bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic value of secondary cardiac alterations in patients with moderate aortic valve stenosis
Authors: Stoebe S , Kandels J , Metze M , Lenk K , Kuehne C , Lavall D , Laufs U , Hagendorff A 
Published: October 2021

Abstract

Purpose
Echocardiographic characteristics that predict the progression of moderate aortic valve stenosis (mAS) are lacking. The aim of the present study was to evaluate the prognostic value of left ventricular hypertrophy (LVH), diastolic dysfunction (DD) and pulmonary artery hypertension (PAH) in patients with mAS.

Methods
A total of 137 patients with asymptomatic mAS (age 72±10 years; females: 51 (37%); Blood Pressure: 143±21 / 78±13 mmHg) were included. Echocardiography was performed at baseline and at follow-up every six or/and twelve months. Patients with concomitant valvular defects, hypertrophic cardiomyopathy or chronic obstructive pulmonary disease were excluded. mAS was defined by current guideline criteria. Left ventricular ejection fraction (LVEF), LVH (LV mass index, males: &gt;115g/m2, females: &gt;95 g/m2), DD (E/e' &gt;14) and PAH (maximum regurgitant velocity of tricuspid valve (TRVmax) &gt;2.8m/s) were assessed.
mAS patients were divided into 4 subgroups based on the number of secondary cardiac alterations: (0) no; (1) one; (2) two; (3) three cardiac alterations. The primary endpoint was progression to severe AS with indication for treatment (effective aortic orifice area (EOA) by continuity equation &lt;1 cm2/&lt;0.6 cm2/m2) or the onset of symptoms.

Results
mAS patients showed (0) no secondary cardiac alterations in 20% (n=28), (1) one in 40% (n=55), (2) two in 26% (n=35) and (3) three in 14% (n=19). Among mAS subgroups, no significant differences were observed for age and comorbidities. Echocardiographic parameters are summarised in Tab.1. In general, mAS patients with ≥ two cardiac alterations showed significantly smaller EOA ((0): 1.32±0.19 vs. 1.29±0.19, p&gt;0.05; (1): 1.26±0.21 vs. 1.18±0.21, p&gt;0.05; (2): 1.29±0.20 vs. 1.01±0.20, p&lt;0.01; (3): 1.31±0.16 vs. 1.06±0.25, p&lt;0.01) and higher mean pressure gradients (PGmean) ((0): 19.8±6.64 vs. 21.8±6.32, p&gt;0.05; (1): 20.0±9.26 vs. 22.3±9.94, p&gt;0.05; (2): 22.7±9.32 vs. 30.5±12.61, p&lt;0.01 (3): 25.0±8.87 vs. 29.4±10.67, p&lt;0.01) between baseline and follow-up (mean follow-up 20±9 months). Further, decrease of EOA/days was significantly higher in these patients ((0) −0.003; (1) −0.006; (2) −0.016; (3) −0.028; p&lt;0.01, Fig. 1). As shown in Kaplan-Meier curve, mAS with ≥ two cardiac alterations showed rapid progression of moderate to severe AS (Fig. 2).

Conclusions
In 40% of patients with mAS ≥ two secondary cardiac alterations (LV hypertrophy, DD and PAH) were observed. The presence of ≥ two of these secondary cardiac alterations is associated with rapid progression of mAS.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Percutaneous bioprosthetic aortic valve durability: results a single center after ten years of follow-up ago
Authors: Munoz-Garcia M , Munoz-Garcia E , Munoz Garcia A J , Dominguez-Franco A J , Alonso-Briales J H , Jimenez-Navarro M F , Hernandez-Garcia J M , Gomez-Doblas J J 
Published: October 2021

Abstract

The durability of transcatheter heart valves and long-term clinical outcomes are unknown. The aim of this study was to evaluate clinical and hemodynamic outcomes 10 years after Transcatheter Aortic Valve Implantation (TAVI).

Methods
Between April 2008 and December 2011, 230 patients underwent TAVI for the treatment of severe symptomatic aortic stenosis with the auto-expandable prosthesis.

Results
The mean age, logistic EuroSCORE and STS score were 79.3±6.4 years, 19.8±13% and 6.8±5% respectively. Mean aortic valve gradient decreased from 49.8±15 mm Hg to 8.6±3.8 mmHg after TAVI, to 11.1±9 mm Hg at 5 years, and 25.7±12 mmHg at 7 years (p for post-TAVI trend 0.03). Mean aortic valve area increased from 0.63±0.16 cm2 to 1.57±0.3cm2 after TAVI to 1.48±0.2 at 5 years and 0.87±0.3 cm2 at 7 years (p for post-TAVI trend 0.01). Mean left ventricular ejection fraction increased from 61.1±15% to 65.5±11% after TAVI, to 58.2±17% at 5 years and 57.2±8% at 7 years (p for post-TAVI trend 0.001).
The total mortality after a mean of 53±34 months was 73% and 34.4% was cardiovascular mortality. Survival rates at 1 to 10 years were at 86%, 75.4%, 64.9%, 59.6%, 52.6%, 33.1%, 24.9%, 20.7%, 10.4% and 10.4% respectively. Only 4 patients had severe prosthetic valve dysfunction (severe stenosis and moderate-severe transvalvular regurgitation). Median survival time after TAVI was 6 years (95% confidence interval [CI]: 5.89 to 6.28), and the risk of death was significantly increased in patients with frailty (adjusted hazard ratio [HR]: 1.874; 95% CI: 1.028 to 3.418), p=0.040, Charlson index [HR=1.212 (95% CI: 1.094–1.341), p&lt;0.001], and age [HR=1.03; (95% CI: 1.001–1.062), p=0.049].

Conclusions
In our center, the transcatheter aortic valve implantation in patients at high surgical risk, presented favourable clinical outcomes and hemodynamic performance after ten years of follow-up.

Funding Acknowledgement
Type of funding sources: None.
Heart rate variability in patients with tetralogy of Fallot
Authors: Otero Luna A V , Church S , Loza A , Rueda-Ochoa O L , Rey Coy M A , Gonzalez Marin C H , Beach C 
Published: October 2021

Abstract

Background
Heart rate variability (HRV) can be used to evaluate cardiac autonomic nervous system activity. In the adult population decreased HRV has been associated with increased mortality in patients with cardiac disease, however, application of HRV in patients with congenital heart disease is not well established.

Purpose
To describe and compare HRV parameters obtained by clinical Holter monitoring in patients with Tetralogy of Fallot (TOF) and healthy controls and to evaluate its association with different clinical outcomes.

Methods
Data from 489 patients were obtained; 150 had undergone repair of TOF and 339 were healthy controls. Using propensity score matching (PSM), 149 TOF patients were matched for sex, age at Holter,body mass index, use of beta-blockers, and ectopic beats with 149 healthy patients. Minimum, maximum, average heart rate and time domain HRV parameters (ASDNN5, SDANN5, SDNN, RMSSD, PNN50) and clinical outcomes (arrhythmias, hospital admission for cardiac disease, and functional class) were compared between groups using simple and multiple linear regression models as well as logistic regression analysis.

Results
No significantdifference was found in time domain HRV parameters between the two groups, though average (−7.0253, p=0.000) and maximum (−15.8585, p=0.000) heart rate values were significantly lower in patients with TOF compare with controls. Logistic regression analysis showed an association between maximum heart rate values and the development of arrhythmias (OR=0.9817, p=0.013), as well as the functional class (OR=0.9706, p=0.03).

Conclusion
Average and maximum heart rates are significantly lower in patients with repaired TOF compared to the control population. Time domain HRV parameters were not associated with clinical outcomes in patients with TOF when compared to healthy controls. Further investigation assessing frequency domain parameters may provide further insight.

Funding Acknowledgement
Type of funding sources: None.
Normal values for paediatric biventricular volumes, ejection fraction and mass – influence of cardiovascular magnetic resonance analysis techniques
Authors: Hinz S , Caliebe A , Wage R , Boroni Grazioli S , Uebing A , Voges I , Krupickova S 
Published: October 2021

Abstract

Background
Measurement of ventricular volumes and function by steady-state free precession (SSFP) cardiovascular magnetic resonance (CMR) is an important diagnostic tool in the treatment and follow-up of paediatric congenital heart disease. However, normal values are rare and the CMR analysis methods are inconsistent.

Aims
We sought to create two sets of ventricular normal values for different CMR analysis (contouring) methods.

Methods
In a retrospective study design, CMR data sets of 154 healthy children with an age range between 4 and 18 years from two centers in the UK and Germany were evaluated. Left and right ventricular end-diastolic and end-systolic volumes (LVEDV, LVESV, RVEDV, RVESV), ejection fraction (RVEF, LVEF) and myocardial mass (LVMM, RVMM) were analysed from short axis steady-state free precession images by using two different analysis techniques: 1) papillary muscles, myocardial trabeculations and the moderator band were included in the ventricular volume and excluded from the ventricular mass (Figure 1), 2) papillary muscles, myocardial trabeculations and the moderator band were excluded from the ventricular volume and included in the ventricular mass (Figure 2). Sex-specific reference curves were created separately for both ventricular contouring methods using the lambda mu sigma method. Correlations between variables were analyzed with the Spearman's rank correlation. Contouring methods were compared through Bland-Altman analysis.

Results
The mean age was 13.85±2.8 years (53 girls).
In children from 4 to 10 years average ventricular volumes and mass normalized for body surface area (BSA) measured:
In children from 11 to 18 years average ventricular volumes and mass measured:
Separate centile charts and centile tables for boys and girls for all cardiac parameters were created.

Conclusion
We provide paediatric CMR reference values for biventricular volumes, ejection and masses for two different CMR contouring methods. They can be used in the diagnosis and follow-up of congenital or acquired heart disease in children and for research purposes.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Transcatheter versus surgical valve repair in patients with severe mitral regurgitation
Authors: Koschutnik M , Dannenberg V , Dona C , Nitsche C , Kammerlander A A , Mora B , Bartunek A , Wiedemann D , Zimpfer D , Huelsmann M , Schneider M , Bartko P E , Goliasch G , Hengstenberg C , Mascherbauer J 
Published: October 2021

Abstract

Background
Transcatheter edge-to-edge mitral valve repair (TMVR) is increasingly performed, however, its efficacy in comparison with surgical MV treatment (SMV) is unknown.

Methods
Consecutive patients with severe mitral regurgitation (MR) undergoing TMVR (68% functional, 32% degenerative) or SMV (9% functional, 91% degenerative; 23% MV replacement) were enrolled. To account for differences in baseline characteristics, propensity score-matching including age, EuroSCORE-II, left ventricular ejection fraction, and NT-proBNP was performed. A composite of heart failure (HF) hospitalization/death was defined as primary endpoint. Kaplan-Meier curves and Cox-regression analyses were used to investigate associations between baseline, imaging, and procedural parameters and outcome.

Results
Between July 2017 and April 2020, 245 patients were enrolled, of which 102 patients could be adequately matched (73y/o, 61% females, EuroSCORE-II: 5.7%, p&gt;0.05 for all). Despite matching, TMVR patients were sicker at baseline (higher rates of prior myocardial infarction, coronary revascularization, pacemakers/defibrillators, and diabetes mellitus, p&lt;0.009 for all).
Patients were followed for 28.3±27.2 months, during which 27 events (17 deaths, 10 HF hospitalizations) occurred.Postprocedural MR reduction (MR grade &lt;2: TMVR vs. SMV: 88% vs. 94%, p=0.487) and freedom from HF hospitalization/death (log-rank: p=0.221) were similar at two years. By multivariable Cox analyses, EuroSCORE-II (adj.HR 1.07 [95% CI: 1.00–1.13], p=0.027) and postprocedural MR severity (adj.HR 1.85 [95% CI: 1.17–2.92], p=0.009) emerged as independent predictors of outcome.

Conclusions
In this propensity matched, all-comers cohort, 2-year outcomes after TMVR versus SMV were similar. Given the reported favorable long-term durability of TMVR, the interventional approach emerges as valuable alternative for a substantial number of patients with functional and degenerative MR at high/prohibitive surgical risk.

Funding Acknowledgement
Type of funding sources: None.
The impact of valve selection on haemodynamics in patients with small annuli undergoing contemporary transcatheter aortic valve implantation
Authors: Medranda G , Rogers T , Zhang C , Case B C , Yerasi C , Forrestal B J , Chezar-Azzerad C , Bendor I , Satler L F , Waksman R 
Published: October 2021

Abstract

Background/Introduction
The use of smaller THVs in transcatheter aortic valve implantation (TAVI) can result in suboptimal haemodynamics with long-term implications on valve durability in patients with smaller aortic annuli.

Purpose
The objective of this study was to examine the predictive value of aortic annulus size on THV haemodynamics in patients with small annuli undergoing contemporary TAVI.

Methods
This was a retrospective, observational study of 857 patients who underwent TAVR using either the intra-annular SAPIEN 3 THV or the supra-annular CoreValve Evolut PRO THV at our institution between 2015–2020. Patients were dichotomized based on a native aortic annulus size above or below 430mm2. We then examined 30-day hemodynamics and outcomes in each subgroup and based on THV selection.

Results
The majority of patients with an annular area &lt;430mm2 were females (82.5%). Of the 857 patients screened, 542 had an annular area &gt;430mm2 and the remaining 315 had an annular area &lt;430mm2. In patients with small aortic annuli, mean gradients were lower at 30 days if they received a supra-annular THV (8.1mmHg vs. 13.8mmHg; p&lt;0.001) which led to lower rates of moderate or severe patient prosthesis mismatch (36.7% vs. 85.4%; p&lt;0.001) (Table 1). All-cause mortality was similar in small annuli between THV groups at 1 year (Table 2).

Conclusions
The majority of patients with small aortic annuli (&lt;430mm2) undergoing TAVI with contemporary THVs were females. Those that received a supra-annular THV saw superior haemodynamics at 30-days with similar mortality at 1 year.

Funding Acknowledgement
Type of funding sources: None.
Factors determining mitral valve dysfunction in patients who underwent surgical mitral valve replacement with bio-prosthetic valves
Authors: Gwak S Y , Kim D Y , Seo J W , Cho I S , Lee S H , Lee S , Hong G R , Ha J W , Shim C Y 
Published: October 2021

Abstract

Background
There is increasing Interest in bio-prosthetic MVD as recent advances in transcatheter MV interventions, but there is limited data.

Objectives
The aim of this study was to identify the factors determining mitral valve (MV) dysfunction (MVD) in patients who underwent MV replacement with bio-prosthetic valves. Also, we sought to investigate clinical outcomes in patients with bio-prosthetic MVD.

Methods
A total of 233 patients underwent surgical bio-prosthetic MV replacement between June 1996 and May 2015. Finally, 226 patients (mean age 66.9±11.5 years, 74.3% of women) were analyzed, excluding patients who followed-up for less than 5 years and patients whose baseline or follow-up echocardiography could not be analyzed. Clinical, echocardiographic, and laboratory data were collected early after the surgery and during follow-up. MVD was defined as an increase in mean gradient ≥5 mmHg with leaflet motion limitation and/or newly developed MV regurgitation during follow-up. Clinical outcome was defined as a composite of cardiovascular death, redo MV surgery or intervention, and hospitalization for heart failure.

Results
During a median of 102.0 months (interquartile range 72.0 to 132.0 months), 65 patients (28.8%) revealed MVD. 8 (12.3%) patients revealed predominant MV obstruction, and 57 (87.7%) showed predominant MV regurgitation. Factors associated with bio-prosthetic MVD by multivariate regression analysis were young age at operation (hazard ratio 0.97, 95% CI 0.95–0.99, p=0.001), end-stage renal disease (hazard ratio 4.29, 95% CI 1.45–12.71, p=0.007), elevated mean diastolic pressure gradient&gt;5.5 mmHg across the bio-prosthetic MV early after operation (hazard ratio 1.86, 95% CI 0.97–3.74, p=0.063) and anemia after operation (hazard ratio 0.84, 95% CI 0.74–0.95, p=0.007). However, the presence of hypertension, dyslipidemia, or porcine bio-prosthesis was not related to the bio-prosthetic MVD. Kaplan-Meier curves revealed significant differences in event-free survivals for the occurrence of bio-prosthetic MVD according to each factor (Figure 1). Patients with bio-prosthetic MVD showed significantly poor clinical outcomes compared with those without bio-prosthetic MVD (event-free survival 43.1% vs. 91.9%, log-rank p&lt;0.001) during the follow-up.

Conclusions
Young age at operation, end-stage renal disease, elevated mean pressure gradient early after the operation, and anemia after operation were associated with bio-prosthetic MVD in patients who underwent bio-prosthetic MV replacement.

Funding Acknowledgement
Type of funding sources: None.
Effect of antimicrobial therapy on the embolic events in patients with infective endocarditis
Authors: Povalyaev N , Kotova E , Pisaryuk A , Karaulova Y , Kobalava Z 
Published: October 2021

Abstract

Background
Embolic events (EE) are presented in up to 50% of the cases of infective endocarditis (IE). Main approach in prevention of the embolisms is properly timed surgery and antimicrobial therapy. But specific antimicrobial drug to prevent embolic events is not yet established.

Purpose
To analyze effect of a distinct group of an antimicrobials on association with embolic events in patients with IE.

Methods
255 patients with verified IE (DUKE 2009, 2015), hospitalized and treated from January 2010 to January 2020, were included in the study. Patients underwent clinical investigation including physical examination, laboratory and instrumental studies.

Results
About one quarter (27.5%) of the patients had an embolic event after initiation of antimicrobial therapy. Embolism localizations include: brain (30%), lungs (47%), kidneys (20%), spleen (14%), coronary (8%) and peripheral arteries (5.7%). Most common causative agent was Staphylococcus aureus (25.5%). There were no clinical association between a certain group of antimicrobials and embolic outcome (table). However, effectiveness of the first-line antimicrobial, eradication of pathogen and abscence of infection persistence was associated with lower rate of embolism

Conclusion
In correspondence to guidelines adequate antimicrobial therapy (eradication of a pathogen and abscence of infection persistence) is associated with lower thromboembolic risk regardless of certain group of antimicrobials.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): RUDN University Strategic Academic Leadership Program.
Natural history of left ventricular hypertrophy in infants of diabetic mothers
Authors: Monda E , Verrillo F , Altobelli I , Lioncino M , Caiazza M , Rubino M , Cirillo A , Fusco A , Di Fraia F , Pacileo R , Gragnano F , Passariello A , Calabro' P , Russo M G , Limongelli G 
Published: October 2021

Abstract

Background
Left ventricular hypertrophy (LVH) in infants of diabetic mothers (IDMs) has been generally considered a benign condition, which usually regresses as the stimulus for the insulin production disappears, resulting in normalized left ventricular wall thickness in the 6 months of life. However, these conclusions have been based on small, mostly outdated cohort studies. Indeed, it has been recently shown that increased left ventricular mass persists in late infancy (6 to 12 months), long after the intrauterine exposure has been removed, suggesting that other factors may potentially contribute.

Purpose
This study sought to describe the characteristics and the natural course of LVH in a well-characterized consecutive cohort of IDMs.

Methods
Sixty consecutive IDMs with LVH have been retrospectively identified and enrolled in the study. All IDMs were evaluated at baseline and every 6 months until LV wall thickness regression, defined as the decrease of wall thickness measurement into the normal reference range for cardiac parameters (z-score &gt;−2 and &lt;2). A comprehensive assessment was performed in those patients with diagnostic markers suggestive of a different cause and/or without significant reduction of the LVH during follow-up.

Results
At 1-year follow-up, all IDMs showed a significant reduction of maximal wall thickness (MWT) (MWT-mm: 6.67±2.37 vs. 5.83±1.70, p-value&lt;0.001; MWT-z-score: 6.67±4.71 vs. 2.39±2.55, p-value&lt;0.001) and left ventricular outflow tract (LVOT) gradient (15.35±15.58 vs. 11.22±8.14, p-value&lt;0.004), compared to baseline, and all patients showed LV wall thickness regression or residual mild or moderate LVH (57%, 28%, and 12%, respectively) (Figure 1), except 2 patients with persistent severe LVH, that after a comprehensive clinical-genetic assessment were diagnosed as Noonan syndrome with multiple lentigines.
At multivariate analysis, MWT was significantly associated with LV wall thickness regression at 1-year follow-up (MWT-mm: OR 0.48 [0.29–0.79], p-value=0.004; MWT-z-score: OR 0.71 [0.56–0.90], p-value=0.004) in an inversely proportional fashion.
Overall, 59%, 72% and 79% of IDMs with LVH showed a complete LV wall thickness regression at 1-year, 2-year and 3-year follow-up, respectively (Figure 2). Excluding the two patients with a different cause of LVH, all IDMs showed a LV wall thickness regression in the first 6 years of life.

Conclusions
LVH in IDMs represents a benign condition with complete regression during the first years of life. In those patients without LV wall thickness regression, combined with clinical markers suggesting a specific disease, a complete work-up is required for a definite diagnosis.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2