bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term survival benefit of SAVR over TAVR in low-risk elective patients
Authors: Kowalowka A , Kowalewski M , Wanha W , Kolodziejczak M , Mariani S , Li T , Stefaniak S , Los A , Hudziak D , Gocol R , Suwalski P , Rogowski J , Jemielity M , Wojakowski W , Deja M 
Published: October 2021

Abstract

Background
Aortic valve (AV) stenosis can be treated either by surgical AV replacement (SAVR) or since 2002 by transcatheter aortic valve implantation (TAVI). Due to lower invasiveness, TAVI is a preferred approach in high- and prohibitive risk surgical candidates, yet outcome data is conflicting when lower risk patients are considered and in particular at long-term.

Purpose
Our study evaluates long-term survival in elective low-risk patients after AV replacement with severe AV stenosis.

Methods
We conducted a registry data analyses of patients scheduled for elective isolated AV with AV stenosis between 2015 and 2019 and underwent TAVI or SAVR. Urgent, emergent and salvage procedures were excluded. In TAVI group only transfemoral access was considered. Propensity score matching to determine SAVR controls for TAVI group in 1:3 ratio with caliper 0.2 of standardized deviation (figure 1).

Results
Study group included 2393 elective AVR patients 1765 was in SAVR group and 628 in TAVI group. Median follow-up was 2.72 years ([IQR: 1.32–4.08], max 6.0). Propensity matching with replacement returned 329 TAVI cases and 593 SAVR controls with median age 76 (Interquartile range [IQR:71–73]) and EuroScore II 1.81 [IQR:1.36–2.53]). 30-day mortality was 11/329 (3.32%) vs 18/593 (3.03%) in the TAVI vs SAVR respectively (RR 1.10 [0.52–2.37]; p=0.801). At two years, there was no difference between SAVR and TAVI in terms of mortality (HR 1.23 [0.83–1.83] P=0.309). At 6 years, overall survival analysis favored SAVR which was associated with 30% lower mortality (HR 0.70 [0.496–0.997]; p=0.048, see figure 2).

Conclusions
TAVI as compared to SAVR is equally safe in elective low-risk patients up to 2 years post-op. After that time survival is better in surgically managed patients. Extended observations from randomized trials in low-risk patients are warranted to draw definite conclusions regarding long-term safety of TAVI in this population.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The work was supported by the research non-commercial grant from Medical University of Silesia Figure 1Figure 2
Clinical outcomes following isolated transcatheter tricuspid valve repair: a meta-analysis and meta-regression study
Authors: Bocchino P P , Angelini F , Vairo A , Andreis A , Fortuni F , Franchin L , Frea S , Raineri C , Pidello S , Conrotto F , Montefusco A , Alunni G , De Ferrari G M 
Published: October 2021

Abstract

Background
Significant tricuspid regurgitation (TR) is a common valvular heart disease worldwide.

Purpose
We aimed to assess the pooled clinical and echocardiographic outcomes of different isolated transcatheter tricuspid valve repair (ITTVR) strategies for significant (≥ moderate) TR.

Methods
We systematically searched the literature for studies evaluating the efficacy and safety of ITTVR for significant TR in adult. The primary outcomes were the improvement of New York Heart Association (NYHA) functional class and 6-minutes walking distance (6MWD) and the presence of severe or greater TR at the last available follow-up of each individual study. Random-effect meta-analysis was performed comparing outcomes before and after ITTVR.

Results
14 studies with 771 patients were included. Mean age was 77±8 years and mean EuroScore II was 6.8%±5.4%. At a weighted mean follow-up of 212 days, 209 (35%) patients had a NYHA III to IV functional class compared to 586 (84%) patients at baseline (risk ratio: 0.23, 95% CI 0.13 to 0.40, P-value&lt;0.001). 6MWD significantly improved from 237±113 meters to 294±105 meters (mean difference: +50 meters, 95% CI +34 to +66 meters, P-value&lt;0.001). 147 (24%) patients showed severe or greater TR after ITTVR compared to 616 (96%) at baseline (risk ratio: 0.29, 95% CI 0.20 to 0.42, P-value&lt;0.001).

Conclusion
Patients undergoing ITTVR for significant TR experienced a significant improvement in NYHA functional status and 6MWD and a significant reduction in TR severity at mid-term follow-up.

Funding Acknowledgement
Type of funding sources: None.
Patent foramen ovale closure: a comparison between two types of devices in a retrospective cohort
Authors: Chatelain Q , Giannakopoulos G , Adamopoulos D , Roffi M , Muller H , Noble S 
Published: October 2021

Abstract

Background
Patent foramen ovale (PFO) closure has been shown to reduce the risk of recurrent stroke in selected patients. Different PFO occluding devices have been validated by the authorities and are used in the clinical practice.

Purpose
The main purpose of this study is to compare the use of two types of devices for PFO closure, the GORE CARDIOFORM Septal occluder and the AMPLATZER occluders (PFO or CRIBIFORM) in terms of major clinical safety and efficacy outcomes.

Methods
In this single-center retrospective study, the final cohort comprised 182 patients who underwent PFO closure between January 2012 and May 2019 (mean age 57±13 years, 34% males). The population was divided in two groups according to the device used (GORE CARDIOFORM Septal occluder [n=66, 36%] or the AMPLATZER occluders [n=116, 64%]). The endpoints assessed at 6 months, were the presence of a significant shunt (at least moderate [10–25 microbubbles] at rest or during the Valsalva manoeuvre), the incidence of supraventricular arrythmias, recurrent stroke, or serious device-related adverse events.

Results
At 6 months, a small percentage of patients with significant residual shunt was found in both the GORE and the AMPLATZER groups (7% vs 14% respectively, p=0.182). The incidence of supraventricular arrythmias was lower in the GORE as compared to the AMPLATZER group (9.1% vs 22.4% respectively, p=0.023). During the 6-month follow-up period there were 3 ischemic strokes, all of them in the AMPLATZER group, but this difference did not reach statistical significance (p=0.188). Finally, no serious device-related adverse events were noted in the total cohort.

Conclusion
PFO closure with a GORE device is related to lower incidence of supraventricular arrythmias at 6 months. The presence of a significant residual shunt and the incidence of recurrent stroke were comparable between both groups.

Funding Acknowledgement
Type of funding sources: None.
Changes in aortic valve hemodynamics and ventricular functional measurements in patients undergoing transcatheter and surgical aortic valve replacement: a head-to-head comparison
Authors: Manla Y , Khalouf A , El Zouhbi A , Lee St John T , Bafadel A , Traina M , Al Badarin F J , Edris A 
Published: October 2021

Abstract

Introduction
Both surgical and transcatheter aortic valve replacement are effective interventions for treatment of patients with severe aortic stenosis. Data from landmark randomized trials have shown comparable improvement in aortic valve hemodynamics and left ventricular remodeling. Whether similar patterns will be observed in real-world practice has not been completely investigated.

Purpose
To compare the impact of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) on short- and intermediate-term changes in aortic valve hemodynamics and left ventricular reverse-remodeling.

Methods
A total of 213 patients with severe AS were referred for TAVR (n=137) or SAVR (n=76) at a single center (August/ 2015-Feb/ 2021). Patient demographics and echocardiographic parameters of aortic valve stenosis severity were collected retrospectively. Changes over-time in aortic valve area, mean gradient, dimensionless index, left ventricular ejection fraction (EF), and ventricular septal thickness were examined using linear mixed models.

Results
Patients undergoing TAVR were older with higher STS risk scores and a greater burden of comorbidities (Table). Over a median follow-up of 13 months (IQR 4–31), both groups experienced a significant reduction in aortic valve mean gradient (25.7 mmHg with TAVR and 18.8 mmHg with SAVR), with no significant between-group difference (P=0.15). Aortic valve dimensionless index significantly increased in TAVR and SAVR groups (0.23 and 0.13, respectively) and was more pronounced in the TAVR group (P=0.01). Similarly, aortic valve area increased significantly in both groups (0.66 cm2 and 0.42 cm2, respectively) without a significant across-group difference (P=0.07). On the other hand, left ventricular ejection fraction did not change significantly over time (−0.61 and 1.15 EF points, respectively) with no significant between-group difference at 12 months (P=0.06). Ventricular septal thickness was significantly reduced in both groups, with no significant between group difference (P=0.4; Figure).

Conclusion
In this real-world experience, both TAVR and SAVR were associated with significant improvement in aortic valve hemodynamic parameters and modest reverse left ventricular remodeling. Furthermore, these changes were comparable with both modalities, adding to available evidence from randomized clinical trials on beneficial effects of both TAVR and SAVR.

Funding Acknowledgement
Type of funding sources: None. Table 1Figure 1
Association of markers of vascular inflammation with blood pressure in midlife: the Hordaland Health Study
Authors: Kringeland E A , Tell G S , Ulvik A , Midtbo H , Igland J , Haugsgjerd T R , Ueland P M , Gerdts E 
Published: October 2021

Abstract

Background
Hypertension is a pro-inflammatory condition. A steeper rise in blood pressure (BP) has been observed in middle-aged women than men. However, sex-specific associations of vascular inflammation with midlife BP has not been much explored.

Purpose
To test the association of markers of vascular inflammation, including neopterin, kynurenin:tryptophan ratio (KTR) and high sensitive C-reactive protein (CRP) with BP.

Methods
Circulating levels of neopterin, KTR and CRP were measured in 2042 women and 1646 men aged 47–49 years from the community-based Hordaland Health study. The associations with systolic and diastolic BP were tested in sex-specific linear regression analyses and adjusted for body mass index, serum total- and high-density lipoprotein cholesterol, triglycerides, creatinine, physical activity, daily smoking and diabetes.

Results
Compared to men, women had lower average BP (124/72 vs. 131/78 mmHg, p&lt;0.001), higher plasma neopterin (7.5 vs 7.0 nmol/l, p&lt;0.001) and comparable plasma KTR and serum CRP (both p&gt;0.05). In multivariable analyses 1) higher neopterin was associated with higher diastolic BP in women, but not in men; 2) higher CRP was associated with higher systolic and diastolic BP in women, but not in men; 3) no association of higher KTR with BP was found in either sex (Table 1). A significant sex-interaction between neopterin and diastolic BP was found.

Conclusion
Among participants in the Hordaland Health study, higher circulating levels of neopterin and CRP with higher BP was found among women only, suggesting that vascular inflammation contributes to BP elevation in middle-aged women.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): University of Bergen
Cardiovascular protection by combination of the selective nonsteroidal MR antagonist finerenone and the SGLT2 inhibitor empagliflozin in a preclinical model of hypertension-induced end-organ damage
Authors: Kolkhof P , Hartmann E , Freyberger A , Pavkovic M , Mathar I , Sandner P , Droebner K , Joseph A , Eitner F , Hueser J 
Published: October 2021

Abstract

Background
The nonsteroidal mineralocorticoid receptor (MR) antagonist finerenone and SGLT2 inhibitors have demonstrated clinical benefits in HFrEF and CKD patients with T2D. Cardiovascular protection with finerenone and the SGLT2 inhibitor empagliflozin in combination in hypertensive cardiorenal disease is unknown.

Purpose
To test the hypothesis that the combination of finerenone with empagliflozin provides cardiovascular protection in preclinical hypertension-induced end-organ damage.

Methods
Cardiovascular morbidity and mortality was studied in hypertensive L-NAME (20 mg/L) treated renin-transgenic (mRen2)27 rats. Rats (10–11 weeks old female, n=13–17/group) were treated once daily orally for up to 7 weeks with placebo, finerenone (1 and 3 mg/kg), empagliflozin (3 and 10 mg/kg), or a combination of the respective low doses. Blood pressure (week 1, 3 and 5), urinary (week 2 and 6) and plasma parameters (week 6 and at the end of the study) were determined during the course of the study, while cardiac histology and left ventricular gene expression analysis were performed after study end.

Results
Empagliflozin induced a strong and dose-dependent increase in urinary glucose excretion which was not influenced by finerenone co-administration in the combination arm. Treatment with 3 mg/kg finerenone and the low dose combination significantly decreased systolic blood pressure (SBP) after 3 and 5 weeks as well as plasma uric acid after 6 weeks. SBP was significantly more reduced in the combination arm vs. the individual monotherapies after 3 weeks. Plasma NT-proBNP was reduced by empagliflozin, finerenone and the combination with similar efficacy. There was a dose-dependent protection from cardiac vasculopathy, cardiac and vascular fibrosis with both agents while low dose combination therapy was more efficient than the respective monotherapy dosages on these cardiac histology parameters. Placebo-treated rats demonstrated a ca. 50% survival rate over the course of 7 weeks while low dose combination provided the most prominent survival benefit (93%).

Conclusion
Non-steroidal MR antagonism by finerenone and SGLT2 inhibition by empagliflozin confer cardiovascular protection in preclinical hypertensive-induced cardiorenal disease. Combination of these two modes of action at low dosages revealed efficacious reduction in blood pressure, cardiac lesions and mortality indicating a strong potential for combined clinical use in cardiorenal patient populations.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): BAYER AG
Echocardiography indices in urbanized representatives of the Shor ethnic group with the presence of arterial hypertension
Authors: Sumin A , Gomozova N S , Shcheglova A V , Arhipov O G 
Published: October 2021

Abstract

In patients with arterial hypertension, the detection of left ventricular hypertrophy has important clinical and prognostic significance. The use of published regulatory “control limits” remains limited and cannot be extended to other racial and ethnic groups. The aim of this study was to compare echocardiography indicators in patients with arterial hypertension from two ethnic groups living in the Gornaya Shoria region.

Methods
The study included patients with arterial hypertension: 58 indigenous and 50 non-indigenous urbanized residents, comparable in age, and divided by ethnicity and gender into 4 groups: men of indigenous nationality (n=20), women of indigenous nationality (n=38), men of non-indigenous nationality (n=15) and women of non-indigenous nationality (n=35). All of them underwent echocardiographic examination.

Results
The body weight and BSA were lower in men and women of Shor ethnicity than in men and women of non-indigenous ethnicity (p=0.0014 and p=0.004). LAi was significantly larger in men of Shor nationality (p=0.049), at the same time, the size of their RA was the smallest (p=0.04). The data of the longitudinal LV systolic function in the form of a systolic excursion of the septum (s'sept) were the highest in Shor men (p=0.004), and the LV performance index was the lowest in them (p=0.012). Also in this group, the minimum isovolumic relaxation time (p=0.03) and the highest rate of early diastolic filling of the LV (p=0.04) were noted. When assessing correlations independent factors associated with pronounced LVH were glucose, DBP, and urea in Shor patients. Non-indigenous nationality independent factors associated with pronounced LVH were waist circumference and DBP.

Conclusion
Echocardiographic examination of patients with hypertension revealed the features of structural and functional indicators in the representatives of the indigenous urbanized population of the Mountain Shoria in comparison with the representatives of the non-indigenous population. This study can be useful in assessing the impact of the development of arterial hypertension, as well as the impact of changing the lifestyle of the Shors when moving to the city from rural areas on ethnic differences in echocardiography.

Funding Acknowledgement
Type of funding sources: None.
Blood pressure changes during the the COVID-19 pandemic and associated lockdown period
Authors: Girerd N , Meune C , Duarte K , Vercamer V , Lopez-Sublet M , Mourad J J 
Published: October 2021

Abstract

Background
Despite widespread investigation into the incidence of acute myocardial infarction during the COVID-19 pandemic and associated lockdown, no study has examined the situation's impact on blood pressure (BP) levels.

Methods
Measurements of BP and heart rate (HR) were obtained from persons living in the Paris urban area using connected home BP monitors (accessible to patients and health providers through a secured server). Three time periods of e-Health recordings were compared: during the pandemic prior to the lockdown, during the lockdown and the same time period in 2019.

Results
A total of 297,089 BP recordings from 2,273 participants (age 56.3±12.8 years, 81.1% male) were made. During confinement, systolic BP gradually decreased by 3 mmHg (−2.4 to −3.9), and diastolic BP, by 1.5 mmHg (−1.4 to −2.2) (all p&lt;0.001); this decrease was greater for participants with higher BP (p&lt;0.0001 each). No significant variation in HR was noted.

Conclusion
Among a very large cohort, we observed a significant decrease in home BP measured with e-Health devices during the first lockdown period. This study emphasizes the research potential of e-Health during the Covid crisis.

Funding Acknowledgement
Type of funding sources: None. Changes in BP during the French Lockdown
Influences of smoking on central blood pressure in hypertensive subjects
Authors: Hayashi K , Takase H , Nakano S , Ohno K , Takayama S , Machii M , Sugiura T , Ohte N , Dohi Y 
Published: October 2021

Abstract

Background/Introduction
Smoking is known to induce systemic vascular damage, leading to cardiovascular diseases. Recent studies demonstrated that central blood pressure has a greater impact on cardiovascular events than brachial blood pressure.

Purpose
We investigated influences of habitual smoking on central systolic blood pressure (CSBP) in hypertensive subjects.

Methods
A total of 5630 subjects (male = 2622, 51.7±12.0 year-old at baseline), who visited our hospital for a physical check-up at least twice during the last 10 years and underwent CSBP measurement at each visit, were enrolled, and they were divided into three groups; normotensive (n=4634), non-treated hypertensive (n=91) and treated hypertensive subjects (n=905). Then, the influences of smoking on the average and yearly changes of CSBP (median follow-up 5 years) were analyzed. Brachial blood pressure (oscillometer) and radial artery pressure waveforms (tonometer) were recorded using an automated device, and the pressure corresponding to the second systolic peak of radial pressure waveforms was taken as CSBP (HEM-9000AI, Omron Healthcare, Kyoto). Hypertension was defined as brachial BP ≥140/90mmHg or the use of antihypertensive medications. A yearly change in CSBP was calculated in each subject by linear regression analysis using longitudinal data.

Results
The average CSBP was higher in habitual smokers than in non-smokers when analyzed in normotensive (109.1±11.7 vs. 107.6±12.8 mmHg, p&lt;0.001) and non-treated hypertensive subjects (150.7±14.8 vs. 142.8±16.7 mmHg, p&lt;0.05), whereas in hypertensive subjects under medication the average CSBP was lower in smokers than in non-smokers (124.6±12.4 vs. 127.8±13.6 mmHg, p&lt;0.01). Smoking status did not affect yearly changes of CSBP in normotensive (habitual smokers vs. non-smokers; 1.38±6.00 vs. 1.44±6.04 mmHg/year), treated hypertensive (−0.16±7.08 vs. −0.66±8.24 mmHg/year), and non-treated hypertensive subjects (4.09±15.1 vs. −0.53±10.3 mmHg/year).

Conclusions
Habitual smoking increases CSBP, however, antihypertensive medications counteract the unfavorable effects of smoking on CSBP. These results imply a new pathway underlying the development of cardiovascular diseases in smokers. Unfavorable changes in the cardiovascular system caused by smoking may quite slowly progress that short period of observation in the present study could not have detected enhanced yearly increases of CSBP by smoking.

Funding Acknowledgement
Type of funding sources: None.
Cardio-ankle vascular index is useful screening method to detect obstructive coronary artery disease in asymptomatic diabetes patients with subclinical atherosclerosis
Authors: Ono T , Miyoshi T , Ueki Y , Kuroda K , Saito E , Tsuji M , Kawamura K , Tokioka K , Ohe T , Kawai Y 
Published: October 2021

Abstract

Background
Patients with diabetes mellitus are at very high risk for obstructive coronary artery disease; however, invasive coronary angiography is not allowed to apply in all patients. Cardio-ankle vascular index (CAVI), a marker of arterial stiffness has been reported to reflect atherosclerotic burden.

Purpose
To assess the diagnostic performance of CAVI vs. coronary calcium score for detecting obstructive coronary artery disease determined by Coronary CT angiography (CCTA) in asymptomatic diabetes patients.

Methods
During May 2015 to December 2019, 816 patients with diabetes mellitus were evaluated. First, intima-media thickness of carotid artery was measured in all subjects. Then, patients with intima-media thickness over 11mm underwent CAVI. Finally, 209 patients who have one or more cardiovascular risk factors other than diabetes mellitus were enrolled (68±11 years, 68% men). Patients were excluded if they had a disorder of the kidney, a prior history of coronary artery revascularization, atrial fibrillation, LV ejection fraction &lt;50%, ABI &lt;0.9 or allergy to contrast. Diagnostic performance of CAVI was evaluated with coronary stenosis &gt;50% by CCTA.

Results
CAVI, Agatston score, and intima-media thickness of carotid artery were 9.2±1.3, 396±621 and 2.0±0.7mm, respectively. CAVI was significantly correlated with age (r=0.530, p&lt;0.001), coronary artery calcification (r=0.182, p=0.008), and intima-media thickness of carotid artery (r=0.195, p=0.005). Among them, 108 patients (48%) had coronary stenosis. CAVI, Agatston score and intima-media thickness of carotid artery in patients with coronary stenosis were higher than that without coronary stenosis, respectively (9.8±1.1 vs 8.5±1.0, p&lt;0.001, 526±676 vs. 255±525, p=0.001, 2.2±0.7 vs. 1.8±0.6, p&lt;0.001). The ROC curve analysis of CAVI for discriminating coronary stenosis showed that the sensitivity 75.0% and specificity 77.2% at the cut off value of 9.23 (AUC=0.812, p&lt;0.001). Contrastingly, diagnostic performance of coronary calcium score and intima-media thickness of carotid artery were less than CAVI (sensitivity: 91.7%, specificity: 56.4%, AUC=0.753, p&lt;0.05 vs. CAVI, sensitivity: 68.5%, specificity: 59.4%, AUC=0.663, p&lt;0.05 vs. CAVI). Multivariate logistic analysis demonstrated that CAVI was significantly associated with coronary stenosis (OR=4.133, p&lt;0.001) after adjustment of conventional risk factors, although coronary calcium score was not correlated with coronary stenosis.

Conclusion
CAVI could be informative to select patients having obstructive coronary artery disease in asymptomatic diabetes patients with thick intima-media thickness.

Funding Acknowledgement
Type of funding sources: None.