bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sutureless bioprosthesis as an alternative to conventional aortic valve replacement surgery
Authors: Rua N , Ferreira R , Sena A , Nobre A 
Published: October 2021

Abstract

Background
Aortic valve stenosis is the most common adult valve disease in industrialized countries. The ageing population and the rising in comorbidities have urged the development of safer alternatives to the current gold standard surgical treatment. Sutureless bioprosthesis have shown promising results, especially in technically difficult procedures and as more and more patients need concomitant surgeries.

Purpose
Assess clinical and haemodynamic performance, safety and durability of the sutureless bioprosthesis implanted in patients with aortic valve disease, over a period of 5 years, both in isolated aortic valve replacement surgeries as well as in concomitant procedures.

Methods
Single centre retrospective longitudinal cohort study collected data of all adult patients with aortic valve disease who underwent valve replacement with a sutureless bioprosthesis between February 2015 and October 2020. Of the 196 patients analysed (mean age 77.20±5.08 years; 45.40% were female; mean logistic EuroSCORE 2.91±2.20%), the majority had aortic stenosis. To assess the comparative risk of adding concomitant procedures, patients were divided into two groups and compared: one comprised patients who underwent isolated valve implantation (n=132) and the other patients who had concomitant coronary artery bypass graftings (n=49). 15 patients had other heterogeneous concomitant procedures and were therefore not considered in this comparison.

Results
Overall mean cross-clamp and cardiopulmonary bypass times were 45.50±19.04 and 36.50±11.40 minutes, respectively. 4 valves were reimplanted due to misplacement. Mean transvalvular gradients were 7.82±3.62 mmHg. Mean ICU and total hospital stay were 3.32±3.20 and 7.70±5.82 days, respectively. Procedural success was 99%, as two explantations occurred. Pacemaker implantation occurred in 12.8% of patients, atrial fibrillation de novo in 21.9% and renal replacement support was necessary in 3.1%. Early mortality was 0.51%. We report no structural valve deterioration, strokes or endocarditis and one successfully treated valve thrombosis. By comparison, patients with concomitant procedures had worse left ventricular function (40.8 vs 79.5%; p=0.030), longer aortic clamping (43.33±11.60 vs 27.30±8.10 minutes; p&lt;0.001) and cardiopulmonary bypass times (59.98±17.60 vs 37.45±11.30 minutes; p&lt;0.001), as expected. ICU stay after surgery was also longer (3.96±3.20 vs 2.80±2.70 days; p=0.016). Apart from this, there were no other significant differences in postoperative complications and survival, even up to 5 years.

Conclusion
Our study confirms the excellent clinical and haemodynamic performance and safety of a truly sutureless aortic valve, even up to the 5-year follow-up. These results were consistent both in isolated and concomitant interventions, solidifying this device as a viable treatment of isolated aortic valve disease, and now also in patients needing concomitant procedures.

Funding Acknowledgement
Type of funding sources: None.
Long-term outcomes in patients with left bundle branch block after transcatheter aortic valve replacement
Authors: Simon Paracuellos T , Perez Guerrero A , Gambo Ruberte E , Peiro Aventin B , Gomez Martin D , Ferrer Gracia M C , Galache Osuna G , Sanchez-Rubio Lezcano J , Fuertes Ferre G , Cortes Villar C , Ortas Nadal R , Diarte De Miguel J A 
Published: October 2021

Abstract

Introduction
New-onset persistent left bundle branch block (NOP-LBBB) is one of the most common complications after transcatheter aortic valve replacement (TAVR). The impact that this conduction disorder may have on the cardiovascular events during the follow-up of these patients remains unclear.

Objective
The main goal was to assess the prognosis of TAVR recipients that develop persistent LBBB after TAVR, evaluating long-term outcomes.

Methods
A cohort study was conducted. Consecutive patients undergoing TAVR from January 2012 to December 2020 were included. NOP-LBBB was defined as a new LBBB occurring during the hospitalization period after the TAVR procedure that persisted at hospital discharge. Patients were divided into 2 groups according to whether they had a NOP-LBBB. Patients carrying a pacemaker before the procedure and those who already presented LBBB were excluded.
MACE (major adverse cardiovascular events including cardiovascular death, myocardial infarction, cerebrovascular accident and heart failure hospitalization) as primary outcome was searched.

Results
A total of 254 patients were included with a median age of 81.07 years (77.73–86.22). 77% TAVR patients received self-expanding prosthesis. 21.57% of our cohort presented NOP-LBBB and 29% of this group required a pacemaker. We reported a single case of prosthesis dysfunction, in a patient of the NO-LBBB group. Global baseline characteristics and long term events at follow-up according to the occurrence of LBBB are summarized at figure 1. Patients in both groups were statistically comparable.
At a median of 21.3 (8.52–38.94) months of follow-up, a higher incidence of syncope was found among the patients with NO-LBBB, reaching the statistical significance. There were no significant differences between groups regarding cardiovascular mortality (OR 1.48 95% CI: 0.36–4.00 p=0.41). NOP-LBBB group showed higher rates of heart failure hospitalization (OR 1.95 95% CI: 0.98–3.9 p=0.057)
NOP-LBBB was associated with an increased risk of MACES at follow-up (27.72% vs 17.54%; adjusted HR: 1.77 95% CI 1.02–3.06, p 0.04).
Survival curves are displayed in figure 2.

Conclusions
Developing LBBB after TAVR seems to lead to more cardiovascular events, with a significant difference in long- term survival. These data suggest an adverse clinical impact of “de novo” LBBB, highlighting the necessity of a close vigilance of these patients.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Predictors of exercise capacity in patients with asymptomatic primary moderate to severe mitral regurgitation and preserved left ventricle ejection fraction
Authors: Zvirblyte R , Tamulenaite E , Montvilaite A , Bucius P , Berontaite S , Vaskelyte J J 
Published: October 2021

Abstract

Introduction
Patients with primary moderate or severe mitral regurgitation (MR) often remain asymptomatic for a long time due to mechanisms of compensation. Exercise stress could provoke symptoms, unmask subclinical changes of left and right ventricles and reveal decreased functional capacity. Reduced exercise capacity is related to worse outcomes.

Purpose
The aim of this study was to evaluate an exercise capacity and factors influencing it in patients with asymptomatic primary moderate to severe MR and preserved left ventricle (LV) ejection fraction (EF).

Methods
60 patients with asymptomatic moderate or severe MR and LV EF &gt;60% underwent resting and stress (bicycle–ergometry as per protocol 25 + 25W every 3 minutes) echocardiography. Their exercise capacity was evaluated in Watts (W) and metabolic units (MET). The blood sample for NT-proBNP evaluation was collected just before the stress test.

Results
Patients with primary MR achieved 84.74±35.16 W and 4.87±1.51 MET. According to univariate linear regression analysis exercise capacity in MET was significantly related to age (B=−0.066, p&lt;0.001), systolic pulmonary artery pressure (SPAP) at rest (B=−0.048, p=0.034), resting E wave (B=−0.015, p=0.031) and NT-proBNP (B=−0.003, p=0.006). Predictors of exercise capacity in W also were age (B=−1.273, p=0.002), resting E wave (B=−0.318, p=0.041), NT-proBNP (B=−0.057, p=0.018). Higher concentration of NT-proBNP and bigger SPAP at rest correlated with lower exercise capacity (picture 1). In patients who had exercise induced pulmonary hypertension (EIPH; SPAP &gt;60 mmHg during peak stress) ergometry was more frequently terminated prematurely (19 (95%) and 24 (60%), p=0.012). They also had significantly lower exercise capacity than subjects without EIPH ((W: p=0.015 and MET: p&lt;0.001).

Conclusions
Age, NT-proBNP concentration, resting SPAP and E wave were predisposing factors of exercise capacity in patients with asymptomatic primary moderate to severe MR and preserved LV EF. EIPH and elevated NT-proBNP were related to premature exercise termination and lower exercise capacity.

Funding Acknowledgement
Type of funding sources: None. Picture 1
Circulating transforming growth factor-beta1 and progression of the mitral valve prolapse: fifteen-year follow-up
Authors: Malev E , Reeva S , Timofeev E , Zemtsovsky E 
Published: October 2021

Abstract

Introduction
Transforming growth factor-β1 (TGF-β1) is a crucial regulatory cytokine that contributes to the development of the mitral valve and regulates extracellular matrix protein synthesis in syndromic and non-syndromic mitral valve prolapse (MVP). Our aim was to evaluate the effect of elevated circulating TGF-β level on the progression of the valve myxomatosis and leaflets billowing at long-term follow-up.

Methods
78 asymptomatic young subjects (mean age 19.7±1.6, 72% male) with MVP were consecutively enrolled in our observational, prospective, single-center study. MVP was diagnosed by billowing one or both mitral leaflets &gt;2 mm above the mitral annulus in the long-axis parasternal view. Concentration of TGF-β1 in serum was determined by enzyme-linked immunosorbent assay using a test system Human Platinum ELISA.

Results
During 1170 person-years of follow-up (median 14.5 years), no deaths or MVP-related events occurred. Posterior leaflet's thickening (from 3.9±1.4 mm to 4.4±1.7 mm (D=+0.5 mm), p&lt;0.01) and increase of the billowing (progression in maximal prolapse depth from 3.5±2.4 mm to 4.8±2.8 mm (D=+1.3 mm), p&lt;0.001) leads to the mitral regurgitation (MR) progression (vena contracta: 2.3±0.4 mm vs. 3.5±0.4 mm (D=+1.2 mm), p&lt;0.0001) over 15 years of follow-up.
TGF-β1 serum level was increased (15.2±12.3 ng/ml) and strongly correlated with the thickening of the posterior leaflet (r=0.72; p≤0.0001). In multivariate Cox analysis the TGF-β1 level was the independent predictor of the posterior leaflet's thickening (2.07; 95% CI: 1.34 – 3.29; p=0.001) and progression of the billowing (2.89; 95% CI: 1.61 – 4.37; p=0.0001).
TGF-β1 &gt;7.0 ng/ml was a strong predictor (area under ROC curve = 0.84 (95% CI, 0.7–0.9); sensitivity 82%, specificity 95%) for progression of MVP (maximal prolapse depth increase: D +1.9±1.2 mm (TGF-β1 &gt;7.0 ng/ml) vs. 0.7±0.6 mm (TGF-β1 &lt;7.0 ng/ml), p&lt;0.0001) and MR (vena contracta increase: D +1.1±0.5 mm (TGF-β1 &gt;7.0 ng/ml) vs. 0.5±0.4 mm (TGF-β1 &lt;7.0 ng/ml), p&lt;0.0001).

Conclusions
Despite the overall benign prognosis, we found the obvious echocardiographic progression of the valve myxomatosis and leaflets billowing at long-term follow-up in young person. Elevated above 7.0 ng/ml TGF-β1 serum level might serve as a prognostic biomarker and identifies patients with increased risk of the mitral valve prolapse progression.

Funding Acknowledgement
Type of funding sources: None.
Head-to-head comparison of NT-proBNP and soluble ST2 for long-term prognosis of patients with hypertrophic cardiomyopathy
Authors: Cediel Calderon G , Resta H , Codina P , Santiago-Vacas E , Domingo M , Spitaleri G , Lupon J , Bayes-Genis A 
Published: October 2021

Abstract

Background
N-terminal pro-brain natriuretic peptide (NT-proBNP) predicts mortality and the development of heart failure (HF) in hypertrophic cardiomyopathy (HCM), however, evidence regarding soluble interleukin-1 receptor-like 1 (ST2) in this population is lacking.

Purpose
To assess the ST2 and NT-proBNP significance for risk stratification of patients with HCM during long-term follow-up.

Methods
We prospectively enrolled a cohort of consecutive patients with HCM admitted to an ambulatory HF Unit in a Tertiary University Hospital. All patients had clinical and echocardiographic evaluation and measurement of NT-proBNP and ST2 at inclusion. The primary endpoint was the composite of all-cause death or HF-related hospitalization.

Results
103 patients were enrolled, 68% (n=70) males with a median (IQR) age of 60 (50–71) years. The median (IQR) of ST2 was 31.5 (IQR: 24.5 – 40.7) pg/mL. During a median follow-up of 2.5 years, 17 patients had the primary endpoint. Both, NT-proBNP and ST2 (both log-transformed) were associated with the primary endpoint in the univariable analyses (p&lt;0.01). However, after adjustment by age, sex, NYHA functional class and left ventricular ejection fraction (LVEF), this association remained statistically significant only for ST2 (HR: 4.62, 95% CI 1.80–11.87, p=0.001 vs HR: 1.57, 95% CI 0.97–2.54, p=0.068 for NT-proBNP). The addition of ST2 to a clinical model (age, sex, NYHA functional class and LVEF) increased the Harrel's C statistic from 0.70 to 0.76, while the addition of NT-proBNP increase this C-statistic only to 0.73.

Conclusions
ST2 appears to be a valuable biomarker for the prediction of death and heart failure related hospitalization in patients with HCM, outperforming the prognostic value of NT-proBNP. Future research should delve into this association.

Funding Acknowledgement
Type of funding sources: None.
All-cause mortality and cardiovascular death in 52091 patients with hypertrophic cardiomyopathy. A nationwide cohort study
Authors: Fauchier L , Bisson A , Bodin A , Herbert J , Spiesser P H , Pierre B , Clementy N , Babuty D , Bernard A , Lip G Y H 
Published: October 2021

Abstract

Background
Patients with hypertrophic cardiomyopathy (HCM) have high risk of death related to cardiovascular (CV) death. Improvements in risk stratification are needed to help identify those HCM patients at higher risk of all-cause death and cardiovascular death.

Methods
This French longitudinal cohort study from the database covering hospital care from 2010 to 2019 analyzed adultshospitalized with isolated HCM. The overall sample of 52,091 patients was randomly partitioned into derivation (n=26,067) and validation (n=26,024) populations. A logistic regression model was used to construct HCM death and CV-death scores in the derivation sample, which were compared to the Charlson index, Frailty index and CHA2DS2VASc scores using c-indexes and calibration analysis.

Results
In 52,091 patients with isolated HCM, 12,676 (24.0%) died during follow-up of 3.0±2.8 years (median 2.3, interquartile range 0.4–5.0). Rate of all-cause death was 8.10%/year (7.96–8.24) and was 2.76%/year (2.68–2.84) for CV death.Independent predictors of CV death in HCM were older age, diabetes mellitus, heart failure, history of pulmonary edema, atrial fibrillation, ventricular tachycardia or fibrillation, ischemic stroke, while smoking and poor nutrition were associated with better survival (all p&lt;0.05). In addition to these, male sex, vascular disease, alcohol related diagnoses, kidney disease, lung disease, liver disease anemia and cancer were independent predictors of all-cause death. In the derivation cohort, c-indexes for the HCM death score were 0.720 (0.713–0.727) for all-cause death and 0.695 (0.685–0.705) for CV death. For the HCM CV-death score, c-indexes were 0.679 (0.671–0.686) for all-cause death and 0.723 (0.712–0.733) for CV death. Performances were very similar in the validation cohort. Both scores had good calibrations. Charlson and Frailty indexes however had a better clinical usefulness than the HCM death score and HCM CV-death scores for predicting all-cause death. Decision curve analysis for CV death demonstrated that the HCM CV-death score had the best clinical usefulness of all the tested risk scores.

Conclusion
HCM patients have a high risk of all-cause and CV mortality. Independent predictors of CV-mortality in HCM were used to derive and validate a simple risk prediction model (French HCM CV-mortality score) which performed better than clinical scores, Charlson Index and Frailty Index; showing the best clinical usefulness, with good calibration.

Funding Acknowledgement
Type of funding sources: None.
Glucocorticoids in myocarditis therapy after COVID-19
Authors: Kovalenko V , Nesukay E , Cherniuk S , Kirichenko R , Kozliuk A , Titova N , Titov E , Giresh J 
Published: October 2021

Abstract

The aim of the study - to evaluate the efficacy of glucocorticoids (GC) in patients with acute myocarditis (AM) after COVID-19 infection.

Material and methods
We included 60 pts with severe AM and heart failure (HF) with reduced (&lt;40%) left ventricular (LV) ejection fraction (EF) who had COVID-19 infection 1–2 months before the enrollment. According to the results of cardiac magnetic resonance (CMR) included pts had ≥2 Lake Louise criteria for myocarditis. All pts on the background of HF therapy (β-blockers, ACE-inhibitors, MRA antagonists, diuretics) were prescribed GC: 0.25 mg/kg per day methylprednisolone for 3 months, followed by a gradual dose reduction of 1–2 mg per week until complete discontinuation after 6 months. Evaluation before the start of GC therapy and after 6 months included CMR, 2D- and speckle-tracking echocardiography.

Results
After 6 months according to the results of CMR the number of LV segments with inflammatory lesions decreased to (3,58±0,42) from (6,32±0,77) segments in average (p=0,001). This was followed by improvement of LV systolic function: increase of LV EF in average to (43,5±2,6) from (32,2±2,4) % (p=0,003), longitudinal global systolic strain (LGSS) absolute value to (11,3±1,1) from (7,9±0,5) % (p=0,012) and circumferential global systolic strain (CGSS) to (12,1±1,0) from (8,9±0,6) % (p=0,023). Also we observed LV volume reduction: decrease of LV end-diastolic (from 118,9±8,6 to 95,3±7,2 ml/m2, p=0,033) and LV end-systolic (from 80,1±5,1 to 59,1±4,4 ml/m2, p=0,027) volume indexes. Wherein in 24 of 60 pts (41,6%) on the background of significant decrease in the number of LV segments with inflammatory lesions (to 1,34±0,21 from 6,12±0,73 segments, p=0,0001) after 6 months we observed the recovery of LV EF ≥50%, followed by an improvement of LGSS and CGSS on 42,1 and 39,4% respectively (p=0,001). According to multivariate regression analysis, predictors of LV EF recovery (≥50%) after 6 months of GC treatment were established: presence of inflammatory lesions in ≤5,0 LV segments, values of LGSS and CGSS ≥9.0% and ≥9.5% respectively before the start of GC.

Conclusions
The use of GC in pts with severe AM after COVID-19 was followed by the decrease of LV segments number affected by inflammation, improvement of LV systolic function and reduction of LV volume indexes. In 41,6% of pts GC therapy was associated with LV EF recovery after 6 months and predictors of its effectiveness were found: presence of inflammatory lesions in ≤5,0 LV segments, values of LGSS and CGSS ≥9.0% and ≥9.5% respectively before the start of GC.

Funding Acknowledgement
Type of funding sources: None.
Predictive factors for requiring heart transplantation in patients with hypertrophic cardiomyopathy: data from a referral center
Authors: Brufau-Cochs M , Ramos-Jovani M , Lopez Sainz A , Farrero M , Castel M A , Sole-Gonzalez E , Quintana E , Sandoval E , Pereda D , Rodriguez Arias J J , Fernandez Valledor A , Castella M , Perez-Villa F , Sitges M , Garcia-Alvarez A 
Published: October 2021

Abstract

Background
Heart transplant (HT) remains the last treatment option for patients with non-obstructive hypertrophic cardiomyopathy (HCM) who develop end-stage heart failure (HF). Early identification of patients who may require a HT in the future is crucial in order to advise them, establish the appropriate follow-up and determine the appropriate time to include them in the waiting list.

Objectives
Our study sought to find predictive factors related with requiring HT during follow-up in patients with HCM.

Methods
Consecutive patients with HCM referred to a HCM monographic clinic from 2018 to 2020 (HCM controls) and transplanted patients due to HCM in the same tertiary HT hospital since 2003 (cases) were included. Baseline (on the date of HCM diagnosis) and longitudinal data regarding clinical, genetic, ECG and echocardiographic variables were retrospectively evaluated. Follow-up was registered from HCM diagnosis to HT (in cases) or last medical check up (controls).

Results
A total of 157 patients (24 HCM-HT cases and 133 HCM controls) were included (45±19 yo; 57% male). At the time of MCH diagnosis (Table), cases were significantly younger than controls, were more frequently symptomatic and showed significantly higher BNP levels and more advanced diastolic dysfunction (larger left atrium, higher E/A ratio and lower e'); also, HCM-HT reported more family history and had higher proportion of pathogenic mutations (being MYH7 the most frequently involved). Left ventricular (LV) systolic function was slightly reduced in HCM-HT cases. In contrast, HCM controls were more frequently diagnosed by casual findings or family screening and had more LV outflow tract obstruction at first medical evaluation. LV maximal wall thickness (MWT) did not differ between groups. During a median follow-up since HCM diagnosis of 6.2 years (median follow-up of 8.9 and 7.1 years in cases and controls, respectively), HCM-HT cases presented a higher incidence of sustained ventricular tachycardia or ICD therapy (HR=4.0; CI95%:1.6–10.0 p=0.03) and HF admissions (HR=3.9; CI95%:1.8–8.1 p&lt;0.001). There were no cardiovascular deaths during follow-up.

Conclusions
The presence of symptoms in a young non-obstructive HCM patient, along with family history and a pathogenic mutation, should advice clinicians a closer follow-up and early transfer to a HT referral center, especially if associated with diastolic dysfunction and high BNP values.

Funding Acknowledgement
Type of funding sources: None. Table 1