bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of increased mortality in untreated moderate aortic stenosis
Authors: Gupta A , Liu T , Pounds C , Sharma R P , Yong C , Krumholz H M , Leon M B 
Published: October 2021

Abstract

Background
The natural history of native valvular moderate aortic stenosis (AS) is poorly understood.

Purpose
To examine the prognosis of patients with native valvular moderate AS, and identify high risk-features associated with increased mortality.

Methods
Natural language processing of electronic health records in the claims-linked Optum® database (2011–2018) from over 200 hospitals and 7000 clinics in the United States identified severity of AS (mild/moderate/severe) from echocardiograms and physician notes of patients more than 65 years old. Our cohort included 30,204 patients (3594 with mild, 9938 with moderate, and 16672 with severe AS). We used competing risk Kaplan-Meier analysis to compare 5-year mortality (obtained from the Social Security Death Masterfile) between the different AS severity groups adjusted for demographics and comorbidities, censoring for aortic valve replacement. The relationship between AS severity and survival was examined during median 1049 days (interquartile range: 597 to 1652 days) of follow-up. We performed Fine-Gray modeling to examine risk factors associated with long-term mortality in patients with moderate AS.

Results
A higher proportion of comorbidities like atrial fibrillation, diabetes, and coronary artery disease were observed with increasing severity of AS (Figure 1). After adjustment, compared with mild AS (5-year mortality: 31.6%), patients with untreated moderate (5-year mortality: 40.0%, HR 1.34, 95% CI 1.25 – 1.44) and untreated severe AS (5-year mortality: 51.1%, HR 1.88, 95% CI 1.75– 2.01) have increasing risk of long-term mortality (Figure 2). Significant predictors of 5-year mortality in patients with moderate AS include older age (HR 1.38, 95% CI 1.29 –1.47), male sex (HR 1.21, 95% CI 1.15 – 1.27), heart failure (HR 1.37, 95% CI 1.29 – 1.44), coronary artery disease (HR 1.20, 95% CI 1.13 – 1.27), and atrial fibrillation (HR 1.08, 95% CI 1.02 – 1.14). In a subcohort of 5189 patients for whom left ventricular ejection fraction (LVEF) information was available, reduced LVEF was associated with worse long-term mortality (LVEF&lt;40%: HR 1.17, 95% CI 1.05 –1.31; LVEF 40–50%: HR 1.08, 95% CI 0.97 –1.20).

Conclusion
Our findings suggest that moderate AS is associated with poor long-term survival with higher risk associated with LVEF &lt;40%, and comorbidities including heart failure, coronary artery disease and atrial fibrillation. Whether patients with moderate AS, particularly with high-risk features, benefit from treatment remains unknown.

Funding Acknowledgement
Type of funding sources: None. Baseline CharacteristicsAdjusted KM curves with Competing Risk
Differential characteristics associated with progression of mitral and aortic regurgitation in patients undergoing kidney transplantation
Authors: Kim M J , Kim D R , Lee J H , Seo J W , Cho I S , Huh K H , Hong G R , Ha J W , Shim C Y 
Published: October 2021

Abstract

Background
Heart valve regurgitation is common in patients with end-stage renal disease (ESRD). However, there are no data on the fate of mitral regurgitation (MR) and aortic regurgitation (AR) after kidney transplantation (KT). In this study, we sought to investigate regression or progression rates of MR and AR after KT in patients with ESRD. Moreover, we aimed to explore clinical and echocardiographic factors associated with the progression of MR and AR in patients undergoing KT.

Methods
Among 1,734 patients who underwent KT from 2005 to 2018 at a single tertiary hospital, 674 patients (407 men; mean 48±12 years) who underwent both pre- and post-KT echocardiography were analyzed comprehensively. Pre-KT echocardiography was performed within three months of KT, and post-KT echocardiography was done between 6 months and 24 months after KT. Severities of MR and AR were graded as no/trivial, mild, moderate, and severe according to the current guidelines. Regression was defined if the severity decreased by one or more grades, while progression was defined if the severity increased by one or more grades.

Results
Figure 1 shows the regression or progression of MR and AR after KT. 78 (11%) patients showed MR regression, but 41 (6%) experienced MR progression. 13 (2%) revealed AR regression, while 23 (4%) presented AR progression. In patients with MR progression, there were more cases of receiving a second KT, having mitral annular calcification, and showing lesser reduction of left atrial volume after KT. Patients with AR progression showed a longer hemodialysis duration, persistent hypertension after KT, and aortic root dilatation. Factors related to the progression of MR and AR showed statistically meaningful predictive values in a stepwise manner (Figure 2)

Conclusions
In patients undergoing KT, MR and AR may progress in patients with certain distinct characteristics. Different clinical and echocardiographic characteristics before KT, and reduction of hemodynamic loads after KT determine the progression of MR and AR. Further echocardiographic surveillances after KT are needed in patients with clinical and echocardiographic factors for progression of valve regurgitation.

Funding Acknowledgement
Type of funding sources: None.
Prognostic utility of global longitudinal strain (GLS) in patients with severe primary mitral regurgitation undergoing mitral valve surgery: a systematic review and meta-analysis
Authors: Agustin R D , Ramiro V R , Villanueva D L , Tiongson M D , Ramos J D , Ramirez-Ragasa R , Magno J D , Punzalan F E 
Published: October 2021

Abstract

Background
Mitral valve (MV) surgery is recommended for the treatment of chronic severe mitral regurgitation (MR). However, the optimal timing of surgery in patients with asymptomatic severe primary MR remains elusive. Global longitudinal strain (GLS) may provide additional prognostic value in predicting postoperative outcomes in patients with chronic severe primary mitral regurgitation (MR) undergoing MV surgery.

Purpose
We aimed to determine the prognostic value of GLS in predicting postoperative mortality and LV dysfunction among patients with chronic severe primary MR.

Methods
Systematic search of Pubmed, Cochrane library, Clinicaltrials.gov, and Herdin.ph from inception to July 2019, using the terms “mitral insufficiency”, “mitral regurgitation”, “mitral valve surgery”, and “global longitudinal strain” was done without language restriction. We included and extracted data from cohort studies of patients with chronic severe primary MR who underwent MV surgery and which GLS, mortality and ejection fraction. We used the Newcastle Ottawa Scale to assess the quality of included studies. Review Manager 5.3 was used to perform analysis. Forest plots with summary hazard ratios (HR) and odds ratios (OR) with 95% confidence intervals (CI), I2 test for heterogeneity, and funnel plots were reported.

Results
Our search yielded 12 cohort studies with 2,843 patients; 7 prospective and 5 retrospective studies were included in the qualitative synthesis with 11 good quality studies. Cut-off GLS values ranged from −21.7% to −18.1%. In terms of postoperative all-cause mortality, the summary HR for worse versus better preoperative GLS is 1.22 (95% CI 1.04–1.44, p value &lt;0.ehab724.16031, I2 95%). In terms of postoperative LV dysfunction, the summary OR is 1.74 (95% CI 1.14–2.66, p value 0.01, I2 94%) with significant heterogeneity.

Conclusion
Left ventricular GLS has prognostic value in terms of predicting postoperative mortality and LV dysfunction. However, significant heterogeneity exists between studies. Larger studies with well-defined inclusion criteria need to be performed and standardized GLS cut-offs need to be determined.

Funding Acknowledgement
Type of funding sources: None. GLS in Predicting All-Cause MortalityGLS in Predicting Post-op Dysfunction
Regression of electrocardiographic left ventricular hypertrophy after transcatheter aortic valve replacement for aortic stenosis
Authors: Tobe A , Tanaka A , Tokuda Y , Akita S , Fujii T , Miki Y , Furusawa K , Ishii H , Usui A , Murohara T 
Published: October 2021

Abstract

Background
The changes in electrocardiographic left ventricular hypertrophy (ECG-LVH) after transcatheter aortic valve replacement (TAVR) are not fully elucidated.

Methods
This retrospective single-center study investigated 156 patients who underwent TAVR for severe aortic stenosis. Twelve-leads ECGs obtained before and at 2 days and 1, 6 and 12 months after TAVR were analyzed. Patients with an implanted pacemaker, with a bundle branch block before or after TAVR or whose electrocardiogram at any measuring point was not available were excluded. As an assessment of ECG-LVH, Sokolow-Lyon voltage, Cornell voltage, Cornell product and Peguero–Lo Presti voltage were evaluated.

Results
Finally, 64 patients were included. Sokolow-Lyon voltage, Cornell voltage, Cornell product and Peguero–Lo Presti voltage significantly decreased between 1 and 6 months after TAVR compared to baseline. The prevalence of ECG-LVH criteria for each parameter decreased as well. QRS duration significantly decreased at 6 months after TAVR and the number of patients with strain pattern decreased significantly at 1 month when compared to baseline. When the patients were divided into two groups, those with and without ECG-LVH at baseline, ECG-LVH parameter values decreased significantly, especially in patients with ECG-LVH at baseline.

Conclusion
Regression of ECG-LVH after TAVR was demonstrated as per various criteria of ECG-LVH. The voltages and prevalence of ECG-LVH decreased significantly between 1 and 6 months after TAVR.

Funding Acknowledgement
Type of funding sources: None.
Incidental findings on computed tomography for preoperative assessment before transcatheter aortic valve implantation in japanese patients
Authors: Tobe A , Tanaka A , Tokuda Y , Akita S , Fujii T , Miki Y , Furusawa K , Ishii H , Usui A , Murohara T 
Published: October 2021

Abstract

Background
Extra-cardiovascular incidental findings (IFs) on preoperative computed tomography (CT) are frequently observed in transcatheter aortic valve implantation (TAVI) candidates. However, the backgrounds of TAVI candidates and comorbidities differ based on the race and/or country, and data on IFs in a specific population are not always applicable to another.

Objective
To assess the prevalence, type, and clinical impact of IFs in Japanese TAVI candidates.

Methods
This was a retrospective, single-center, observational study. CT reports of 257 TAVI candidates were reviewed, and IFs were classified as (a) insignificant: findings that did not require further investigation, treatment, or follow-up; (b) intermediate: findings that needed to be followed up or were considered for further investigation but did not affect the planning of TAVI; and (c) significant: findings that required further investigation immediately or affected the planning of TAVI.

Results
At least one IF was found in 254 patients (98.8%). Insignificant, intermediate, and significant IFs were found in 253 (98.4%), 153 (59.5%), and 34 (13.2%) patients, respectively. Newly indicated significant IFs were found in 19 patients (7.4%). In 2 patients (0.8%), TAVI was canceled because of significant IFs. In patients who consequently underwent TAVI, the presence of significant IFs was not associated with the duration from CT performance to TAVI [28 (19–40) days vs. 27 (19–43) days, p=0.74] and all-cause mortality during the median follow-up period of 413 (223–805) days (p=0.44).

Conclusion
Almost all Japanese TAVI candidates had at least one IF, and the prevalence of significant IFs was not negligible. Although the presence of significant IFs was not associated with mid-term mortality, appropriate management of IFs was considered important.

Funding Acknowledgement
Type of funding sources: None.
Cerebral protection in TAVR – can we do without? Impact on stroke rate, length of hospital stay and 12-month mortality
Authors: Dona C , Koschutnik M , Nitsche C , Winter M P , Mach M , Andreas M , Bartko P , Kammerlander A , Goliasch G , Lang I , Hengstenberg C , Mascherbauer J 
Published: October 2021

Abstract

Stroke associated with transcatheter aortic valve replacement (TAVR) is a potentially devastating complication. Until recently, the Sentinel™ Cerebral Protection System (CPS; Boston Scientific) has been the only commercially available device for mechanical prevention of TAVR-related stroke. However, its effectiveness is still undetermined.

Methods
Between January 2019 and August 2020 consecutive patients were randomly assigned to TAVR with or without Sentinel™ in a 1:1 fashion. We defined as primary endpoint clinically detectable cerebrovascular events within 72 hours after TAVR, and as secondary endpoints LOS and 12-month mortality. Logistic and linear regression analyses were used to assess associations of Sentinel™ use with endpoints.

Results
Of 411 patients (80±7 y/o, 47.4% female, EuroSCORE II 6.3±5.9%), Sentinel™ was used in 213 (51.8%), with both filters correctly deployed in 189 (46.0%). 20 (4.9%) cerebrovascular events were recorded, 10 (2.4%) of which were disabling strokes. Sentinel™ reduced cerebrovascular events in univariate analysis by 71% (OR 0.29, 95% CI 0.11–0.82; p=0.02) and after multivariate adjustment by 75% (adj. OR 0.25; 95% CI 0.08–0.80; p=0.02). Sentinel™ use was also significantly associated with shorter LOS (8.4±9.6 versus 6.7±6.1 days; p=0.03) and lower 12-month all-cause mortality (15.7% versus 7.5%, p=0.01).

Conclusions
In the present prospective all-comers TAVR cohort, Sentinel™ significantly 1) reduced cerebrovascular events, 2) shortened LOS, and 3) improved 12-month survival. These data promote the use of a CPS when implanting TAVR valves.

Funding Acknowledgement
Type of funding sources: None.
Midterm outcomes after aortic valve neocuspidalization with autologous pericardium. Single center experience
Authors: Semagin A P , Zybin A A , Karpushkina E M , Shubin E I 
Published: October 2021

Abstract

Objective
The aim of the study was to analyze the midterm results of the aortic valve neocuspidalization with autologous pericardium.

Methods
From August 2017 through October 2018, 40 patients were treated with aortic valve neocuspidalization using autologous pericardium, their medical records were retrospectively reviewed.

Results
There were 40 patients (19 males, 21 females) with aortic stenosis, 17 patients had bicuspid valve. The median age was 66 (26–77) years. Preoperative echocardiography revealed a peak pressure gradient had mean value of 84.5±23.32 mm Hg, and mean pressure gradient average of 48.2±16.4 mm Hg. Surgical annular diameter was 21.2±2.16 mm. Body mass index was 29.7±3.4 kg / m2. Severe patient-prosthesis mismatch was predicted in 18 cases, moderate – in 14 cases (Hancock II prosthesis was used as a reference). Intraoperative control of neocuspidalized valve (coaptation, pressure gradient) was performed with transesophageal echocardiography. There was no conversion to a prosthetic valve replacement. There were no in-hospital mortalities. Postoperative echocardiography revealed a peak pressure gradient mean value of 16.3±5.3 mm Hg, and mean pressure gradient average of 8.5±3.1 mm Hg on the 5th postoperative day, the mean height of coaptation was 12.3±3.1 mm. Mean observation period was 17 months. During the observation period 4 (10%) patients died from non-surgery related causes. 1-year after surgery echocardiography revealed a peak pressure gradient mean value of 14.5±5.0 mm Hg, and mean pressure gradient average of 9.2±4.0 mm Hg, mild-to-moderate (grade 2) aortic insufficiency was identified in two patients. Reoperation was required in one case – patient was found to have severe aortic regurgitation due to rupture of the commissural suture.

Conclusion
Our short-term and mid-term results demonstrate satisfactory neovalves' hemodynamic performance. The simplicity and reproducibility of aortic valve reconstruction with autologous pericardium may make this method an option for surgical treatment of aortic valve diseases.

Funding Acknowledgement
Type of funding sources: None.
Stroke volume index and outcomes in low gradient severe aortic stenosis
Authors: Snir A , Ng M K , Stewart S , Playford D , Strange G , Celermajer D S 
Published: October 2021

Abstract

Background
Conventionally, stroke volume index (SVI) ≤35ml/m2 is considered as “low-flow” in severe aortic stenosis (AS). Recent evidence suggests a lower threshold SVI (30ml/m2) may be more prognostically informative.

Objectives
To assess the association between SVI and survival in patients with low-gradient severe AS, with either preserved (LVEF ≥50%) or reduced (LVEF&lt;50%) ejection fraction.

Methods
Data were derived from the National Echocardiography Database of Australia (NEDA). Of 192,060 adults (aged 62.8±17.8 years) with comprehensive aortic valve profiling between 2000–2019, 12,013 (6.3%) had severe AS. Based on standard echocardiographic parameters, 1,623 patients had severe low-gradient AS with preserved LVEF and 744 patients had severe low-gradient AS with reduced LVEF. All-cause and cardiovascular-related mortality were assessed for each low-gradient group on an adjusted basis (age, sex, BMI, AVA indexed and RVSP), according to SVI. Mean follow-up was 81±42 months.

Results
Compared to patients with “normal” flow (SVI &gt;35ml/m2), those with “low-flow” (SVI ≤35ml/m2) had significantly higher BMI, smaller AVA index and lower AV mean gradient and peak velocity (p≤0.001). In low-gradient with preserved LVEF patients, adjusted survival at 1- and 3-years was significantly lower only for SVI ≤30ml/m2 compared with SVI&gt;35ml/m2 (p&lt;0.001 and p&lt;0.03, respectively). In low-gradient with reduced LVEF patients, adjusted survival at 1- and 3-years was significantly lower for SVI ≤35ml/m2 compared with SVI&gt;35ml/m2 (p=0.015 and p=0.018, respectively).

Conclusions
Taken together with previous data, our results suggest that a SVI threshold of ≤30ml/m2 (rather than ≤35 ml/m2) is prognostically significant in severe low-gradient AS with preserved LVEF.

Funding Acknowledgement
Type of funding sources: None. Survival plots LGAS with preserved EFSummary of results
Impact of catheter ablation on functional tricuspid regurgitation in patients with atrial fibrillation
Authors: Nishiwaki S , Watanabe S , Yoneda F , Tanaka M , Komasa A , Yoshizawa T , Kojitani H , Shizuta S , Morimoto T , Kimura T 
Published: October 2021

Abstract

Background
Since atrial functional tricuspid regurgitation (AF-TR) is associated with increased heart failure and mortality, the management of AF-TR is clinically important. Atrial fibrillation (AF) plays the main role in AF-TR. However, the effectiveness of catheter ablation (CA) and mechanism of improvement of AF-TR haven't been fully evaluated.

Purpose
We sought to investigate the impact of CA for AF on AF-TR in patients with moderate or more TR.

Methods
We retrospectively investigated consecutive 2685 patients with AF who received CA from February 2004 to December 2019 in Japan. The current study population consisted of 102 patients with moderate or greater TR who underwent CA for AF. The echocardiographic parameters were compared between pre-ablation and post-ablation transthoracic echocardiography (TTE), and the recurrence rate of AF/ atrial tachycardia (AT) was measured.

Results
The mean age was 73.2 years, 53% were women. TR severity and TR jet area significantly improved after CA for AF (TR jet area: 5.8 [3.9–7.6] cm2 to 2.0 [1.1–3.0] cm2, p&lt;0.001). In addition, mitral regurgitation (MR) jet area, left atrial (LA) area, mitral valve diameter, right ventricular (RV) end-diastolic area, right atrial (RA) area, tricuspid valve (TV) diameter decreased after CA (p&lt;0.001, &lt;0.001, &lt;0.001, = 0.02, &lt;0.001, and &lt;0.001, respectively). There was no significant difference between one-year recurrence of AF/AT and TR severity at pre-ablation TTE (moderate 28.6%, moderate to severe 37.2%, and severe 31.6%, p=0.72).

Conclusions
TR severity and jet area improved after CA in patients with AF and moderate or more TR. RV size, RA size, TV diameter also decreased after CA, which may be associated with TR improvement. There was no significant difference between one-year recurrence of AF/AT and TR severity at pre-ablation TTE.

Funding Acknowledgement
Type of funding sources: None.
Evolving trends in infective endocarditis over three decades in a developing country
Authors: Maaroufi A , Zahidi H , Abdulhakeem M , Arous S , Benouna E G , Drighil A , Azzouzi L , Habbal R 
Published: October 2021

Abstract

Introduction
Infective endocarditis (IE) is a rare serious disease for which diagnosis and treatment and prophylaxis continue to develop.

Purpose
The aim of our work were to analyze evolution in its epidemiologic, clinical, and microbiologic characteristics, as well as the outcomes.

Methods
This study compare data from a retrospective study conducted by Bennis and Al based on 157 cases of infectious endocarditis admitted in tertiary care Hospital between January 1983 and December 1994, theses cases are referred as Group A; and 103 cases of infective endocarditis according to Duke criteria admitted to the same center three decades afterwards from december 2013 to January 2020, which are referred as Group B.

Results
The mean age of the patients has became older over decades, with a mean of 27.5 years (11–65 years) in the group A versus 39.2 years [13–84] in the group B, with preservation of the male predominance (62.8% in group A vs 62.1% in group B).
Infectious endocarditis secondary to rheumatic valvular heart disease has significantly decreased from 63.% of patients in group A to 27.5% in group B.
Mitral or mitro-aortic valve involvement stayed predominant in both groups with a increase of mechanical prosthetic valve involvement with 9.7% in group B.
A portal of entry of the infection was identified in 63% of patients in group A versus 41% in group B, we noted a significant decrease of dental-related cases from 64% in group A to 29% in group B, and a predominance of invasive procedure/devices cases in group B with 36% of identified cases.
In group A Blood cultures were positive in 42% of cases with a predominance of Staphylocci (30%) and coagulase-negative Staphylococci (25.7% of cases) whilst in group B blood cultures were positive in 30% of cases with a predominance of Staphylococci (36.6%) and Streptococci (20% of cases).
Echocardiography as a useful diagnostic tool demonstrated specific lesions of infectious endocarditis (abcess or vegetations) in 73.2% of cases in group A and 82% in group B. The clinical course in group A was complicated by congetive heart failure CHF (47.8%) or neurological lesions (11.5%) while in group B CHF was noted in 35% of cases and 8% of neurological lesions and The global mortality went from 28.7% in group A to 15% in group B related mostly to cardiogenic shock.

Conclusion
Our work demonstrated changes in the epidemiologic characteristics of IE that parallel changes in demographic and risk factors. The progress of diagnosis and treatement options in developing countries explains the better prognosis for this condition today.

Funding Acknowledgement
Type of funding sources: None.