bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in incidence and mortality from non-rheumatic degenerative mitral valve disease across europe, over the past three decades
Authors: Al-Khayatt B , Crawley C , Salciccioli J , Marshall D , Hartley A , Hammond-Haley M , Sikkel M , Shalhoub J ,   Medical Research Collaborative
Published: October 2021

Abstract

Background
Valvular heart disease is common globally; mitral regurgitation is the most common valve pathology in the general population and subsequently the second most frequent indication for valve surgery in Europe. Whilst the European epidemiology of aortic stenosis is well elucidated in the literature, no Europe-wide study has been undertaken to identify trends in incidence and mortality secondary to non-rheumatic degenerative mitral valve disease.

Purpose
Our aim is to describe trends in degenerative mitral valve disease incidence and mortality throughout Europe from 1990 to 2019.

Methods
We performed a temporal analysis of data deposited in the Global Burden of Disease Study Database across the European Union. We extracted age-standardised incidence and age-standardised mortality rates for 20 member states from the database. We graphically inspected the data and performed Joinpoint regression analysis to detect and summarise periods of significant change. These periods were described using estimated annual percentage change (EAPC).

Results
Trends in age-standardised incidence and mortality rates were heterogenous amongst the 20 member states included. A gender disparity in mortality rates favouring males were present in Austria, Belgium, Greece, Hungary and the Netherlands throughout the time period studied. Except for Hungary, this disparity was not reflected in the incidence rates for the aforementioned countries. Incidence rates of degenerative mitral valve disease in 2019 were highest in Italy for both males and females with 90.6 and 140.1 cases per 100,000 respectively. Mortality rates in 2019 were highest in the Netherlands for both males in females with 1.7 and 2.0 cases per 100,000 respectively; this was preceded by a downwards trend in mortality with an EAPC of −7.3% and −8.5% respectively. Other notable inflection points in incidence trends were observed in Italy, with an EAPC of −4.9% females between 1994 to 2004 followed by an EAPC of 0.8% between 2009 to 2019.

Conclusion
No overall trends in non-rheumatic mitral valve disease were observed throughout Europe, but gender disparities and some notable deviations in incidence and mortality rates from the European median were identified. Overall, however, incidence rates remained static in most countries studied despite the ubiquity of colour flow doppler echocardiography. Further analysis of the burden of mitral valve disease can help elucidate this geographical variation.

Funding Acknowledgement
Type of funding sources: None.
TAVI via alternative access routes: patient selection and 10-year center experience
Authors: Rocha B , Nolasco T , Teles R , Madeira S , Vale N , Madeira M , Brito J , Raposo L , Goncalves P , Gabriel H M , Sousa-Uva M , Abecasis M , Almeida M , Neves J P , Mendes M 
Published: October 2021

Abstract

Background
Femoral access is considered the gold standard for transcatheter aortic valve implantation (TAVI). However, this route might be precluded due to the presence of tortuosity, small vessel diameter and/or peripheral artery disease. We aimed to investigate TAVI through an alternative access (AA), focusing on the selection criteria and clinical outcomes compared to the femoral route (TF).

Methods
We conducted an all-comers longitudinal single-centre prospective registry in whom a TAVI was performed. The feasibility, safety and efficacy of TAVI by means of an access route other than standard TF was assessed, according to the VARC-2 criteria. The prospective surgical criteria used at our institution to accept an AA route were: a) TF deemed inappropriate; b) acceptable haemorrhagic risk; c) acceptable general anaesthesia risk; and d) adequate anatomy and diameter within acceptable range (subclavian, axillar, transaortic) or e) age &lt;85 years and non-frail patient (transapical). The primary endpoint was all-cause death at 1-year.

Results
From 2008 to 2018, there were 548 patients submitted to TAVI [median age 84 (79–87) years, males 45.4%]. An AA route was used in 100 patients (79 trans-apical, 9 trans-aortic, and 12 trans-subclavian), with a decreasing rate over follow-up (−11% per year). Compared to TF, these patients were younger [80 (77–84) vs. 85 (80–87) years; p&lt;0.001) with a similar baseline surgical risk as per EuroSCORE II [5.1 (3.3–9.0) vs. 4.7 (3.3–7.0); p=0.410). AA patients presented a higher burden of atherosclerotic disease, namely coronary (54.0 vs. 41.3%; p&lt;0.001) and peripheral artery disease (35.0 vs. 16.5%, p&lt;0.001) despite a lower number of other comorbidities (e.g. glomerular filtration rate &lt;50mL/min: 53.1 vs. 64.8%; p=0.030). Left ventricular ejection fraction (56±13 vs 55±12%; p=0.203) and aortic stenosis severity (e.g. valve area: 0.70±0.19 vs. 0.67±0.18cm2; p=0.302) were similar between groups. Haemorrhagic events (minor or major) following TAVI were less often documented in the AA group (11.0 vs 21.7%; p=0.015), contrasting with de novo atrial fibrillation (18.5 vs 7.6%; p=0.048). Overall, 67 patients met the primary endpoint (18.8 vs 16.2%; p=0.584). After adjusted multivariate analysis, the independent predictors of one-year mortality did not include the TAVI access route.

Conclusion
In the first 10 years of experience, 1 in every 6 patients was treated with a TAVI by means of an AA, most often trans-apically initially and, nowadays, via a trans-subclavian approach. The use of meticulous prospective selection criteria seems to explain the one-year similar results, regardless of the access route.

Funding Acknowledgement
Type of funding sources: None.
Multilayer global longitudinal strain assessment of subclinical myocardial dysfunction related to insulin resistance
Authors: Atici A , Asoglu R , Ali Barman H 
Published: October 2021

Abstract

Myocardial tissue is sensitive to insulin resistance (IR) due to its interactions with insulin levels. Previous studies demonstrated that heart failure prevalence was higher in IR patients. Evaluation of myocardial deformation by multilayer global longitudinal strain (MGLS) might provide more information about IR related left ventricular dysfunction. In this study, we aimed to investigate subclinical LV dysfunction with MGLS in patients with IR. The study was designed as a prospective cross-sectional study. The present study included 64 patients with IR(+), and 54 subjects without IR(−) prospectively. The homeostasis model of insulin resistance (HOMA-IR) was used to quantify insulin resistance. Specific analysis for endocardial, mid-myocardial and epicardial layers were performed by two-dimensional (2D) speckle tracking echocardiography (STE) for multilayer global longitudinal strain. MGLS (Endocard-Mid-myocard-Epicard) values were significantly lower in the IR(+) group compared to IR(−) group ((GLS-endocard; −15.1±1.5 vs. −18.7±1.3, p&lt;0.001), (GLS-mid-myocard; −16.0±2.0 vs. −18.0±2.0, p&lt;0.001), (GLS-epicard; −17.0±1.7 vs. −18.01±1.94, p=0.004)). GLS-endocard levels were significantly and positively correlated with HOMA-IR levels (r=0.643, p&lt;0.001). HOMA-IR and age were found to be independent factors in detecting a decrease in GLS-endocard level in regression analysis. In conclusion, our data reveal that IR(+) patients had significantly lower strain values compared to IR(−) group. Besides, we presented that the HOMAIR value was an independent predictor of subclinical left ventricular dysfunction.

Funding Acknowledgement
Type of funding sources: None.
Survival analysis in hypertrophic cardiomyopathy caused by the three most common pathogenic TPM1 variants
Authors: Lamounier Junior A , Alonso Garcia D , Fernandez Ferro G , Cardenas Reyes I J , Noel Brogger M , Valverde Gomez M , Garcia Hernandez S , Fernandez X , Ortiz M , Barriales-Villa R , McKenna W , Monserrat Iglesias L 
Published: October 2021

Abstract

Purpose
To evaluate survival free of cardiovascular events in carriers of the three most frequent TPM1 pathogenic hypertrophic cardiomyopathy (HCM) variants.

Methods
Clinical and genetic data on families carrying TPM1 variants in the literature and identified in our center were systematically revised and collected in a database. Classification of variant's pathogenicity was in accordance with ACMG criteria. We evaluated available follow-up data and constructed Kaplan-Meier survival curves to cardiovascular death (sudden death, appropriate cardiodefibrillator shock, heart failure death, and stroke-related death) or heart transplant. Long-rank test was used to compare event-free survival time.

Results
562 carriers (343 HCM-probands and 219 relatives; 51.3% male carriers) were identified carrying 73 missense variants considered disease causing. TPM1 p.Asp175Asn (87 probands, 109 relatives, 6 unaffected), p.Arg21Leu (52 probands, 25 relatives, 16 unaffected), and p.Met281Val (37 probands, 8 relatives, 9 unaffected) were the most prevalent HCM-variants. Among these three variants, survival data was reported for 508 individuals. Eight-nine carriers had suffered events: 74 sudden deaths (55% males), nine heart failure deaths (44% males), two transplants (50% males), and five stroke-related death (25% males). Incidence of cardiovascular death or transplant was similar between TPM1 p.Arg21Leu and p.Met281Val (p=0.75) and different than p.Asp175Asn (p=0.03 and p=0.06, respectively) and all TPM1 variants (p=0.004 and p=0.04). Analysis by sex showed TPM1 p.Arg21Leu female carriers had better prognosis than p.Asp175Asn male carriers (p=0.048) and all TPM1 male and female carriers (p=0.02 and p=0.04) (curves not showed in the graph).

Conclusion
TPM1 p.Arg21Leu and p.Met281Val could have a better prognosis than p.Asn175Asn and all other TPM1 missense variants in HCM. No marked difference was observed between male and female carriers. More than 80% of the events were arrhythmic deaths.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): HEALTH IN CODE SL
Characterization of left atrial geometry and function in patients with non-obstructive hypertrophic cardiomyopathy: a cardiac magnetic resonance imaging study
Authors: Agoston Coldea L , Muresan I , Zlibut A , Cojan-Minzat B O , Cionca C , Horvat D 
Published: October 2021

Abstract

Background
Left atrial (LA) function and geometry are important predictors of cardiac dysfunction and prognosis in cardiovascular disease, however studies that evaluate their role in patients with hypertrophic cardiomyopathy (HCM) are scarce. Furthermore, altered LA phasic functions might become predictors for disease progression, even in these patients. This study sought to assess the use of cardiac magnetic resonance imaging (CMR) in the assessment of LA function and geometry in patients with HCM.

Methods
We conducted a prospective case-control study on eighty-six patients with first non-obstructive HCM (NO-HCM) diagnosis. They underwent standard cardiovascular examinations and CMR. LA geometry was assessed using LA maximum, minimum and pre-A volumes (LAVmax, LAVmin, LAVpre-A), LA sphericity index (LASI), and LA late gadolinium enhancement (LA-LGE). LA phasic functions were assessed using LA total emptying fraction (LATF), LA passive emptying fraction (LAPF) and LA active emptying fraction (LAAF). LA strain parameters of all three phasic functions were quantified by total strain (et); passive strain (ep), active strain (ea).

Results
86 HCM patients (51±13.7) and 86 healthy volunteers (51±13.6) were enrolled. LA volumes parameters were significantly increased in NO-HCM group (LAVmax: 39.7 vs 33.9 mL/m2; LAVmin: 20.4 vs 13.9 mL/m2; LAVpre-A31.7 vs 24.1 mL/m2, all p&lt;0.001). LA geometry was significantly altered by an increased LASI (56.3 vs 39.7, p&lt;0.001). All three LA phasic functions and strain were impaired in those withHCM (LATF: 49.2±6.5% vs. 58.8±3.1%, et 30.9% vs 39.8%; LAPF: 19.9±5.9% vs. 29.1±8.4%, ep 15.9% vs 18.1%; LAAF: 36.3±8.8% vs. 41.2±8.2%, ea: 20.5% vs 29.1%; all p&lt;0.001). Last but not least, LA replacement fibrosis was present in 39.5% (n=34) of patients with NO-HCM. In multivariable analysis, increased LA-LGE was associated with lower LAPF, peak global longitudinal LA strain (p&lt;0.001).

Conclusion
LA function, strain and geometry are significantly impaired in patients with NO-HCM, even before left ventricular outflow tract obstruction occurs. These parameters might have predictive ability, however further studies are required.

Funding Acknowledgement
Type of funding sources: None.
Cause of death in adult patients with congenital heart disease: experiences of a tertiary centre
Authors: Kecskemeti D , Szegedi M , Temesvari A , Andreka P , Balint H 
Published: October 2021

Abstract

Background
We are currently facing a growing and aging population of adults with complex congenital heart disease. However, long-term survival in these patients remained reduced.

Purpose
To identify the main causes of death and compare mortality based on the complexity of the underlying congenital heart defect.

Methods
Patients with at least one visit in our adult congenital heart disease (ACHD) clinic between 2010 and 2020 were reviewed. Clinical data were obtained from digital medical records. Based on the complexity of the underlying heart defect patients were classified as mild, moderate, and severe. Data about the median age at death in the general population was collected from the National Statistical Office. Survival difference between the groups was analysed using the Kaplan-Meier method along with the log rank test.

Results
We included 2658 patients (53% female, overall median age of 35.6 years) with severe (21.2%), moderate (46.2%), and mild (32.6%) lesions. Over the median follow-up of 8.5 years (IQR 5.2–12.2) 125 patients (4.7%) died with an incidence of 0.51 deaths/100 patient years. The median age at death was 39.1 years (severe: 37.2 years, moderate: 50.3 years, mild: 83.1 years, p&lt;0.001) Heart failure was the leading cause of death (35.2%) followed by non-cardiac causes (12.8%), perioperative/periprocedural death (11.2%), arrhythmia (7.4%), sudden cardiac death (4.1%) and endocarditis (2.4%). Heart failure related death was the most likely present in severely complex lesions (mild: 2.3%, moderate: 13.6%, severe: 84.1%). Underlying CHD with the highest mortality were univentricular heart (26.3%), pulmonary atresia (24.3%), Eisenmenger syndrome (22.7%), Ebstein anomaly (15.2%), and transposition of the great arteries after Senning procedure (13.4%).

Conclusions
Adult patients with moderately to severely complex congenital heart disease die at a relatively young age. The highest mortality rates were observed in patients with severely complex defects, with heart failure being the most common cause of death.

Funding Acknowledgement
Type of funding sources: None. Kaplan-Meier survival curve
Exercise stress echocardiography in children and teenagers with congenital heart diseases
Authors: Avesani M , Calvo G , Sirico D , Castaldi B , Reffo E , Cerutti A , Biffanti R , Di Candia A , Sabatino J , Borrelli N , Piccinelli E , Fraisse A , Padalino M , Vida V , Di Salvo G 
Published: October 2021

Abstract

Background
Exercise Stress Echocardiography (ESE) is currently applied to paediatric patients mainly to detect myocardial ischemia and few data is available for congenital heart diseases (CHDs).

Purpose
The aim of this study is to describe the current application of ESE in our Departments.

Methods
Data from patients who underwent ESE in our two centres were retrospectively analysed, as well as clinical management plans formulated based on ESEs results.

Results
Fifty-five patients (median age 15 years) were included. Among them, 19 had been previously treated surgically, 6 percutaneously and 30 were under follow-up.
Indications for ESE were: hypertension and/or evaluation of aortic arch gradient in patients treated surgically (5) or percutaneously (1) for aortic coarctation (ACo); aortic/subaortic gradient in bicuspid aortic valve (BAV) after balloon valvuloplasty (4), Ross (1), or under follow up (1); right ventricular and pulmonary valve function in Tetralogy of Fallot (3) and after percutaneous treatment of pulmonary atresia (1); atrio-ventricular valves gradient (1 for tricuspid dysplasia and 1 for left cor triatriatum); single ventricle function (1); pulmonary artery gradient (2) and myocardial ischemia (6) after Arterial Switch; rule out myocardial ischemia in coronary anomalies (4), chest pain (9), Kawasaki disease (KD 9), syncope (1) and in patients with ectopic beats under exercise (2); rule out dynamic obstruction in hypertrophic cardiomyopathy (HCM, 3).
The exercise was maximal in 28 patients, with 2 of them having symptoms at the peak of exercise. In the other patients, peak heart rate ranged from 52% to 84% of targeted values. Mean exercise duration and reached Watts were 10 minutes and 112, respectively. Reasons for ending exercise were muscle fatigue in 25 patients and dyspnoea in 2 patients. No arrhythmia was detected.
Clinical management changed in 10 of patients after ESE (20%), all having CHDs. Three patients underwent percutaneous interventions; 1 aortic balloon valvuloplasty, 1 stent dilation and 1 pulmonary valve replacement; 2 underwent surgery (1 aortic valve replacement and 1 subaortic membrane resection), 4 underwent further imaging including cardiac computed tomography (1), cardiac magnetic resonance (2) and cardiac catheterization (1); 1 received indication for restriction from intense physical activities.

Conclusions
ESE has an important clinical role in patients with congenital heart diseases, impacting clinical management.

Funding Acknowledgement
Type of funding sources: None. Indications for ESEChangements in clinical management
Percutaneous transluminal pulmonary angioplasty for hypertensive pulmonary Takayasu's arteritis
Authors: Zhou Y.-P , Jiang X , Zhu Y.-J , Xu X.-Q , Wu T , Wei Y.-P , Peng F.-H , Wang H.-P , Sun K , Wang Y.-N , Li M.-T , Jing Z.-C 
Published: October 2021

Abstract

Background
Percutaneous transluminal pulmonary angioplasty (PTPA) is a treatment modality for chronic thromboembolic pulmonary hypertension, but whether it can be applied to patients with hypertensive pulmonary Takayasu's arteritis (PTA), another chronic obstructive pulmonary vascular disease, remains unclear.

Purpose
To investigate the potential efficacy and safety of PTPA for hypertensive PTA.

Methods
All consecutive patients with hypertensive PTA who completed PTPA in our center between January 1, 2016 and December 31, 2019 were prospectively enrolled. Hemodynamics, exercise capacity and oxygen saturation were measured at baseline and at least 3 months after the last PTPA session. PTPA procedure related complications, restenosis and all-cause deaths during follow-up were recorded.

Results
A total of 50 patients were enrolled, with the median age of 41 (IQR, 30–49) years and female predominance (82.0%). After PTPA, significant improvements in hemodynamics including mean pulmonary artery pressure (from median 48 [39–60] to 37 [31–42] mm Hg, p&lt;0.001) and pulmonary vascular resistance (from 9.6 [7.0–11.8] to 4.8 [3.6–6.4] Wood U, p&lt;0.001) were achieved. Furthermore, PTPA also significantly improved the WHO functional class (p&lt;0.001), six-minute walking distance (from 412 [313–470] to 492 [430–539] meters, p&lt;0.001) and arterial oxygen saturation (from 91.3 [86.9–94.1] to 93.9 [91.8–95.3] %, p&lt;0.001). No peri-procedural death occurred. The most common complication was pulmonary artery injury (27/150 PTPA sessions, 18.0%), which was always asymptomatic and without further clinical sequelae. Pulmonary angiography during follow-up revealed complete self-healing in 26 out of 27 (96.3%) vessels. Restenosis occurred in 5 out of 360 treated vessels (1.4%). Three patients died during follow-up, and the 1-year, 2-year and 3-year survival rates were 98.0%, 95.7% and 92.8%, respectively.

Conclusion
PTPA appears to be a promising therapeutic option for patients with hypertensive PTA.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): the National Key Research and Development Program of China Efficacy of PTPA
Current use of catheter directed treatment of acute PE in Europe: results of survey of EAPCI and ESC Working Group on Pulmonary Circulation and Right Ventricular Function
Authors: Roik M , Pruszczyk P , Klok F A , Barco S , Jermakow M , Dudek D 
Published: October 2021

Abstract

Aims
This survey conducted by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and ESC Working Group on Pulmonary Circulation & Right Ventricular Functioncollected information on current practices in catheter-directed treatment (CDT) of acute pulmonary embolism (PE) among cardiology intervention centers in European countries.

Methods and results
Responses from 157 Catheterization laboratories (Cath Lab) representing European countries were collated and analyzed.Sixty seven centers (43%) centers reported application of CDT in PE patients. Almost all centers performing CDT (96%) provided 24/7 service and had experience with a wide spectrum of percutaneous interventions including those for the treatment of structural heart diseases; 53% of the Cath labs utilizing CDT were located in teaching hospitals, and involved 5 to 10 interventional cardiologists performing more than 600 coronary procedures per year. The survey showed a rapid increase in CDT use in European countries after 2015 (45 out of 67 centers). Over 60% of responding centers performed 5–10 CDT procedures per year. It was estimated that 24 patients were treated with CDT per center on a yearly base. The majority of centers (80.3%) indicated that CDT is used in high-risk PE patients, while 38% also apply CDT to intermediate high risk PE.
The survey revealed that pigtail catheters are most commonly used for CDT (49%), while dedicated systems such as AngioJet, Indigo and EKOS were reported to be used in 25%, 23.81% and 20.24% of the centers, respectively. Local thrombolysis during CDT was used in 71% of the procedures. More than 60% of the responders indicated that according to their expert opinion CDT will be routinely used in PE patients in the future. However, they stressed the need for randomized trials to evaluate the safety and efficacy of CDT and determine the patients that would benefit most.

Conclusions
According to the survey, use of CDT in patients with PE is increasing over time. Currently, it is mostly but not exclusively applied to patients with high-risk PE. The respondents indicated the need for high-quality randomized trials to establish the optimal indication for CDT and further standardize the use of the available techniques.

Funding Acknowledgement
Type of funding sources: None.