bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between fragmented QRS and post-procedural rhythm disturbances in patients who underwent transcatheter aortic valve implantation with CoreValve system
Authors: Duran M , Tezcan H , Ayhan H 
Published: October 2021

Abstract

Background
Transcatheter aortic valve implantation (TAVI) is a less invasive and safe therapeutic alternative in patients who are at very high surgical risk or in whom there are contraindications to open surgery (1,2).On the other hand, life threatening complications including stroke, paravalvular leak, and rhythm disturbances that require permanent pacing still persist (3).Fragmented QRS (fQRS) is defined as RSR' pattern with different morphologies of QRS complexes with or without the Q wave on a resting 12-lead electrocardiogram (ECG) (4).

Purpose
In this study, we examined association between fQRS and post-procedural rhythm disturbances and the need for permanent pacing in patients who underwent TAVI with CoreValve system.

Methods
We analysed standard 12-lead electrocardiographic recordings of 124 consecutive patients in whom a CoreValve prosthesis (MedronicInc; Minneapolis; USA) was implanted. Patients having bundle branch block or QRS duration ≥120 ms in baseline ECG recordings and patients with prior history of permanent pacing were excluded from the study. We examined 12-lead ECGs before and after procedure along with one month and six month follow up. We documented QRS fragmentation and post-procedural rhythm disturbances.

Results
Based on our data, 39 out of 71 patients (54.9%) with fQRS developed temporary rhythm disturbances. However, only 4 out of 29 patients (13.7%) without fQRS developed temporary rhythm disturbances.The difference between two groups in terms of temporary rhythm disturbances was statistically significant (59.4% vs 13.7%, p=0.002). Furthermore, 28 out of 71 patients (39.4%) with fQRS and 1 out of 29 patients (3.4%) without fQRS developed permanent rhythm disturbances, (39.4% vs 3.4%, p&lt;0.001).The difference in permanent rhythm disturbances was also maintained in 1st month and 6th-month follow-ups (37.1% vs 0%, p&lt;0.0001, and 38.7% vs 0%; p&lt;0.0001). According to our data, presence of QRS in anterior derivations was the only independent factor associated with development of post-procedural rhythm disturbances (p&lt;0.05).

Conclusion
Our data showed an increased risk for development of new-onset LBBB and AV blocks following TAVI in patients whose baseline ECG recordings demonstrated fQRS.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Ankara Ataturk Training and Research Hospital
Outcomes of transfemoral-transcatheter aortic valve replacement with Sapien-3 valve in liver cirrhosis patients
Authors: Lak H , Chawla S , Verma B , Vural A , Gad M , Shekhar S , Nair R , Yun J , Burns D , Puri R , Reed G , Harb S , Krishnaswamy A , Kapadia S 
Published: October 2021

Abstract

Background
Little is known about the outcomes of liver cirrhosis patients with severe aortic stenosis (AS) who undergo transcatheter aortic valve replacement (TAVR).

Methods
We undertook a retrospective analysis of consecutive patients with severe symptomatic AS who underwent transfemoral-TAVR with Sapien-3 valve at our Clinic between April 2015 and December 2018, yielding 32 patients with liver cirrhosis on imaging including ultrasound and/or computed tomography. Their baseline characteristics, procedural and long-term outcomes after TAVR with the non-cirrhotic group were compared, along with their management strategies as per the hepatology team.

Results
Among 1028 patients, 32 were assigned to the cirrhosis, and 996 were assigned to the non-cirrhosis (control) group. Compared with the control group cirrhotic patients were slightly younger in age (74.5 vs 81.2 years), had a slightly higher BMI (31.3 vs 29.3), and had a higher incidence of prior history of myocardial infarction (38% vs 33%). Baseline variables including the history of smoking, hypertension, diabetes, and atrial fibrillation were comparable in both groups. Among cirrhotic patients (n=32), the most common etiologies were non-alcoholic steatohepatitis (NASH) (37.5%), Alcoholism (18.75%), and Hepatitis C (12.5%). The mean MELD-NA score was 11.8 and 67% of patients were Child PUGH Class A and 33% were Child PUGH Class B and all patients had a Child PUGH score of ≥5. 53% of patients (n=17) in the cirrhosis group were evaluated by Hepatology and 12.5% (n=4) were evaluated for a liver transplant but only 1 patient had a liver transplant post-TAVR. Compared with the control group cirrhotic patients had similar 1-year mortality (12% vs 12%, p=1), had a lower rate of 30-day new pacemaker post tavr (6% vs 9% p=0.85), had a higher rate of 1-year readmission for heart failure (12% vs 5% p=0.12) and similar 1-year major adverse cardiac and cerebrovascular event (MACCE) rate (15% vs 14% p=0.98)

Conclusion
Patients with severe AS undergoing TAVR with concomitant liver cirrhosis demonstrate comparable outcomes compared with their non- cirrhotic counterparts. NASH followed by alcoholic cirrhosis was found to be most common etiology.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
The effect of MitraClip mitral valve repair on a number of ventricular tachycardia episodes
Authors: Hudec M , Januska J , Jiravsky O , Kala P , Kufova P , Konderlova L , Stepanova R , Muchova T , Kubat T , Sknouril L 
Published: October 2021

Abstract

Background
Mitral valve repair with MitraClip is an established method in the treatment of severe mitral regurgitation. Effect on mitral regurgitation severity, NYHA class and left ventricular function is known, as well as on mortality and number of hospitalizations. Otherwise, there is a lack of evidence, if a successful repair can affect the number of episodes of malignant arrhythmias.

Purpose
To compare the number of ventricular arrhythmias and ICD therapies before and after successful mitral valve repair with MitraClip in retrospective analysis.

Methods
We analysed patients after a MitraClip mitral valve repair in whom an ICD was implanted at least 1 month before the procedure. Out of 217 patients, there were 47 with ICD, traceable history and successful repair (MR grade ≤2.5 after the procedure). We searched all recorded ICD controls for evidence of ventricular arrhythmias and ICD therapies (ATP or shock). Statistical analysis was performed comparing the number of ventricular arrhythmias and ICD therapies “per month-per patient” before and after the procedure.

Results
We didn't found any statistical difference in number of malignant arrhytmia events before and after the procedure (mean 0.024±0.069 vs 0.029±0.079, p=0.46), neither in ATP therapies (mean 0.038±0.146 vs 0.542±3.249, p=0.39) nor in shocks (mean 0.063±0.225 vs 0.148±0.499, p=0.33). After dividing patients into two groups – with or without previous myocardial infarction, there was also no statistical difference in both groups. In “MI” group: a number of ventricular arrhythmia (mean 0.016±0.036 vs 0.016±0.047, p=0.95), ATP therapies (mean 0.029±0.109 vs 0.073±0.285, p=1.0), shocks (mean 0.049±0.184 vs 0.048±0.172, p=0.77). In “no MI” group: a number of ventricular arrhythmia (mean 0.035±0.098 vs 0.047±0.108, p=0.22), ATP therapies (mean 0.05±0.19 vs 1.203±5.024, p=0.16), shocks (mean 0.083±0.277 vs 0.289±0.733, p=0.17).

Conclusion
Our results don't reflect any influence of MitraClip mitral valve repair on ventricular arrhythmias, ATP therapies or shocks before and after the procedure. Another and deeper analysis should be performed to understand these results.

Funding Acknowledgement
Type of funding sources: None.
Asymmetric leaflet tethering is associated with worse outcomes after edge-to-edge mitral valve repair for secondary mitral regurgitation
Authors: Stolz L , Orban M , Braun D , Doldi P , Orban M , Stocker T , Mehr M , Steffen J , Loew K , Hagl C , Massberg S , Naebauer M , Hausleiter J 
Published: October 2021

Abstract

Background
The impact of mitral valve (MV) tethering patterns on outcomes of patients undergoing transcatheter edge-to-edge mitral valve repair (TEER) for severe secondary mitral regurgitation (SMR) is unknown.

Purpose
The purpose of this study was to evaluate the impact of asymmetric postero-anterior and medio-lateral MV leaflet tethering on procedural and survival outcomes after TEER for SMR.

Methods
Symmetry of postero-anterior leaflet tethering was defined as the ratio of the posterior to anterior MV leaflet angle (PLA/ALA) in the central MV segment 2. The ratio of the tenting area between MV segments 3 and 1 (S3/S1 ratio) was defined as medio-lateral tethering symmetry. We used receiver operating characteristics and a proportional Cox model to identify cut-off values of asymmetric postero-anterior and medio-lateral tethering for prediction of two-year survival after TEER.

Results
178 patients receiving TEER for SMR were included. Asymmetric postero-anterior tethering was observed in 67 patients (37.6%, PLA/ALA ratio cut-off &gt;1.54). Medio-lateral tethering was asymmetric in 49 patients (27.5%, S3/S1 ratio cut-off &gt;1.49). MR was reduced to MR ≤2+ in 91.6% of patients, while postprocedural MR remained higher in the presence of asymmetric postero-anterior tethering (p=0.01). After adjustment for potential clinical and echocardiographic confounders, multivariable Cox regression analysis confirmed asymmetric postero-anterior tethering (HR=2.77, CI=1.43–5.38, p&lt;0.01) and asymmetric medio-lateral tethering (HR=2.90, CI=1.54–5.45, p&lt;0.01) as independent predictors for two-year survival.

Conclusions
Asymmetric postero-anterior and medio-lateral MV leaflet tethering patterns independently increase two-year all-cause mortality in patients undergoing TEER for SMR. Detailed echocardiographic patient selection might improve outcomes after TEER.

Funding Acknowledgement
Type of funding sources: None. Postero-anterior tetheringMedio-lateral tethering
Impact of leaflet-to-annulus index on residual tricuspid regurgitation following transcatheter edge-to-edge tricuspid valve repair
Authors: Tanaka T , Sugiura A , Kavsur R , Vogelhuber J , Oeztuerk C , Becher M U , Zimmer S , Nickenig G , Weber M 
Published: October 2021

Abstract

Introduction
Edge-to-edge transcatheter tricuspid valve repair (TTVR) is a promising treatment option for tricuspid regurgitation (TR), and it is required to identify anatomical parameters to predict the procedural success of TTVR.

Purpose
In this study, we assessed leaflet-to-annulus index (LAI), a simple tool to evaluate the remodeling of tricuspid annulus in relation to the leaflets, and investigated the association of the LAI with residual TR after edge-to-edge TTVR.

Methods
Consecutive 140 patients with symptomatic TR who underwent edge-to-edge TTVR from June 2015 to July 2020 were enrolled. The LAI was calculated using preprocedural transesophageal echocardiography and was defined as follows: (anterior leaflet length + septal leaflet length)/anteroseptal tricuspid annulus diameter (Figure 1). Primary outcome was residual TR ≥3+ at discharge, and patients were allocated into two groups as follows: residual TR ≥3+ and &lt;3+. Secondary outcome was the composite outcome, consisting of all-cause mortality and heart failure hospitalization, within one year after TTVR.

Results
Of the 140 patients, 43 patients had residual TR ≥3+ after TTVR. The patients with residual TR ≥3+ had lower LAI compared to those with residual TR &lt;3+ (1.06±0.10 vs. 1.13±0.09; p=0.001). Multivariable analysis revealed that LAI was associated with residual TR ≥3+ (odds ratio [by 0.1 increase]: 0.57; 95% confidence interval [95% CI]: 0.35–0.94; p=0.02), independently of baseline TR severity, location of TR jet, and coaptation gap size (Table 1). Patients with residual TR ≥3+ had a higher incidence of the composite outcome within one year after TTVR (34.9% vs. 18.6%; log-rank p=0.04) and residual TR ≥3+ was an independent predictor of the composite outcome within one year (hazard ratio: 2.04; 95% CI: 1.01–4.11; p=0.04).

Conclusion
Lower LAI is associated with residual TR ≥3+ after edge-to-edge TTVR, which itself was a significant predictor of the one-year composite outcome. Our findings suggest that LAI is a useful tool to identify patients to be successfully treated with edge-to-edge TTVR.

Funding Acknowledgement
Type of funding sources: None. Figure 1Table 1
Transesophageal echocardiography versus intracardiac echocardiography-guided left atrial appendage occlusion: a comparative analysis
Authors: Grazina A , Fiarresga A , Ramos R , Sousa L , Cacela D , Bernardes L , Branco L M , Galrinho A , Viegas J M , Cardoso I , Teixeira B , Teixeira A R , Jacinto S , Cruz Ferreira R 
Published: October 2021

Abstract

Introduction
The left atrial appendage occlusion (LAAO) procedure is a therapeutic option for stroke prevention in patients with atrial fibrillation (AF) which have contraindication to oral anticoagulants or still develop embolic events despite therapeutic anticoagulation. Transesophageal echocardiography (TEE) has been the gold standard to guide this procedure, with the intracardiac echocardiography (ICE) emerging as an alternative because of the advantage of reducing the general anesthesia burden compared to TEE.

Objectives
This study aims to compare the safety, procedure-related parameters and outcomes between TEE-guided LAAO and ICE-guided LAAO.

Methods
In a tertiary center, patients who underwent TEE-guided LAAO and ICE-guided LAAO were compared retrospectively regarding technical success, procedure-related events, procedure-related parameters (fluoroscopy time, dose of radiation and contrast volume), 45 days-transthoracic echocardiography (TTE) and 1-year outcomes (mortality, stroke and major bleeding).

Results
88 patients underwent LAAO between 2009 and 2020 (n=43 with TEE, n=45 with ICE). Baseline characteristics were similar. Success was achieved in 95.3% (n=41) and 95.6% (n=43) of the patients in the TEE and ICE groups, respectively (OR 0.95, p=0.96). Procedure-related complications (major vascular complications, perforation, device embolization) didn't show significant differences (14.0% vs 8.9%, OR 1.66, p=0.46) in the TEE and ICE groups, respectively. Fluoroscopy time was inferior in the TEE group (29.1±13.6 vs 44.1±17.4 minutes, p=0.001), while radiation dose (2761±1555 vs 3397±2118 mGy, p=0.113) and contrast volume (220.3±104.1 vs 204.0±100.9mL, p=0.469) showed no significant differences. 45 days-TTE showed no significant differences between the TEE and ICE groups regarding peri-device leaks (14.0% vs 24.4%, p=0.212), device thrombus (2.3% vs 0%, p=0.990) and iatrogenic atrial septal defects, all mild (4.7% vs 13.3%, p=0.174). 1-year outcomes showed no significant differences regarding stroke (9.3% vs 4.4%, p=0.186), major bleeding (9.3% vs 2.2%, p=0.78) and all-cause mortality (9.3% vs 11.1%, p=0.38) between the TEE and ICE groups, respectively.

Conclusions
ICE-guided LAAO is associated with similar results, procedure-related events, procedure related-parameters (fluoroscopy time being the only exception) and 1-year outcomes, compared with TEE-guided LAAO.

Funding Acknowledgement
Type of funding sources: None.
Twelve months results from a prospective real-world multicenter clinical practice of CAS using the CGuard Embolic Prevention System (EPS): the IRONGUARD 2 study
Authors: Sirignano P , Stablie E , Taurino M , Speziale F 
Published: October 2021

Abstract

Objectives
When compared to carotid endarterectomy, carotid artery stenting (CAS) has been associated to a higher rate of post procedural neurologic events, potentially related to plaque's debris prolapsing through stent's mesh. Consequently, the need for increased plaque coverage has resulted in the development of dual layered mesh covered carotid stent systems (DLS). However, recent reports demonstrated that these devices are also associated with a not-negligible restenosis rate among the studies. Aim of this registry was to evaluate 1-year safety and efficacy of DLS for CAS in the clinical practice.

Methods
From January 2017 to June 2019 a physician-initiated, prospective, multispecialty, registry enrolled 733 consecutive patients undergoing CAS using the CGuard Embolic Prevention System (EPS) in 20 centres. The primary endpoint was the occurrence of death and stroke at 1 year; secondary endpoints were transient ischemic attack (TIA), acute myocardial infarction (AMI), restenosis rate and in-stent thrombosis, ECA occlusion at 1 year.

Results
Among all enrolled subjects, late results were collected for 726 patients (99.04%). Dual antiplatelet therapy was maintained for at least 30 days post-procedurally in all patients, and for 3 months in 295 (40.63%), according with each center routine practice. After 30th post-operative day, new neurological adverse event was detected in 5 patients (0.68%), accounting for 1 minor stroke (0.13%), and 4 (0.55%) transient ischemic attacks. Eight patients (1.10%) died during the study period: 2 fatal acute myocardial infarctions (0.27%), 4 malignancies (0.55%), 1 suicide (0.13%), 1 undefined complication in Guillain-Barré Syndrome (0.13%). At duplex ultrasound examination, internal carotid artery was found patent in all but two patients (0.27%), and 2 asymptomatic in-stent restenosis (0.27%) were judged to be severe (&gt;70%, peak systolic velocity &gt;450cm/sec) and successfully treated by stent-in-stent. External carotid artery patency rate was 98.8% (718/726). At univariate analysis, post-dilatation (p=0.62; OR: 0.67; CI95%: 0.13–3.34), and dual antiplatelet therapy duration (p=0.97; OR: 0.96; CI95%: 0.11–8.31) were found to be not statistically related to occlusion and/or restenosis occurrence.

Conclusion
This real-world registry suggests that use of EPS in clinical practice is safe and associated to a minimal occurrence of adverse neurological events up to 12 months follow up.

Funding Acknowledgement
Type of funding sources: None.
Smoking habit does not differentiate young patients with first diagnosed and never treated hypertensive disease regarding blood pressure levels and hypertension mediated organ damage
Authors: Triantafyllidi H , Benas D , Schoinas A , Trivilou P , Varoudi M , Kosteli G , Birmpa D , Ikonomidis I 
Published: October 2021

Abstract

Background
Early onset hypertension is associated with a considerably greater risk for CVD mortality compared with hypertension that begins later in life. Aim of this study is the evaluation of cardiovascular risk (CV) factors and hypertension mediated organ damage (HMOD) in young patients with first diagnosed and never treated hypertensive disease regarding smoking habit.

Methods
From a cohort of 520 non-diabetic and first diagnosed and never treated hypertensive patients, we studied those patients aged &lt;50 years (n=216, age=42±7, 149 males). Ambulatory blood pressure monitoring (24-h ABPM), cardiovascular risk factors [smoking, obesity (BMI), hyperlipidemia (HDL-C, LDL-C)] and HOMD [aortic stiffness (PWV), left ventricular diastolic dysfunction (E/Ea), cardiac hypertrophy (LVMI), coronary arteries microcirculation (CFR), carotid intima-media thickness (IMT), endothelial function (PBR5–25)] were estimated in each young patient before treatment initiation.

Results
Young patients' population was divided regarding smoking habit in Group A (smokers, n=89, age=42±7, 64 males) and Group B (non-smokers, n=127, age=42±6, 85 males). While increased LDL-C (p=0.002), decreased HDL-C levels (p&lt;0.001) and augmented 24-h systolic and diastolic BP variability (p=0.001 and p=0.03, respectively) were revealed in Group A, no other differences were found between groups regarding BMI, 24-h ABPM and HMOD.

Conclusion
In early phases of arterial hypertension disease, young people have similar BP and HMOD burden despite the pre-existence of smoking habit and hyperlipidemia. Subsequently, there is still time for combined treatment of these three risk factors (smoking, hyperlipidemia, arterial hypertension) and prevention of future CV adverse events.

Funding Acknowledgement
Type of funding sources: None. Young hypertensives and smoking
Cerebrovascular disorders in diabetic patients with resistant hypertension and factors associated with their severity
Authors: Falkovskaya A Y U , Mordovin V F , Sukhareva A E , Manukyan M A , Zyubanova I V , Lichikaki V A , Tsoi E I , Gusakova A E 
Published: October 2021

Abstract

Introduction
Diabetes mellitus (DM) and hypertension (HTN) are associated with accelerated brain damage that often precedes the development of stroke and dementia. However, little is known about the features of silent brain damages and possible mechanisms of their development in patients with resistant hypertension (RHTN) and type 2 DM.

Objective
To study the features of MRI- sings of silent brain damage in patients RHTN with type 2 DM and to establish the factors associated with their development.

Methods
We studied 46 with RHTN and type 2 DM (mean age 60.3±7.9 years; 27 females (59%), mean 24-hour (systolic/diastolic) BP 169.0±16.4/89.0±14.7 mmHg, HbA1c 7.4±1.3%). On average, patients were taking 4.3±1.0 antihypertensive drugs. Patients were subjected to brain MRI (1.5 T), 24-hour BP monitoring, lab tests (HbA1c, TNF-α, hsCRP, leptin, resistin, aldosterone, basal end postprandial serum glucose, insulin, C-peptide). According to MRI linear dimensions of liquor spaces (subarachnoidal spaces (SAS), lateral ventricles, III and IV ventricles), white matter lesions (WMLs), basal ganglia and thalamus abnormalities were assessed. In addition, severity of periventricular WMLs (PWMLs) was evaluated semi-quantitatively on a scale of 0 to 4.

Results
The frequency of ventricular dilatation was 45%, expansion of SAS – 65%, lacunar infarctions – 25%, focal WMLs (diameter &lt;3 mm) – 52%, PWMLs – 89%. According to the correlation analysis, an increase in density of the MR signal of PWMLs was associated with an increase in levels of TNF-α (r=0.55 p=0.01) and hsCRP (r=0.64 p=0.045). The increase in density of the MR signal from basal ganglia and thalamus correlated with postprandial levels of glucose (r=0,48 p=0,025; r=0.46 p=0.04, respectively), insulin (r=0.54 p=0.011; r=0.52 p=0.017, respectively) and C-peptide (r=0.54 p=0.011; r=0.46 p=0.037, respectively), as well as with basal level of insulin (r=0.52 p=0.007; r=0.48 p=0.012, respectively) and the leptin (r=0.40 p=0.027; r=0.36 p=0.048, respectively). The severity of PWMLs depended on the level of basal glycaemia (r=0.35, p=0.020) and HbA1c (r=0.37, p=0.04). The transverse size of the chiasmal cistern had a relationship with of the resistin level (r=0.43, p=0.03), and the transverse size of the III ventricle correlated with the serum aldosterone level (r=0.51, p=0.13). There were no direct correlations between MRI- sings of silent brain damage and blood pressure levels.

Conclusion
Thus, diabetic patients with resistant hypertension have a high frequency of white matter lesions and of liquorodynamics dysturbanses. The severity of these changes depends on a complex of metabolic, pro-inflammatory and neurohormonal factors in the absence of a direct relationship with the blood pressure level.

Funding Acknowledgement
Type of funding sources: None.