bluuebunny/crossref_metadata_2025_split huggingface dataset:
Chromogranin B is associated with impaired coronary collateralization and heart failure in patients with stable angina and chronic total occlusion
Authors: Shen Y , Wang X.Q , Ding F.H , Yang Z.Q , Lu L , Zhang R.Y , Shen W.F 
Published: November 2020

Abstract

Background
Chromogranin B (CgB) is a member of granin family that can be cleaved into a number of bioactive peptides. Previous studies showed that CgB is produced in cardiomyocytes and is increased in heart failure animals and patients in proportion to disease severity. Chronic total occlusion (CTO) of coronary artery leads to sustained myocardial ischemia which predisposes to adverse cardiovascular outcomes including heart failure.

Purpose
In this study, we sought to investigate the association between CgB and coronary collateralization formation and heart failure in patients with stable angina and CTO.

Methods
A total of 720 subjects with stable angina and CTO of at least one major coronary artery were enrolled in this study. CgB was assayed using an ELISA kit and the degree of coronary collaterals supplying the distal aspect of a total occlusion from the contralateral vessel was graded according to Rentrop classification.

Results
These was a stepwise decrease in levels of CgB with increasing Rentrop grades of coronary collateralization (P=0.001). Compared with the good collateralization (Rentrop grade 2–3) group, CgB was significantly higher in subjects with poor coronary collateralization (Rentrop grade 0–1; 1222.95 [IQR 506.24–2710.24] pg/mL vs. 776.17 [IQR 276.24–2209.39] pg/mL, P&lt;0.001). Consistent results were found across subgroups of age, sex and the presence of diagnosed diabetes. In subjects with poor collateralization, CgB was positively correlated to N-terminal–pro-brain natriuretic peptide (NT-proBNP) levels (both log-transformed; Pearson's r=0.280, P=0.005). This correlation was markedly enhanced (Pearson's r=0.501, P&lt;0.001) in the poorly-collateralized heart failure subgroup with left-ventricular ejection fraction (LVEF) &lt;50%. Consistently, an inverse correlation was present between log-transformed CgB and LVEF (Pearson's r=−0.528, P&lt;0.001) in the same subgroup. After adjusting for conventional confounding factors and LVEF, CgB remained significantly associated with impaired coronary collateralization (odds ratio: 1.314 [95% CI 1.097–1.590], P=0.004). Inclusion of CgB led to a better diagnostic accuracy as confirmed by net reclassification improvement (NRI) of 17.70% (95% CI 8.08–27.32%, P&lt;0.001) and integrated discrimination improvement (IDI) of 1.98% (95% CI 0.63–3.34%, P=0.004).

Conclusions
CgB is an independent predictor of poor coronary collateralization and is related to worse heart function in patients with stable angina and CTO.
Figure 1

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Natural Science Foundation of China
Computed tomography derived predictors of permanent pacemaker implantation after transcatheter aortic valve implantation: a meta-analysis
Authors: Maier O , Zeus T , Jung C , Westenfeld R , Polzin A , Kelm M , Veulemans V 
Published: November 2020

Abstract

Background
Transcatheter aortic valve implantation (TAVI) is a well-established alternative to surgery for the treatment of patients with severe symptomatic aortic stenosis at high and intermediate surgical risk. Unfortunately, the occurrence of electrical conduction disturbances remains one of the most frequent complications of the procedure. While the impact of electrocardiographic and procedural predictors on PPI is well examined, there is still a lack of knowledge regarding anatomical predictors screened by multislice computed tomography (MSCT).

Purpose
We performed a meta-analysis to summarize available studies that reported the incidence of PPI after TAVI with new-generation devices and provided raw data for preprocedural MSCT.

Methods
The authors conducted a literature search in PubMed database until December 31, 2019 to identify studies that investigated preprocedural MSCT data and rate of PPI following TAVI with new-generation devices. Twelve observational studies (n=3133) met inclusion criteria for final analysis.

Results
PPI was performed in 509 patients (16.2%) after TAVI, mostly due to high degree atrioventricular (AV) block (80.8%). The rate of PPI varied widely from 7.9% to 35.8% in individual studies. Regarding secondary endpoints' analysis of relative risk (RR) and mean difference (MD) electrocardiographic PPI-predictors after TAVI appeared to be pre-existing atrial fibrillation (AF) (RR 1.21; 95% CI 1.05–1.40; p=0.008), right bundle branch block (RBBB) (RR 4.22; 95% CI 3.30–5.41; p&lt;0.0001) and AV block grade I (RR 1.63; 95% CI 1.16–2.29; p=0.005). Patients requiring PPI had larger annulus perimeter (MD 1.66 mm; 95% CI 0.67–2.66 mm; p=0.001) and shorter membranous septum length (MD −0.86 mm; 95% CI −1.74–0.02 mm; p=0.05) assessed by preprocedural MSCT. Concerning calcium load of device landing zone, pacemaker dependent patients showed increased calcification of the non-coronary cusp (MD 39.76 mm3; 95% CI 18.60–60.93 mm3; p=0.0002), the left-coronary cusp (LCC) (MD 47.60 mm3; 95% CI 19.40–75.81 mm3; p=0.0009) and the total left ventricular outflow tract (LVOT) (MD 19.17 mm3; 95% CI 6.68–31.66 mm3; p=0.003). Lower implantation depth (MD 0.83 mm from NCC; 95% CI 0.20–1.47 mm; p=0.01) and oversizing by annulus diameter/area (MD 1.76%; 95% CI 0.68–2.84%; p=0.001) were procedural predictors of PPI following TAVI.

Conclusion
This structured meta-analysis proved PPI rate in 16.2% of patients following TAVI. Beside well-known electrocardiographic (AF, RBBB, AV block grade I) and procedural predictors (implantation depth, oversizing) this meta-analysis showed for the first time that MSCT derived anatomical values (annulus perimeter, membranous septum length) and distribution of device landing zone's calcification (NCC, LCC, LVOT) are associated with increased risk of PPI following TAVI.

Funding Acknowledgement
Type of funding source: None
Influence of prosthesis related factors on the occurrence of early leaflet thrombosis after transcatheter aortic valve implantation
Authors: Breitbart P , Pache G , Minners J , Hein M , Schroefel H , Neumann F.-J , Ruile P 
Published: November 2020

Abstract

Background
Early leaflet thrombosis (LT) is a well described phenomenon after transcatheter aortic valve implantation (TAVI) with an incidence between 10 and 16%. So far, data about predictors of LT are scarce.

Purpose
The purpose of the study was to investigate the influence of prosthesis related factors on the occurrence of LT.

Methods
Fusion imaging of pre- and post-procedural CTA was performed in 140 TAVI-patients (55 with LT, 85 without LT) to obtain a 3D-reconstruction of the transcatheter heart valve (THV) within the native annulus region. All patients received a balloon-expandable Sapien 3 THV. The length of the THV above and below the native annulus was measured within the fused images to assess the implantation depth. The deployed THV area was quantified on three heights (left ventricular outflow tract end, center of the stent, aortic end) to determine the average expansion of the prosthesis as percent of the nominal area. We also calculated the extent of prosthesis waist in percent of maximum area. The stent tilt was determined in relation to the annulus plane.

Results
After multivariate adjustment the extent of THV expansion (odds ratio per 10 percent [CI]: 0.660 [0.555–0.786], P&lt;0.001) and waist (odds ratio per 10 percent [CI]: 0.725 [0.615–0.854], P&lt;0.001) had significant, independent influence on the occurrence of LT. Neither the implantation depth nor the stent tilt showed any influence on LT manifestation (P=0.393 and 0.578).

Conclusion
Our study suggests that less than fully expanded Sapien 3 THVs are more prone to LT, whereas some degree of waist was protective. These deployment characteristics may help identify patients who qualify for intensified surveillance.

Funding Acknowledgement
Type of funding source: None
Determinants, impact, and association with heart failure therapies of heart failure readmission after transcatheter aortic valve replacement
Authors: Auffret V , Bakhti A , Leurent G , Bedossa M , Sharobeem S , Donal E , Galli E , Boulmier D , Le Breton H 
Published: November 2020

Abstract

Aims
To evaluate the incidence, predictors, and impact of heart failure (HF) readmission within 1-year post-transcatheter aortic valve replacement (TAVR), and assess the effects of the prescription of guidelines-recommended therapies (i.e. renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists) at discharge on the risk of HF readmission and death.

Methods and results
Patients included in the TAVR registry of a single expert centre from 2009 to 2017 were analysed. Competing-risk and Cox regressions were performed to identify predictors of HF readmission and death. Among 750 patients, 102 (13.6%) were readmitted for HF within 1-year post-TAVR. The 30-day incidence of HF readmission was 6.6%, 53 patients (7.1%) experienced late readmissions (&gt;30 days post-TAVR), and 17 (2.3%) had multiple readmissions. Independent predictors of HF readmission included diabetes mellitus, chronic lung disease, previous acute HF, grade III or IV aortic regurgitation, and pulmonary hypertension both at discharge from the index hospitalisation but not guidelines-recommended therapies. Overall, HF readmission did not significantly impact all-cause mortality (HR: 1.36, 95% CI: 0.99–1.85). However, late (HR: 1.90, 95% CI: 1.30–2.78) and multiple HF readmissions (HR: 2.10, 95% CI: 1.17–3.76) were significantly associated with all-cause mortality. Prescription of RAS inhibitors at discharge was associated with a lower rate of all-cause mortality, especially among patients receiving doses of 25–&lt;50% (HR: 0.67, 95% CI: 0.48–0.94), and 75–100% (HR: 0.61, 95% CI: 0.37–0.98) of the optimal daily dose.

Conclusion
HF readmission is common within 1-year of TAVR. Late and multiple HF readmissions associate with an increased risk of long-term all-cause mortality. Baseline comorbidities (diabetes, chronic lung disease, previous acute HF) and echocardiographic findings at discharge (grade III or IV aortic regurgitation, pulmonary hypertension) identified patients at high-risk of HF readmission. Guidelines-recommended therapies did not significantly affect the 1-year risk of HF readmission.

Funding Acknowledgement
Type of funding source: None
Impact of tapered-shaped left ventricular outflow tract on permanent pacemaker implantation after the third-generation balloon-expandable valve implantation
Authors: Ishizu K , Takiguchi H , Ito S , Taniguchi T , Kawaguchi T , Hayashi M , Isotani A , Yamaji K , Shirai S , Ando K 
Published: November 2020

Abstract

Background
In the era of transcatheter aortic valve implantation (TAVI) for patients with lower surgical risk, conduction disturbances requiring permanent pacemaker implantation (PPI) after TAVI remain a serious concern. The association between tapered-shaped left ventricular outflow tract (LVOT) and PPI after TAVI has not been elucidated.

Purposes
This study sought to identify predictors for PPI after TAVI with the third-generation balloon-expandable valve, with focus on LVOT morphology.

Methods
Of 272 consecutive patients treated with the third-generation balloon-expandable valve, 256 patients without previous PPI or bicuspid valve were retrospectively analyzed.

Results
PPI was implanted after TAVI in 20 (7.8%) patients. Patients requiring PPI had smaller LVOT area (356.3 mm2 vs. 399.4 mm2, p=0.011). Moreover, receiver-operating characteristic (ROC) statistics showed that LVOT area /annulus area possessed significantly higher predictive ability than LVOT area (area under the curve: 0.91 [95% confidence interval [CI]: 0.84 to 0.95] vs. 0.67 [95% CI: 0.57 to 0.77], p&lt;0.001). Multivariable analysis revealed LVOT area /annulus area (odds ratio [OR]: 1.93 [95% CI: 1.38–2.71]; p&lt;0.001 per % of decreasing), the difference between membranous septum length and implantation depth (ΔMSID) (OR: 6.82 [95% CI 2.39–19.48]; p&lt;0.001 per mm of decreasing) and pre-existing complete right bundle branch block (CRBBB) (OR: 32.38 [95% CI 2.30–455.63]; p=0.002) as independent predictors of PPI. Further analysis using ROC statistics revealed LVOT area / annulus area of 88.5% and ΔMSID of 1.8 mm as the optimal cutoff points for prediction of PPI after the third-generation balloon-expandable valve implantation, with high negative predictive values of 98.1% and 99.0%, respectively. Figure shows the PPI rates stratified by the number of following predictors: LVOT area /annulus area &lt;88.5%, ΔMSID &lt;1.8 mm and pre-existing CRBBB. Patients with 2 or more predictors had significantly higher PPI rates than those with 1 or less predictor (67% [18 of 27 patients] vs. 1% [2 of 229 patients], p&lt;0.001).

Conclusions
LVOT area /annulus area, ΔMSID and pre-existing CRBBB were identified as powerful independent predictors for PPI after TAVI. Higher valve implantation is important to prevent excessive PPI especially for patients with pre-procedural tapered-shaped LVOT, short membranous septum or pre-existing CRBBB.
PPI rates stratified by predictors

Funding Acknowledgement
Type of funding source: None
Anticoagulation with or without antiplatelet therapy after transcatheter aortic valve replacement, when less is more: a meta-analysis
Authors: Franchin L , Vaira M.P , Piroli F , Angelini F , Elia E , Bocchino P.P , Conrotto F , D'Ascenzo F , Giustetto C , De Ferrari G.M 
Published: November 2020

Abstract

Background
About 40% of patients undergoing transcatheter aortic valve replacement (TAVR) have a history of atrial fibrillation (AF) and an additional 10% develop AF after TAVR. However, there is paucity of data regarding the optimal antithrombotic regimen following TAVR in patients with a clinical indication for oral anticoagulants (OAC).

Purpose
To compare the prognostic impact of OAC plus at least one antiplatelet agent (APT) versus OAC therapy alone in patients undergoing TAVR.

Methods
We systematically searched the literature for studies evaluating the comparative efficacy and safety of OAC + APT versus OAC alone in TAVR. Random-effect meta-analysis was performed comparing clinical outcomes between the two groups. All-cause mortality and cardiovascular mortality were the efficacy outcomes. Stroke and major bleeding, defined as Bleeding Academic Research Consortium bleeding types 3 to 5, constituted the safety outcome.

Results
Overall, 398 titles and abstracts were identified through database searching. Four observational studies were selected, for a total of 1929 patients. After a median follow-up of 18.5 months (IQR 11.3–29.3), OAC + APT increased major bleeding events compared to OAC alone (OR=1.79; 95% CI 1.21–2.66; P=0.004) with no difference in stroke (OR 01.02; 95% CI 0.52–2.01; P=0.95), all-cause mortality (OR=1.07; 95% CI 0.78–1.47; P=0.66) and cardiovascular mortality (OR=1.08; 95% CI 0.79–1.47; P=0.62).

Conclusion
A combination strategy of OAC + APT provides increased risk of bleeding compared to OAC therapy alone in patients undergoing TAVR with similar outcomes in terms of stroke, all-cause mortality and cardiovascular mortality; therefore, when feasible, it should be advised not to add APT on top of OAC therapy in patients without other clinical indications for APT treatment.

Funding Acknowledgement
Type of funding source: None
Impact of transcatheter aortic valve replacement on anemia: new approach to Heyde's syndrome
Authors: Lopez-Pais J , Lopez Otero D , Izquierdo Coronel B , Antunez Muinos P.J , Cia Mendioroz X , Perez-Poza M , Garcia Touchard A , Otero Garcia O , Alvarez Rodriguez L , Juskova M , Sanmartin Pena J.C , Cid Alvarez A.B , Trillo Nouche R , Gonzalez Juanatey J.R , Oteo Dominguez J.F 
Published: November 2020

Abstract

Background
There is an association between aortic stenosis and anaemia known as Heyde's syndrome. It is caused by an acquired von Willebrand (VW) deficiency related to turbulent flow. Patients with significant paravalvular leak (SPL) remain with VW deficit. The aim of this work is to assess impact on prognosis and anaemia of SPL.

Methods
Observational analytic study developed at two university hospitals, including all consecutive patients who underwent TAVI during a 10-year period (2009 to 2018). A logistic regression model was created to determine independent predictors of anaemia at 3 months. Time to event outcomes were analysed with Cox regression. Median follow-up was 21.3±21.9 months.

Results
5.3% of 788 patients had SPL, with no differences on their basal characteristics compared to the rest of the cohort. SPL was an independent predictor of anaemia 3 months after TAVI (Odds Ratio: 8.31, Confidence Interval 95% [CI]: 2.06–33.50).
SPL had negative impact on mortality: Hazard Ratio (HR): 1.85, CI 1.2–2.9; but not on cardiovascular mortality (CV): HR 1.13, CI 0.4–3.1. Patients who had anaemia three months after TAVI had an increased mortality. (HR 2.17, CI 1.5–3.3)

Conclusion
SPL after TAVI increases mortality with no impact on CV mortality. SPL is independent predictor of anaemia 3 months after TAVI, a condition that doubles the mortality. The impact of SPL on mortality could be explained by the increase in anaemia that SPL causes. More aggressive approach to SPL could have a benefit on prognosis.
Figure 1

Funding Acknowledgement
Type of funding source: None
Stroke after transcatheter aortic valve implantation: new insights into risk prediction
Authors: Maier O , Bosbach G , Hellhammer K , Afzal S , Piayda K , Zeus T , Jung C , Westenfeld R , Polzin A , Kelm M , Veulemans V 
Published: November 2020

Abstract

Background
Stroke is still a feared complication following transcatheter aortic valve implantation (TAVI), associated with increased mortality and severe impact on patients' daily living. Despite technological development and knowledge improvement, cerebrovascular events (CVE) are still not predictable so far and simple risk scores are lacking.

Purpose
This study aimed to evaluate different preprocedural factors that may favour stroke after TAVI, especially regarding severity of aortic calcification.

Methods
From May 2011 to January 2018 a total of 1365 patients underwent TAVI with a balloon-expandable (n=442, 32.4%) or self-expandable (n=923, 67.6%) device at our institution. All patients underwent multi-slice computed tomography (MSCT) before TAVI. To obtain the significant factors for stroke risk prediction we performed multivariate regression analysis and selected the optimal cut-off values according to the maximum Youden index for dichotomization of the risk score items. Finally, we used receiver operating characteristics (ROC) analysis and areas under the ROC curves (AUC) to validate our risk score in comparison to other existing models.

Results
60 of 1365 patients (4.4%) had new neurological impairment after TAVI during hospital stay (mean 11.2±6.7 days). We performed propensity score matching (1:10) to balance baseline characteristics between patients with and without stroke following TAVI, resulting in 56 patients with in-hospital stroke and 521 patients without. Preprocedural factors associated with stroke turned out to be history of prior stroke (OR 1.94; 95% CI 0.85–4.43; p=0.114), aortic valve area ≥0.545 cm2 (OR 3.11; 95% CI 1.16–8.34; p=0.024), atrioventricular angle ≥48.5° (OR 2.32; 95% CI 1.20–4.49; p=0.013), RCC Agatston Score ≥447.2 AU (OR 1.8; 95% CI 0.94–3.44; p=0.077), LVOT Agatston Score ≥262.4 AU (OR 2.01; 95% CI 1.08–3.75; p=0.028) and ascending thoracic aorta Agatston Score ≥116.4 AU (OR 2.21; 95% CI 1.17–4.17; p=0.015). ROC analysis showed that our risk model had an AUC of 0.73 (95% CI 0.66–0.80; p&lt;0.001), a sensitivity of 70.6%, a specificity of 69.0%, a positive predictive value of 19.5% and a high negative predictive value of 95.7%. Our risk model appeared to be the best for stroke prediction after TAVI compared to other risk scores used in literature before like EuroSCORE II (AUC 0.50; 95% CI 0.43–0.58; p=0.950) or CHA2DS2-VASc Score (AUC 0.62; 95% CI 0.55–0.70; p=0.004).

Conclusion
Especially aortic root calcium volume assessed by MSCT predicts CVE after TAVI and could be integrated into a six items risk model for preprocedural prediction of stroke after TAVI. This model could guide us in identifying those patients who are most likely to benefit from transcatheter cerebral embolic protection devices.

Funding Acknowledgement
Type of funding source: None
Save your brain – does the sentinel cerebral protection device work?
Authors: Dona C , Kammerlander A , Koschutnik M , Nitsche C , Dannenberg V , Winter M.P , Siller-Matula J , Andreas M , Goliasch G , Hengstenberg C , Mascherbauer J 
Published: November 2020

Abstract

Background
Transcatheter aortic valve implantation (TAVI) is increasingly used for the treatment of severe symptomatic aortic stenosis (AS), also in low-risk patients. Periprocedural embolic stroke is rare, but potentially associated with considerable morbidity and mortality. Thus, there is great interest in preventing any cerebral embolic event. At present, only one cerebral embolic protection systems (CPS) is commercially available and little is known about its efficacy in preventing stroke during TAVI. The Sentinel CPS is a FDA-approved system consisting of two inter-connected filters that are placed in the brachiocephalic trunk and the left carotid artery via the right radial artery.

Material and methods
Consecutive patients undergoing TAVI between 11/2018 and 11/2019 were enrolled. Consecutive patients treated by one operator received the Sentinel device, if anatomically possible. Periprocedural stroke rate, as defined by VARC2-criteria, and mortality up to 7 days after procedure was assessed. Descriptive statistics was performed to identify baseline variables associated with elevated risk of stroke and Cox-regression analysis was used to investigate its influence on outcome.

Results
268 patients (47.4% female, 81±7 years) were included. In 74 patients (27.6%), a Sentinel CPS was used, in 63 (23.5%) it was positioned correctly in the brachiocephalic trunk and left carotid artery. Only these patients were considered Sentinel-protected. Patients with and without Sentinel presented with similar baseline characteristics with regard to age (no CPS vs CPS; 80.3 vs 81.5 years; p=0.233), sex (female 47.3% vs 47.7%; p=0.967), previous stroke (6.9% vs 3.2%; p=0.373), peripheral artery disease (9.8% vs 4.8%; p=0.305), coronary artery disease (63.1% vs 57.1%; p=0.370), and kidney function (GFR 52 vs 56 ml/min/m2; p=0.283). The EuroScore II (6% vs 6%; p=0.937), periprocedural predilation (48.3% vs 47.6; p=0.925), postdilation (29.3% vs 31.7%; p=0.707) and procedure time (59min vs 66min; p=0.152) were not different. In total, 15 strokes (5.6%) occurred, of which 9 (3.3%) were disabling strokes as defined by the VARC2-criteria. In Sentinel-protected patients undergoing TAVI, no periprocedural stroke was observed (no CPS 7.3% vs 0.0%; p=0.026).

Conclusion
Our results suggest that Sentinel CPS significantly reduces periprocedural stroke rates in patients undergoing TAVI compared to patients without CPS. However, the study population is small and randomized trials are still needed.

Funding Acknowledgement
Type of funding source: None