tricuspid annuloplasty
Authors: Chen Y , Chan Y.H , Wu M.Z , Yu Y.J , Ren Q.W , Lam Y.M , Seto W.K , Yuen M.F , Lau C.P , Tse H.F , Yiu K.H 
Published: November 2020

Abstract

Background
Hepatic dysfunction was previously suggested to be related to poor outcome in patients undergoing tricuspid annuloplasty (TA), the predictive value of liver stiffness (LS) for adverse events is nonetheless uncertain.

Purpose
The aim of this study was to evaluate the prognostic value and reversibility of LS in patients undergoing TA.

Methods
A total of 158 patients (age 63, male 35%) who underwent TA during left-sided valve surgery were prospectively evaluated. Transient elastography was used to assess LS. Patients were divided into three groups according to tertiles of LS. Adverse outcome was defined as heart failure requiring hospital admission or mortality.

Results
The median LS was 13.9 (8.1–22.3) kPa which independently correlates with tricuspid regurgitation severity (assessed by effective regurgitant orifice area), inferior vena cava diameter and tricuspid annular plane systolic excursion. During a median follow-up of 31 months, 49 adverse events occurred. Multivariable Cox regression analysis demonstrated that LS was an independent predictor of adverse events. Furthermore, a higher LS tertile was predictive for adverse events (Hazard Ratio 4.19, P&lt;0.01) even after adjusting for the other prognosticators. Kaplan-Meier curve showed that patients in the third tertile LS group had the highest percentage of adverse events followed by patients in the second tertile. Significant improvement of LS at 1-year post-TA was noted only in patients who had no adverse events but not in those who experienced heart failure.

Conclusions
The present study demonstrates that LS is predictive of adverse outcome in patients undergoing TA. These findings suggested that assessing LS, an integrative assessment of right heart condition, may aid the management of patients undergoing TA.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): The Health and Medical Research Fund from the Food and Health Bureau, the Government of Hong Kong Special Administrative Region.
Gender specific differences in functional capacity in asymptomatic patients with isolated severe aortic stenosis
Authors: Banovic M , Iung B , Brkovic V , Aleksandric S , Mitrovic P , Nedeljkovic I , Popovic D , Jaukovic M , Asanin M , Penicka M , Bartunek J 
Published: November 2020

Abstract

Risk stratification as well as treatment decision in asymptomatic patients with isolated severe aortic stenosis (AS) is matter of ongoing debate. It has been known that gender-specific difference in left ventricular reaction to AS exists. Female gender has also been linked to increased risk of adverse events after surgical AVR but with better outcome after TAVI. We investigated whether there is a gender difference in functional capacity in asymptomatic patients with isolated severe AS.
Asymptomatic patients with severe AS were prospectively enrolled and underwent cardiopulmonary stress-echocardiography exercise testing (ESE-CPET) on supine ergobicycle, ramp protocol, 15 W/min. Patients with ischemia positive test were excluded (ECG and/or echo)
There were 139 patients, 61 women. There were no gender differences in age (66.36 vs 67.37, p=ns), echo parameters (Vmax 4.54 vs 4.48m/s, AVA 0.62 vs 0.68cm2, and Pmean 52.6 vs 53.8mmHg, all p=ns), LVEF (68.56 vs 70.90%, p=ns), e/E' (12.74 vs 14.45, p=ns), BNP (112.51 vs 110.55 pg/ml, p=ns) and valvulo-arterial impedance (4.65 vs 5.14mm Hg·ml–1·m2, p=0.07). Women had higher body mass index (29.05 vs 26.95, p=0.022), lower VO2max (12.96 vs 17.93 ml/kg/m2, p=0.001) and higher VE/VCO2 slope (33.69 vs 29.01, p=0.003). Univariable and multivariable linear regression analysis were used to test the relation between various clinical and echocardiographic parameters and VO2max. The variables independently associated with the VO2max are shown in table 1, with female gender being the strongest independent predictor of VO2max

Conclusion
Female gender is independent predictor of decreased functional capacity, even when adjusting for other variables, including BMI and echo markers of AS severity. Further studies are needed to determine whether this finding affects the course and outcome of the disease

Funding Acknowledgement
Type of funding source: None
Pace of progression of aortic stenosis severity in patients with tricuspid and bicuspid valve
Authors: Hamala P.H , Kasprzak J.D.K , Wierzbowska-Drabik K.W.D 
Published: November 2020

Abstract

Background
Knowledge about determinants and pace of aortic stenosis (AS) progression may improve classification to aortic valve replacement. We quantified and compared pace of AS progression in patients with tricuspid and bicuspid aortic valve (TAV and BAV) examined by transthoracic echocardiography (TTE) in years 2004–2019.

Methods
We analysed retrospectively 322 TTE performed in two time points (median time between examinations 31±31 months) in 161 AS patients (mean age 69±11 years, 101 male, 40 BAV), evaluating the changes of parameters reflecting AS severity: peak pressure gradient (PG), aortic valve area by planimetry (AVApl) and continuity equation (AVAce). Then we compared pace of AS progression (defined as change of parameters per year) between patients with BAV and TAV and searched for correlates of AS progression.

Results
Although patients with BAV were younger, cardiovascular risk factors profile and baseline AS advancement were similar in both groups, see Table. Severe AS was present in 20% in BAV and 21% in TAV, p=ns. Patients with BAV showed circa 3 times more rapid AS progression expressed as the increase of PG per year (18.5±41.3 mmHg vs 4.1±34.4 mmHg in TAV, p=0.03) and yearly AVAce decrease (−0.23±0.27 vs −0.03±0.32, p=0.028). Smaller AVA value at baseline predicted faster pace of AS progression (with correlation coefficient r=−0.34, p=0.002 for AVApl).

Conclusion
Progression rate of AS depends on valve morphology being more rapid in BAV with similar to TAV baseline AS severity. In the whole group pace of progression correlated negatively with baseline AVA.

Funding Acknowledgement
Type of funding source: None
Outcomes in severe tricuspid regurgitation by CMR: when severe is too severe
Authors: Hinojar Baydes R , Vieitez J.M , Gonzalez-Gomez A , Garcia-Martin A , Hernandez-Jimenez S , Pascual M , Monteagudo J.M , Garcia De Vicente A , Zamorano J.L , Fernandez-Golfin C 
Published: November 2020

Abstract

Introduction
Tricuspid regurgitation (TR) is related to poor prognosis independently of the etiology. Recently a new scale classification has been proposed to better characterize the grading of more than severe TR. Massive and torrential TR seem to have worse prognosis based on recent echocardiographic studies. There is no information on how that classification would apply when TR is quantified by cardiac magnetic resonance (CMR).

Purpose
To define the cut-off value of massive and torrential TR by CMR and to investigate its potential prognostic implications.

Methods
Consecutive patients in stable clinical status with significant TR evaluated in the Heart Valve Clinic with a contemporaneous echo and CMR were included. TR severity was evaluated by biplane vena contracta and effective regurgitant orifice method, using EPIQ system and by TR regurgitant fraction using a 1.5 Tesla CMR Philips scanner. End-point included cardiovascular mortality, tricuspid valve surgery or heart failure.

Results
A total of 56 patients were included (mean age was 72±9 years, 74% females). According to echocardiography n=43 (76%) were severe TR, n=8 (14%) were massive IT and n=5 (9%) were torrential TR. Patients with massive and torrential TR showed higher RV end-diastolic volume and lower RVEF. A TR regurgitant fraction (TRF) &gt;50% held the best accuracy to define massive / torrential TR. During a median follow up of 2.4 years (IQR: 1.1–3.3 years) 31% of the patients reached the combined endpoint. TR regugitant fraction was predictive of worse prognosis (hazard ratio per 1%TRF=1.085 [1.024–1.150] p=0.003). Patients with a massive and torrential TR showed a significantly higher rate of events (figure). Figure shows on the left (A) spline curves displaying survival free of events for each value of TR regurgitant fraction. y-axis represents the hazard ratio regurgitation fraction (green line) and 95% confidence interval (shadow). On the right (B) Kaplan Meier curves show a significantly higher rate of events in patients with RF&gt;50%.

Conclusions
Our results confirm that patients with massive/torrential TR are populations at higher risk of cardiovascular events. New classification scheme may be included in CMR grading scales. Further research will establish who may benefit the most of intensive therapeutic treatments and intervention on the tricuspid valve.

Funding Acknowledgement
Type of funding source: None
Early haemodynamic and structural impact of transcatheter aortic valve replacement in pure aortic regurgitation
Authors: Graziani F , Mencarelli E , Burzotta F , Paraggio L , Aurigemma C , Romagnoli E , Pedicino D , Locorotondo G , Lombardo A , Leone A.M , Laezza D , Crea F , Trani C 
Published: November 2020

Abstract

Background
Patients with severe aortic regurgitation (AR) are treated by surgery and have variable left-ventricular (LV) “reverse remodelling” after intervention. Transcatheter-aortic-valve replacement (TAVR) might be considered in selected AR patients.

Purpose
To evaluate the hemodynamic and structural impact of TAVR in patients with pure AR.

Methods
Consecutive AR patients underwent TAVR in our Institution were identified. Left heart catheterization before and after TAVR and complete echocardiographic assessment before TAVR, after (24–72 hours) TAVR and at follow-up (3–12 months) were systematically performed.
Hemodynamic and echocardiographic parameters were compared before and after TAVR.

Results
Twenty-two patients with severe AR, high surgical risk and advanced heart damage were treated by TAVR using mainly self-expandable prostheses. The procedure was successful in 21 patients (95.5%). An immediate hemodynamic impact of the TAVR procedure was documented by different parameters and included significant decrease in LV end-diastolic pressure (from 26.2 to 20.1 mmHg, P=0.012). Significant reduction in LV size (left ventricular end diastolic diameter (LVEDD): 60.0±8.0 mm vs 54.6±8.1 mm, p=0.002) and mass (left ventricular mass indexed (LVMi): 163.2±58.8 g/m2 vs 140.2±45.6 g/m2, p 0.004) as well as a sharp reduction in systolic-pulmonary-arterial-pressure (48.3±17.6 vs 32.9±7.8 mmHg, p&lt;0.0001) was documented at 24–72 hours. Furthermore, patients with baseline moderate-to-severe mitral and tricuspid regurgitation showed a significant, early, valvular regurgitation reduction. All favourable changes persisted at follow-up. More pronounced LVEDD reduction was predicted by baseline LVEDD (p=0.019).

Conclusions
In patients with severe AR, TAVR determines a profound impact on heart remodelling, which is early detectable and durable.
Impact of TAVR in pure AR

Funding Acknowledgement
Type of funding source: None
Temporal trends in readmissions after transcatheter aortic valve replacement
Authors: Arora S , Strassle P.D , Hendrickson M.J , Sitammagari K , Qamar A , McRee C.W , Yeung M , Vavalle J.P 
Published: November 2020

Abstract

Background
Although readmissions after transcatheter aortic valve replacement (TAVR) were frequent in initial experiences, it is unknown if the incidence of readmission has changed with technological advances and other factors.

Purpose
Assess temporal trends in 30-day readmission after TAVR

Methods
Hospitalizations of adults aged ≥50, with aortic stenosis and undergoing elective TAVR or SAVR between 2012 and 2016 in the National Readmission Database were analyzed. Causes of 30-day readmission were classified as cardiovascular (CV) and non-cardiovascular (non-CV). Poisson regression was used to assess quarterly trends in TAVR and SAVR readmissions.

Results
Overall, 29,031 TAVR and 72,412 SAVR hospitalizations were included (weighted N 56,858 TAVR and 151,899 SAVR), and 14% were readmitted within 30-days (TAVR: 15%; SAVR: 13%). Of all the readmissions, 38% were cardiovascular (TAVR: 35%; SAVR: 40%). Between January 2012 and November 2016, the incidence of overall 30-day readmission significantly declined from 20% to 13% (CIE −0.13, 95% CI: −0.13, −0.13, p&lt;0.0001) after TAVR and from 15% to 12% (CIE −0.05, 95% CI: −0.05, −0.05, p&lt;0.0001) after SAVR. When stratified by readmission cause, the incidence of both CV (7.2% to 4.2%; CIE −0.18, 95% CI: −0.18, −0.18, p&lt;0.0001) and non-CV readmissions declined after TAVR (14% to 9.0%; CIE −0.24, 95% CI: −0.24, −0.24, p&lt;0.0001), Figure 1. CV readmissions (5.6% to 4.7%; CIE −0.05, 95% CI: −0.05, −0.05, p&lt;0.0001) and non-CV readmissions (9.7% to 7.7%; CIE −0.12, 95% CI: −0.12, −0.12, p&lt;0.0001) also declined after SAVR. Finally, the cost of TAVR admissions decreased for both patients who were not readmitted within 30-days (CIE −2.3, 95% CI: −2.5, −2.0, p&lt;0.0001) and patients who were readmitted (CIE −1.9, 95% CI: −2.6, −1.2, p&lt;0.0001) from 2012 to 2016. Costs of readmission have not changed (CIE −0.23, 95% CI: −0.80, 0.35, p=0.44).

Conclusion
Readmissions after TAVR have declined over the last several years, likely due to improvements in technology and operator experience, greater attention to comorbidities, and reductions in inpatient complications. More work is needed to reduce further inpatient complications and the incidence of readmission.
Figure 1

Funding Acknowledgement
Type of funding source: None
High post-procedural transvalvular gradient or delayed gradient increase after transcatheter aortic valve implantation: the FRANCE-2 registry
Authors: Didier R , Le Ven F , Eltchaninoff H , Nasr B , Lefevre T , Fajadet J , Teiger E , Carrie D , Meneveau N , Ghostine S , Souteyrand G , Cuisset T , Le Breton H , Inug B , Gilard M 
Published: November 2020

Abstract

Background
Mean gradient (MG) elevation can be detected immediately post-procedure or secondarily during follow-up. Comparison between these two parameters and impact on outcomes has not previously been investigated.

Objectives
The study aimed to identify incidence, influence on prognosis and parameters associated with immediate high post-procedural mean transvalvular gradient (PPMG) and delayed mean gradient increase (DMGI), in the FRANCE 2 (French Aortic National CoreValve and Edwards 2) registry.

Methods
The registry includes all consecutive symptomatic patients with severe aortic stenosis. Three groups were analyzed: 1) PPMG &lt;20mmHg without DMGI &gt;10 mmHg (control); 2) PPMG &lt;20mmHg with DMGI &gt;10 mmHg (group 1); 3) PPMG ≥20 mmHg (group 2).

Results
From January 2010 to January 2012, 4201 consecutive patients were prospectively enrolled in the registry. The control group comprised 2078 patients; the group 1, 131 patients; and the group 2, 144 patients. DMGI exceeded 10 mmHg in 5.6%, and was not associated with greater 4-year mortality than in control group (32.6% vs. 40.1%, p=0.27, respectively). PPMG was at least 20 mmHg in 6.1%, and was associated with higher 4-year mortality than in control group (48.7% versus 40.1%, p=0.005, respectively) (Figure 1). Two-thirds of patients with initial PPMG ≥20 mmHg had finally a MG &lt;20 mmHg at 1 year, with mortality similar to controls (39.2% vs. 40.1%, p=0.73).

Conclusions
Patients with PPMG &gt;20 mmHg 1 year post-TAVI had higher 4-year mortality than the general population of the registry, unlike patients with MG normalization at 1 year.
Figure 1

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): French National Society of Cardiology
Real world use of cerebral protection in patients undergoing transfemoral transcatheter aortic valve replacement
Authors: Stachon P.S , Kaier K.K , Zehender M.Z , Bode C.B , Von Zur Muehlen C.M 
Published: November 2020

Abstract

Aims
Preventing strokes is an important aim in TAVR (transcatheter aortic valve replacement) procedures. Embolic protection devices may protect from cardiac embolisms during TAVR, but use and outcomes in clinical practice remain controversial.

Methods and result
Isolated transfemoral TAVR procedures performed in Germany with or without cerebral protection devices were extracted from a comprehensive nationwide billing dataset. In the most recent years available, 2015 and 2017, 41,654 TAVR procedures were analyzed. The overall share of procedures employing cerebral protection devices was 3.7%. In order to compare outcomes, which may be related to the use of a cerebral protection device, a risk-adjusted comparison was performed. The risk of in-hospital mortality did not differ (OR 0.71, 95% CI 0.47–1.17, p=0.103). Moreover, there were no differences in in-hospital cerebral events: the risk for stroke did not differ in patients receiving a cerebral protection device (OR 1.07, 95% CI 0.75–1.12, p=0.714). Risk for delirium was similar in both groups (OR 0.95, 95% CI 0.71–1.16, p=0.621).

Conclusions
Based on our findings and previous studies the routine use of cerebral protection devices should be performed with caution until further data from randomized controlled trials show a reliable reduction of strokes or cerebral failure such as delirium or long-term cognitive decline.

Funding Acknowledgement
Type of funding source: None
Echocardiographic assessment of functional changes of prosthetic valve after transcatheter aortic valve implantation in one year follow up: insights from the multicenter, randomized DIRECT trial
Authors: Toutouzas K , Karmpalioti M , Benetos G , Drakopoulou M , Xanthopoulou M , Stathogiannis K , Latsios G , Synetos A , Bei E , Voudris V , Kosmas E , Mastrokostopoulos A , Katsimagklis G , Danenberg H , Tousoulis D 
Published: November 2020

Abstract

Introduction
The DIRECT trial (Predilatation in Transcatheter Aortic Valve Implantation (TAVI) Trial) was a multicenter, randomized, clinical trial designed to evaluate the safety and efficacy of TAVI with or without balloon aortic valvuloplasty (BAV) in patients with symptomatic, severe aortic valve stenosis.

Purpose
To investigate by echocardiography the functional changes of self-expanding prosthetic valves during the first year after TAVI with or without BAV.

Methods
One hundred seventy one consecutive patients with severe aortic stenosis were enrolled at 4 centers and randomized to TAVI using self-expanding prostheses with (pre-BAV) or without pre-dilatation (no-BAV). Transthoracic echocardiography was obtained at baseline, 30 days and 1 year after TAVI.

Results
Of 171 patients, 86 patients were randomized to pre-BAV group and 85 to no-BAV group. Over the one year, 7 (4%) patients died and in 18 (10%) there was no available paired 30 day/1 year echo. At baseline echocardiography the peak and mean aortic valve gradient and the aortic valve area (AVA) in no-BAV group were 77.31±22.56 mmHg, 47.23±14.98 mmHg and 0.69±0.16cm2 and in pre-BAV group 81.97±23.17 mmHg, 49.39±14.78 mmHg and 0.65±0.15cm2 respectively. One year after TAVI, patients in no-BAV and pre-BAV group showed stable peak and mean aortic valve gradients similar to those at 30 days (from 16.36±7.88 to 14.51±6.6 mmHg vs. 17.17±8.88 to 15.95±9.97 mmHg and from 8.87±4.23 to 7.99±4.04 mmHg vs. 9.39±4.79 to 8.38±5.02 mmHg respectively, P&lt;0.001 vs. baseline). The AVA was similarly stable in one year follow up in no-BAV group (from 1.85±0.43cm2 to 1.85±0.44cm2, P&lt;0.001 vs. baseline) and in pre-BAV group (from 1.86±0.49cm2 to 1.84±0.39cm2, P&lt;0.001 vs. baseline). The incidence of moderate or severe paravalvular regurgitation remained unchanged in both groups (from 4.7% to 5.7% in no-BAV group and from 5.8% to 6.6% in pre-BAV group).

Conclusions
In both pre-BAV and no-BAV groups the improvement in hemodynamics of self-expanding prosthetic valves remained durable during the one year echocardiographic follow up assessment.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): MEDTRONIC