bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pulmonary artery capacitance a simple and novel prognostic variable in acute pulmonary embolism
Authors: Quintero-Martinez J A , Cordova S N , Alam M M , Jain V , Vlazny D T , Houghton D E , Casanegra A I , Wysokinski W E , Villarraga H R 
Published: October 2021

Abstract

Background
The non-invasive calculation of right ventricular hemodynamics such as the pulmonary artery capacitance (PAC) has proven to be feasible and easy to perform. The simplified pulmonary embolism severity index (sPESI) and pulmonary vascular resistance (PVR) are other prognostic tools that have been used in the past.

Purpose
To evaluate if baseline PAC can outperform PVR and sPESI to predict all-cause short-term mortality in patients with acute pulmonary embolism (PE).

Methods
373 patients with acute PE and a transthoracic echocardiogram performed within one day of diagnosis from March 2013 through June 2020 were followed prospectively. PAC was calculated as: Left ventricular stroke volume/ (Pulmonary artery systolic pressure – Pulmonary artery diastolic pressure). PVR was calculated as: Tricuspid regurgitant velocity / Right ventricular outflow tract velocity time integral x 10 + 0.16. The sPESI was used to evaluate prognosis by categorizing patients into low and high-risk categories. Multiple logistic regression analyses and receiver-operating characteristic curves were used to evaluate the ability of PAC, PVR, and sPESI to predict all-cause mortality up to six months. The Youden index was used to determine the cut-off value with the highest sensitivity and specificity. Kaplan–Meier curves were performed to determine event-free survival rate, differences between groups were assessed using the Wilcoxon Test.

Results
Mean age was 64±15 years (58% male, 28% cancer). PAC was associated with mortality at thirty days (p 0.0003), three months (p 0.003), and six months (p 0.011) (Table). PVR was associated with mortality at thirty days, three months, and six months (p 0.045, 0.012, and 0.031 respectively). The sPESI score ≥1 (high risk) was associated with all-cause mortality at three months and six months (p 0.0136 and &lt;0.0001 respectively). PAC was the strongest predictor of all-cause mortality with an AUC of 0.95 (CI 0.82- 0.99) at thirty days, 0.84 (CI 0.65–0.99) at three months, and 0.77 (CI 0.57–0.96) for six months. Corresponding Kaplan-Meier survival curve of PAC and thirty days all-cause mortality is presented in the Figure. PVR had an AUC of 0.75 (CI 0.48–0.95) at thirty days, 0.79 (CI 0.58–0.94) at three months, and 0.72 (CI 0.50–0.90) at six months. The sPESI had an AUC of 0.62 (CI 0.54–0.66) at three months and 0.64 (CI 0.59–0.67) at six months.

Conclusion
In patients with acute PE, PAC outperforms sPESI and PVR as a predictor of short-term all-cause mortality at thirty days, three months, and six months. These three variables should be explored head to head prospectively for their utility to predict short term all-cause mortality.

Funding Acknowledgement
Type of funding sources: None.
Prognostic impact of the presence and management of coronary artery disease in patients undergoing TAVI
Authors: Custodio P , Madeira S , Teles R , Almeida M , Mendes M 
Published: October 2021

Abstract

Introduction
Approximately half of transcatheter aortic valve implantaton (TAVI) candidates have coronary artery disease (CAD). Controversial results have been reported regarding the effect of the presence/severity of CAD and its management on clinical outcomes post-TAVI.

Aim
To describe the presence, extension, severityand management of CAD pre-TAVIand to evaluate its impact on 2-yearmortality in areal world all comers population.

Methods and population
Single centre retrospective analysis from a prospectively collected institutional registry (VCROSS) including 517 patients that underwent TAVI for severe aortic stenosis between January 2009 and December 2018. Patients who underwent pre TAVI CA in the context of ACS or at other institution were excluded n=138. Ultimately 380 entered the analysis. Obstructive CAD was defined as stenosis &gt;50% in in major epicardial vessels (&gt;2.5 mm). The total number of major epicardial with obstructive CAD was reported as was assessed the number of those left untreated. Univariate analysis was performed to assess 1) differences between patients with or without CAD and between those with significant CAD who have or have not undergone PCI, 2) variables associated with 2-year mortality. Binary logistic regression was performed to identify independent predictors of 2-year mortality including the presence of significant CAD and the type of management.

Results
A total of 380 patients were included, 55.3% male with an average age of 83YO (±6.3), mean Euroscore II of 4.35. 76 had previous coronary artery bypassgrafting (CABG) and 136 had previous PCI (43 had both). 55 patients (14.4%) presented with normal coronary arteries, 120 (31.6%) with non-obstructive CAD and 205 (54%) with obstructive CAD. Out of the latter, 112 (29.5%) underwent PCI. Statistically significant differences were found between obstructive CAD vs non-obstructive patients in terms of age, previous history of ICP and CABG. In the subgroup population with obstructive CAD, no statistically significant differences was found in the PCI vs non PCI group, apart from previous history of ICP and CABG – Figure 1. Diabetes mellitus, previous history of percutaneous coronary intervention (PCI) and reduced ejection fraction (rEF – defined has &lt;50% echocardiographically) had a negative prognosticimpact in the 2 year mortality of the 380 patients. 2-year mortality was 14,5% (55 patients).The presence and management of CAD pre TAVI had no impact in 2-year mortality, when accounting for the differences in previous ICP history, CABG, age, and rEF.

Conclusion
The presence and type of management of obstructive CAD in this real world all comers registry did not impact the prognosis at 2 years.

Funding Acknowledgement
Type of funding sources: None.
Risk prediction in patients with classical Low-flow, low-gradient aortic stenosis undergoing TAVI
Authors: Ludwig S , Gruhl L , Gossling A , Seiffert M , Westermann D , Sinning J M , Sugiura A , Adam M , Mauri V , Frank D , Seoudy H , Rudolph T K , Potratz M , Conradi L , Schofer N 
Published: October 2021

Abstract

Background
Patients with classical low-flow, low-gradient aortic stenosis (LFLG AS) undergoing transcatheter aortic valve implantation (TAVI) are known to suffer from poor prognosis. Risk prediction is difficult and predictors of outcome are scarce in this complex patient subset.

Purpose
This study aimed to develop a simple score system for risk prediction in patients with classical LFLG AS scheduled for TAVI including baseline clinical, echocardiographic and computed tomography (CT) parameters.

Methods
Among 9,150 patients undergoing TAVI (2008–2019) at five German centers, patients with classical LFLG AS were screened for availability of sufficient CT data for aortic valve calcification (AVC) quantification. Score variables were defined as all variables included into the best performing multivariable regression model. Score performance was assessed by Kaplan-Meier analysis for the endpoint of 1-year all-cause as well as c-index calculation.

Results
A total of 718 patients were included into the study. Predictors of all-cause mortality were male sex (HR 1.27 [0.98, 1.65], p=0.068), chronic obstructive pulmonary disease (HR 1.59 [1.21,2.08], p&lt;0.001), atrial fibrillation (HR 1.33 [1.03,1.70], p=0.026), stroke volume index (HR 0.96 [0.94, 0.98], p&lt;0.001), non-transfemoral access (HR 1.44 [1.09,1.91], p=0.011), pulmonary hypertension (HR 1.58 [1.20,2.08], p=0.0012) and low AVC density (HR 1.49 [1.16,1.90], p=0.0016). A score system was developed ranging from 0 points to 11 points. Kaplan-Meier analysis for low (0–2 points), moderate (3–6 points) and high score (&gt;6 points) demonstrated 1-year mortality rates of 20.9%, 28.9% and 64.3% (p&lt;0.001), respectively. C-index for prediction of 1-year mortality was 0.69 (95%-CI 0.65–0.84). The RELiEF TAVI score outperformed classical risk prediction models like the logistic euroSCORE (c-index 0.60 [95%-CI 0.51–0.72], p=0.013), the EuroSCORE II (c-index 0.57 [95%-CI 0.45–0.70], p=0.039) and the STS PROM (c-index 0.60 [0.48–0.70], p=0.035).

Conclusions
The RELiEF TAVI score is based on simple clinical, echocardiographic and CT parameters and might serve as a helpful tool for risk prediction in the vulnerable subset of patients with classical LFLG AS scheduled for TAVI.

Funding Acknowledgement
Type of funding sources: None. RELiEF TAVI Score
Predicting pacemaker dependency after TAVI with pre-procedural MSCT
Authors: Gama F , Goncalves P A , Abecasis J , Ferreira A M , Freitas P , Cavaco D , Gabriel H M , Brito J , Raposo L , Adragao P , Almeida M S , Mendes M , Teles R C 
Published: October 2021

Abstract

Background and aim
High degree conduction disturbances is a burdensome complication of transcatheter aortic valve implantation (TAVI). There is limited data whether such disorders are permanent or reversible. Anatomic surrogates, such as membranous septum [MS, a distance marker from aortic annulus to His-bundle surge] and calcium distribution within aortic valve have been associated with pacemaker (PM) implantation. The aim of our study was to assess predictors of long-term pacemaker dependency following TAVI.

Methods
Single center prospectively included patients that underwent pacemaker implantation following TAVI (March 2017 to September 2020). Patients who were lost to follow up, with bicuspid aortic valve, previously implanted PM and non-available or low quality MSCT exam were excluded. On MSCT, MS length was measured on modified coronal view, the aortic-valvular complex (AVC) was characterized by leaflet sector and calcium distribution was assessed on a J-score threshold of 850-Hounsfield units. Pacemaker dependency was assessed by reducing ventricular pacing to 30 bpm and defined by subsequent complete AV dissociation in patients in sinus rhythm or an escape rhythm &lt;50 bpm in atrial fibrillation, in addition of &gt;90% pacing percentage since implantation.

Results
From the 352 patients with inclusion criteria, 67 underwent PM implantation (19%) and 55 included in the analysis (male 33.9%, median age=85) (Figure). Median time for pacemaker implantation was 3 days [interquartile range (IQR) 3–5 days], mostly due to complete auriculo-ventricular block (76.4%, N=42). PM dependency occurred in 14 out of 55 (25.5%) patients at mean follow up of 500±363 days. Patients with PM dependency tended to have deeper implantation depth, (6.2 mm vs 5.5 mm, p=0.096) and a significantly shorter MS (5.8 mm vs 6.8 mm, P-value = 0.031) (Table). Increasing MS length was independently associated with a lower risk of PM dependency [odds ratio (OR) 0.58 per mm; 95% CI: 0.35–0.98, p=0.04] regardless prosthesis choice. MS length under 5 mm had 97.6% specificity (95% CI: 87.1–99.9) and 85.7% positive predictive value for pacemaker dependency (AUC=76.7; 95% CI 63.3–87).

Conclusion
Our findings highlight the importance of MSCT-derived MS length to stratify the risk of long term need for pacemaker. Patients with short MS (&lt;5mm) in addition to conduction abnormality following TAVI had a high likelihood of PM dependency on the long term and should be considered for prompt PM implantation.

Funding Acknowledgement
Type of funding sources: None.
Paravalvular leaks: short and long-term outcomes of surgical versus percutaneous closure
Authors: Molina Ramos A I , Sabatel-Perez F , Becerra-Munoz V , Rodriguez-Capitan J , Carrasco-Chinchilla F , Sanchez-Espin G , Alonso-Briales J , Melero-Tejero J M , Hernandez-Garcia J M , Gomez-Doblas J J 
Published: October 2021

Abstract

Introduction
Paravalvular leaks (PVL) appear in 5–17% of patients who undergo surgical valve replacement, causing heart failure (HF), haemolytic anaemia, or both in 2–5% of cases. Surgical intervention (SI) is the first line treatment, although transcatheter intervention (TI) is gaining ground as an alternative. However, there are no randomized studies comparing both techniques.

Purpose
The aim of this study is to compare the short and long-term outcomes in patients with symptomatic PVL undergoing SI or TI.

Methods
We conducted a retrospective analysis of all patients who underwent SI or TI for PVL between 2004 and 2020 in our institution. The primary endpoint (PE) was the composite of cardiovascular mortality, readmission for HF and reintervention for PVL up to 24 months after the procedure. The secondary endpoints were admission length, technical and procedural success, and rate of complications. The definition of technical success was the correct placement of the device with no impaired function of the valve prosthesis and with ≤ grade II residual regurgitation. Procedural success was defined when there was technical success with no presentation of intervention-related complications.

Results
Picture 1 provides information about the clinical and procedural characteristics, initial outcome and outcome during follow-up. A total 85 procedures, 39 transcatheter (45.9%) and 46 surgical (54.1%), were performed on 67 patients. The patients who underwent TI were older (67.5 versus 61.4 years; p=0.03) had a worse functional class (NYHA III-IV 100% versus 80%; p=0.02), a lower frequency of previous endocarditis (22.2% versus 52.2%; p=0.03) and higher surgical risk (EuroScore 18.7 versus 10.4 and EuroScore II 8.6 versus 5.6; both p=0.001). The hospital stay was significantly shorter for TI (10.2 versus 30.4 days; p=0.009). Additionally, although without statistical significance, there was a lower frequency of complications (41% versus 58.7; p=0.16) and less technical success (69.2% versus 86.7%; p=0.052). There were no differences between procedure success (61.5% versus 71.1%, p=0.49). Regarding PE, at 24 months there were no differences in event-free survival (TI 55.9% versus SI 64.1%; Log-Rank p=0.8) (Picture 2).

Conclusion
The main finding of our study was the absence of significant differences in the short and long-term outcomes (composite of cardiovascular mortality, readmission for HF and reintervention) between surgical versus percutaneous closure. In conclusion, transcatheter intervention must be considered as a good alternative, particularly in high-risk surgical patients.

Funding Acknowledgement
Type of funding sources: None. Picture 1. Baseline characteristicsPicture 2
Percutaneous access versus surgical cutdown in TAVI: vascular and bleeding complications
Authors: Stathogiannis K , Latsios G , Oikonomou G , Synetos A , Drakopoulou M , Soulaidopoulos S , Toskas P , Xanthopoulou M , Lalou E , Kolyviras A , Tzifos V , Benetos G , Karmpalioti M , Tsioufis C , Toutouzas K 
Published: October 2021

Abstract

Background
Access options for transcatheter aortic valve implantation (TAVI) are vital, since use of large sheaths may lead to access-related complications and bleeding.

Purpose
To determine the access-related vascular and bleeding complications of patients undergoing transfemoral TAVI.

Methods
Consecutive patients scheduled for transfemoral TAVI were retrospectively grouped according to vascular access [percutaneous access (p-TAVI) and surgical cutdown (sc-TAVI)]. Primary end points were vascular and bleeding complications, based on the VARC-II criteria.

Results
Totally, 187 patients were included in the analysis (p-TAVI: 124 patients; sc-TAVI: 63 patients). Mean procedure time was shorter in the p-TAVI group compared to the sc-TAVI group (45.65±6.17 min versus 64.05±15.73 min, p&lt;0.001). Contrast use was lower in the p-TAVI group compared to the sc-TAVI group (81.18±15.96 ml versus 106.75±25.67 ml, p&lt;0.001), which resulted in higher rates of acute kidney injury in the sc-TAVI group (13% versus 1%, p=0.01). Vascular access complications occurred numerically but not statistically more often in the p-TAVI group compared to the sc-TAVI group (11% versus 5% for minor complications and 6% versus 3% for major complications respectively, p=0.10). Patients in the p-TAVI group had the same minor and major bleeding complications compared to the sc-TAVI group (11% versus 8% for minor, 10% versus 6% for major bleeding complications respectively, p=0.49), but no life-threatening bleeding (0% versus 1.5%).

Conclusions
Transfemoral access options in TAVI (surgical cutdown or percutaneous) have similar efficacy and should be offered in TAVI patients if and when appropriate.

Funding Acknowledgement
Type of funding sources: None.
An assessment of ethnic and environmental influences on the phenotypes of hypertension
Authors: Iyeku A C , Jalaludeen N , Ojji D B , Cheriyan J , McEniery C M , Wilkinson I B 
Published: October 2021

Abstract

Background
Hypertension is a growing global concern with developing countries now having the highest prevalence. Environmental factors such as socioeconomic status and diet, together with ethnicity-related factors may influence the development of hypertension and its complications such as left ventricular hypertrophy (LVH). However, the relative contributions of environment and ethnicity to these outcomes remain poorly understood.

Purpose
To test the hypothesis that black hypertensives living in Nigeria would have a higher prevalence of hypertensive target organ damage (i.e. LVH and dysfunction) compared with black hypertensives living in the UK.

Methods
We conducted a three-arm comparative study based on self-defined ethnicity and country of residence. We carried out detailed cardiovascular phenotyping in untreated Black hypertensives (n=53) living in Nigeria (BNig), untreated Black (BUK) hypertensives (n=25), and untreated White (WUK) hypertensives (n=59) living in the UK. We measured brachial and central blood pressure and undertook 2D echocardiography in all the participants. In addition, we collected serum and 24-hour urine biochemistry.

Results
The three groups had similar mean age and BMI (Table 1). The BNig group had significantly higher brachial SBP (P=0.01) and LV mass index (LVMI); P&lt;0.001) compared with the BUK group. Furthermore, both BNig & BUK groups each had significantly higher brachial SBP (BNig: 162mmHg, BUK: 151mmHg) and LVMI (BNig: 100.9g/m2, BUK:86.4 g/m2) compared with the WUK group (Brachial SBP: 144mmHg, LVMI: 82.2g/m2). The prevalence of concentric LVH was similar in the two UK groups (BUK: 10%, WUK: 12%) but higher in the BNig group (41%). Septal early diastolic velocity was significantly lower in BNig group (7.0cm/s) compared to BUK (10.0cm/s) and WUK (10.0 cm/s). After adjusting for 24-hour sodium, brachial SBP (162mmHg) in the BNig group was still significantly higher compared with the other two groups [F(2,109)=13.805, BK (151mmHg, P=0.032), White UK (145mmHg, P&lt;0.001)). However, after controlling for SBP, difference in LVMI persisted only between the BNig (EMM: 98.4 g/m2) versus WUK (EMM: 84.2 g/m2) groups, with no significant difference in BNig vs BUK (86.6g/m2, P=0.156) [F(2,128)=4.245, p=0.016].

Conclusion
Our data suggest that higher SBP and salt intake do not explain all of the environmental differences in the prevalence of LVH and LV dysfunction in hypertensive patients drawn from different ethnicities and environments, suggesting that other factors are likely to play an important role. Further work is in a larger group is required to confirm these findings.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Niger Delta Development Commission
Right ventricular longitudinal systolic strain as a predictor of new onset heart failure with preserved ejection fraction in hypertensive patients
Authors: Marketou M , Kochiadakis G , Patrianakos A , Maragkoudakis S , Theodosaki O , Zervakis S , Anastasiou I , Fragkiadakis K , Plevritaki A , Papadaki S , Parthenakis F 
Published: October 2021

Abstract

Purpose
Accurate assessment of right ventricular (RV) systolic function is important, as it is an established prognostic marker in cardiac diseases. Speckle-tracking echocardiography is a sensitive tool for detection of subclinical left ventricular impairment in essential hypertension. We associated RV function using longitudinal peak systolic strain (GLS) in patients with essential hypertension with the risk of future development of heart failure with preserved ejection fraction (HFpEF).

Methods
We performed a retrospective observational study that included 452 patients with essential hypertension (266 males, aged 63±18 years) and 175 normotensives (100 males, aged 66±15 years). Standard echocardiography was performed at the initial visit. 2D speckle tracking echocardiography with evaluation of longitudinal strain in each segment of the RV (basal: RVLS-B; mid: RVLS-M, apical: RVLS-A) and global RV free-wall strain (RVLS-G) were also performed. We studied the cases of new onset HFpEF in hypertensive patients.

Results
The median follow up was 85 months (22–122). RVLS-G, RVLS-B and RVLS-M were significantly impaired in hypertensives compared to controls (RVLS-G: −16.1±9.7 vs −20.0±5.1, RVLS-B: −11.7±3.7 vs −20.6±3.3, RVLS-M: −16.3±5.4 vs −20.7±4.9, p&lt;0.05 for all). No significant difference was detected for the RVLS-A (−20.1±3.8 for hypertensives vs −21.31±6.5 for controls, p=NS). Thirty two hypertensive patients developed HFpEF (7%). A cut-off RVLS-G worse than −17% was significantly associated with new onset HFpEF (p&lt;0.001) in those patients. A multivariate Cox regression analysis showed that RVLS-G had independent significant prognostic value for the risk of HFpEF (HR: 10.5, 95% confidence interval (CI): 7.3–25.4).

Conclusions
Essential hypertension leads to a decrease of RVLS which is strong predictor of a new onset HFpEF. Future studies are needed to assess the significance of these findings and the effects of treatment.

Funding Acknowledgement
Type of funding sources: None.
The predictive value of central aortic blood pressure on new onset stroke and differences between brachial blood pressure in a Chinese hypertensive population, a prospective cohort study
Authors: Cao C T Y , Ding D C C , Huang H X 
Published: October 2021

Abstract

Objectives
This study aimed to investigate the association between noninvasive central aortic blood pressure and the risk of first stroke in a Chinese community–based population, meanwhile compare the prediction ability of central SBP and peripheral SBP.

Methods
A total of 8473 Chinese participants without history of stroke and atrial fibrillation at baseline were selected from “Hypertension and Stroke Prevention and Control Project” for analysis. The endpoint of the study was first total stroke and stroke subtypes (ischemic stroke and hemorrhagic stroke). Cox proportional hazards regression, smoothing curve fitting, subgroup analysis, and Kaplan-Meier curve were used to analysis the relationship between central/peripheral systolic blood pressure and first stroke.

Results
Participants were 60.9±9.6 years old, 63.5% were males, and 96.1% had hypertension. After a mean 3.3-year follow-up, the incidence of first total stroke, first ischemic stroke and first hemorrhagic stroke were 5.1%, 4.6%, and 0.5%, respectively. In multivariate logistic-regression analyses, central and peripheral SBP were both independently associated with first total stroke and first ischemic stroke after adjusting for various confounders. Peripheral SBP's significant association with first total and ischemic stroke disappeared when combined analyzed with central SBP, whereas central SBP was still significantly related with first total and ischemic stroke after adjustment of peripheral SBP. For first hemorrhagic stroke, no significant differences were observed between central SBP and peripheral SBP. Subgroup analysis showed that the central SBP-first stroke association was significantly stronger in males (HR: 1.38; 95% CI: 1.16, 1.63) than in females (HR: 1.10; 95% CI: 0.97, 1.24; P-interaction = 0.028).

Conclusions
Among the Chinese community–based population, central SBP is a stronger predictor compared with peripheral SBP for first stroke, especially ischemic stroke.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Key R&D Projects, JiangxiOutstanding Person Foundation