bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left ventricular unloading before percutaneous coronary intervention is associated with improved survival in patients with acute myocardial infarction complicated by cardiogenic shock
Authors: Miyashita S , Marbach J , Banlengchit R , Kapur N 
Published: October 2021

Abstract

Background
Left ventricular unloading with Impella before percutaneous coronary intervention (PCI) may improve survival outcomes in patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS). However, the optimal timing to initiate Impella remains controversial.

Purpose
We conducted a systematic review and meta-analysis to compare survival outcomes of patients supported with Impella before PCI (pre-PCI) with those supporte after (post-PCI).

Methods
This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guidelines. Multiple databases were searched through March 2021. All studies evaluating the impact of pre-PCI versus post-PCI Impella placement in patients with AMI-CS were included. A composite primary endpoint included in-hospital, 30-day, and 6-month survival rates.

Results
We identified five observational studies comparing outcomes in 432 patients with AMI-CS, including 173 patients treated with Impella pre-PCI and 259 patients post-PCI. In the pooled analysis, patients in the pre-PCI group had significantly lower in-hospital mortality compared to patients in the post-PCI group (RR 0.62, 95% CI: 0.50–0.76, I2=0%). Reduced mortality rate in the pre-PCI group persisted through 30-days (HR 0.61, 95% CI: 0.47–0.80, I2=0%) and at 6-months (HR 0.67, 95% CI: 0.45–0.99, I2=0%). There was no difference in the risk of adverse events including re-infarction, stroke, major bleeding, acute ischemic limb, access site bleeding, and hemolysis.

Conclusion
In a meta-analysis of studies evaluating mortality among AMI-CS patients treated with primary versus bailout left ventricular support, Impella placement prior to PCI was associated with improved survival.

Funding Acknowledgement
Type of funding sources: None. Forest plot for mortality
Prevalence and prognostic implications of moderate or severe mitral regurgitation in patients with bicuspid aortic valve
Authors: Butcher S C , Prevedello F , Kong W K F , Ng A C T , Poh K K , Shanks M , Popescu B A , Fijalkowski M , Selvanayagam J B , Pinto F , Zamorano J L , Pibarot P , Evangelista A , Bax J J , Delgado V ,   The BAV international registry
Published: October 2021

Abstract

Background
Significant (≥ moderate) mitral regurgitation (MR) could augment the hemodynamic effects of aortic valvular disease in patients with bicuspid aortic valve (BAV), imposing a greater hemodynamic burden on left ventricle and atrium, possibly culminating in a faster onset of left ventricular (LV) dilation and/or symptoms.

Purpose
To determine the prevalence and prognostic implications of significant MR in patients with BAV.

Methods
In this large, multicenter, international registry, a total of 2,932 patients (48±18 years, 71% male) with BAV were identified. All patients were evaluated for the presence of significant primary or secondary MR by transthoracic echocardiography and were followed-up for the endpoint of all-cause mortality and a combined endpoint of all-cause mortality or aortic valve surgery.

Results
Overall, 147 patients (5.0%) had significant primary (1.5%) or secondary (3.5%) MR. Significant MR was associated with all-cause mortality (HR 2.80, 95% CI 1.91 to 4.11, p&lt;0.001, Figure A) and reduced event-free survival (HR 1.97, 95% CI 1.58 to 2.46, p&lt;0.001) on univariable analysis. However, MR was not associated with all-cause mortality (HR 1.33, 95% CI 0.85 to 2.07, p=0.21, Figure B) or event-free survival (HR 1.10, 95% CI 0.85 to 1.42, p=0.46) after multivariable adjustment. Subgroup analyses demonstrated an independent association between significant MR and all-cause mortality for individuals with significant aortic regurgitation (HR 2.04, 95% CI 1.03 to 4.05, p=0.042), although this association was not observed for subgroups with significant aortic stenosis or without significant aortic valve dysfunction.

Conclusions
Significant MR is uncommon in patients with BAV. Following adjustment for confounding variables, significant MR was not associated with event-free or overall survival.

Funding Acknowledgement
Type of funding sources: None. Survival curves for all-cause mortality
Sex-differences in left ventricular remodeling and mechanics after aortic valve surgery in patients with severe aortic valve disease
Authors: Singh G K , Vollema E M , Prihadi E A , Regeer M V , Ewe S H , Ng A C T , Mertens B J A , De Weger A , Ajmone-Marsan N , Bax J J , Delgado V 
Published: October 2021

Abstract

Background
Sex-differences in left ventricular (LV) remodeling in patients with aortic valve disease have been reported. However, sex-differences in LV remodeling and mechanics in response to aortic valve replacement (AVR) remained largely unexplored.

Purpose
The present study aimed to evaluate the sex-differences during the time course of LV remodeling and LV mechanics (by LV global longitudinal strain (GLS)) after aortic valve replacement.

Methods
Patients with severe aortic valve disease (aortic stenosis (AS) or aortic regurgitation (AR)) undergoing AVR with echocardiographic follow-up at 1,2, and/or 5 years were evaluated. LV mass index, LV ejection fraction, LV GLS and stroke volume (SV) were measured. Linear mixed models analyses were used to assess changes in LV mass index, LVEF, LV GLS and SV between time points. The models were corrected for age, LV end-diastolic diameter at baseline and time between echocardiograms.

Results
A total of 211 patients (61±14 years, 61% male) with severe aortic valve disease (AS 63% or AR 39%) were included. Before AVR, men had larger LV mass index and higher SV compared to women. Both men and women had a preserved LV ejection fraction (54±12 and 56±9, P=0.102, respectively), but moderately impaired LV GLS (14.6±4.1 and 16.1±4.1, P=0.009, respectively). After AVR, both groups showed LV mass regression, improvement in LV ejection fraction and LV GLS. LV mass index and SV remained higher in men. During follow-up women showed significantly better LV GLS compared to men (P=0.030, figure 1).

Conclusion
In men and women with severe aortic valve disease undergoing AVR, the time course of changes in LV mass regression, LV ejection fraction, LV GLS and SV are similar. During follow-up LV mass index remained larger in men and women showed significantly better LV GLS.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The department of Cardiology received unrestricted research grants from Abbott Vascular, Bayer, Bioventrix, Biotronik, Boston Scientific, Edwards Lifesciences, GE Healthcare and Medtronic. Victoria Delgado received speaker fees from Abbott Vascular, Edwards Lifesciences, GE Healthcare, MSD and Medtronic. Nina Ajmone Marsan received speakers fees from Abbott Vascular and GE healthcare. Jeroen J Bax received speaker fees from Abbott Vascular. The remaining authors have nothing to disclose.
Percutaneous edge-to-edge therapy with PASCAL or MitraClip: a multicenter propensity score matched comparison
Authors: Markovic S , Felbel D F , Kessler M K , Schneider L M S , Gercek G M , Rudolph V R , Hausleiter J H , Rotblauer W R 
Published: October 2021

Abstract

Background
The MitraClip is the worldwide established transcatheter edge-to-edge repair system with over 100,000 treated patients. The recently approved PASCAL repair system is well adopted in the field of percutaneous mitral regurgitation (MR) treatment with growing acceptance both in mitral and tricuspid valves. The aim of this retrospective multicenter study was to compare the Edwards' PASCAL System with the Abbott MitraClip System in terms of procedural results and short-term outcome.

Methods
We retrospectively evaluated patient data of three high volume German centers that performed percutaneous edge to edge procedures either with the MitraClip or the PASCAL repair system. Primary endpoint was the amount of MR reduction. Secondary endpoints were residual MR at discharge, technical success, device success and 30-day mortality.

Results
Between 2018 and 2020 a total of 412 procedures were performed in the three centers. 216 cases were performed with the MitraClip compared to 196 procedures done with the PASCAL repair system. Patients were male in 55.6% of the cases (50.5% in the MitraClip cohort compared to 61.2% in the PASCAL cohort, p=0.028), mean Logistic Euro-Score II was 4.42 (3.58 in the MitraClip and 3.23 in the PASCAL cohort, p=0.038) and reduced LVEF beyond 45% was seen in 42.6% of the cases (49.5% in the MitraClip compared to 35.3% in the PASCAL cohort, p=0.004). Severe MR at baseline was seen in 98.5% in the MitraClip cohort compared to 98.6% in the PASCAL cohort, p=0.909). Mean number of implanted devices was 1.41±0.56 in the MitraClip cohort and 1.37±0.55 in the PASCAL cohort (p=0.401). Procedures were successfully conducted with both edge-to-edge systems (device success rate 93.2% in the MitraClip cohort and 94.0% in the PASCAL cohort, p=0.775), leading to comparably good results (final MR ≤2 in 94.4% with the MitraClip compared to 95.9% with the PASCAL system, p=0.448) and very good results (final MR ≤1 in 72.6% in the MitraClip compared to 79.5% in the PASCAL cohort, p=0.102).
After propensity score matching for adjustment of major differences among the two treatment strategies (including age, gender, MR etiology, EROA, Severe MR (III and IV), reduced LVEF and Mitral Valve orifice area) the achieved mean MR reduction remains comparable (2.29±0.82 with the MitraClip compared to 2.46±0.82 with the PASCAL system, p=0.191). In multivariate regression analysis STS Score independently correlates with a very good final result while device choice did not show a significant impact in this cohort.

Conclusion
In this retrospective multicenter study both the MitraClip and PASCAL system performed excellent with comparable procedural success rates. Achieved final average reduction of MR Grade was 2.29±0.82 with the MitraClip and 2.46±0.82 with the PASCAL system.

Funding Acknowledgement
Type of funding sources: None.
Potential candidates for transcatheter tricuspid valve interventions after transcatheter aortic valve implantation: predictors and prognosis
Authors: Tomii D , Okuno T O , Praz F P , Heg D H , Wild M W , Lanz J L , Stortecky S S , Windecker S W , Pilgrim T P 
Published: October 2021

Abstract

Background
The importance of concomitant tricuspid regurgitation (TR) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) remains unclear.

Objectives
To document the prevalence of concomitant TR before and after TAVI, to correlate TR severity after TAVI with clinical outcome, to quantify suitability for transcatheter tricuspid valve interventions (TTVI), and to report clinical outcome in patients eligible for TTVI.

Methods
In a prospective TAVI registry, the severity of TR at baseline and after TAVI was retrospectively evaluated.

Results
Among 2,008 eligible patients, 1,659 patients (82.6%) had ≤mild TR, 242 (12.1%) had moderate TR, 57 (2.8%) had severe TR, and 50 (2.5%) had massive TR. More than half of all patients with ≥moderate TR had an improvement of TR severity after TAVI. In contrast to baseline TR, &gt;moderate TR after TAVI was associated with an increased risk of mortality (HRadjusted 1.89; 95% CI 1.03–3.46, HRadjusted 2.11; 95% CI 1.07–4.16, respectively) compared with ≤mild TR. After TAVI, 30 out of 101 patients with baseline ≥severe TR (29.7%) were deemed suitable candidates for TTVI. They had a 2-fold increased risk of mortality between 30 days and 1 year (HRadjusted: 1.97; 95% CI: 1.17–3.31) and a higher risk of persistent heart failure symptoms (RRadjusted: 2.75; 95% CI: 1.75–4.31).

Conclusions
Severity of TR improved in more than half of all patients after TAVI. More than moderate TR after TAVI was associated with a twofold increased risk of death at one year. Xx% of patients with relevant TR are anatomically suitable for TTVI.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Clinical applicability of echocardiographic strict negative criteria for suspected infective endocarditis
Authors: Marcos Garces V , Gabaldon-Perez A , Merenciano-Gonzalez H , Soler M , Lorenzo-Hernandez M , Nunez-Marin G , Bonanad C , De La Espriella R , Chorro F J , Bodi V , Santas E 
Published: October 2021

Abstract

Introduction
Infective endocarditis (IE) is an uncommon but potentially lethal disease that requires a timely diagnosis. Echocardiography has a pivotal role in EI diagnosis, but this may lead to an overuse of this technology in clinical daily practice, and it is unclear which patients can benefit from a follow-up study if the initial transthoracic echocardiogram (TTE) shows no signs of IE. The strict negative criteria (good ultrasound quality and no high-risk features such as significant valvular regurgitations or stenosis, pericardial effusion or intracardiac devices) have been recently proposed to avoid unnecessary follow-up echocardiograms.

Purpose
The objective of this study is to review the contemporary, real-world use of echocardiography in patients with suspected IE and analyze the potential applicability of the strict negative criteria.

Methods
We retrieved all the echocardiograms that were performed in our center for suspected or confirmed IE between January 2014 and December 2018. We defined different groups according to the strict negative criteria and reviewed the electronic clinical history to check if a definitive diagnosis of IE was established or not.

Results
We included a total of 905 TTEs. 451 (49.8%) of them fulfilled the strict negativity criteria (Group 1). In this group, IE was seldom diagnosed (n=4, 0.9%). In 338 (37.4%) patients no signs of IE were evident but they didn't fulfill the strict negative criteria (Group 2). A follow-up echocardiogram and definitive diagnosis of IE were more frequent (n=48, 14.2% and n=20, 5.9%). Finally, in 116 (12.8%) patients the initial TEE showed typical or suggestive signs of IE, in whom the diagnosis was confirmed in 48 (41.4%). The independent predictors of follow-up echocardiography were the previous history of valvular heart disease (HR 2.38 [1.39–3.89], p=0.001) or cancer (HR 0.47 [0.27–0.84], p=0.01), positive blood cultures for Enterococcus (HR 5.01 [2.34–10.73], p&lt;0.001), methicillin-sensitive Staphylococcus aureus (HR 2.8 [1.27–6.17], p=0.011) or Streptococcus (HR 2.36 [1.12–5], p=0.024), and the presence of typical or suggestive signs of infective endocarditis on initial TTE (HR 13.77 [8.6–22.05], p&lt;0.001). A definitive diagnosis of IE was confirmed in a minority of the study population (n=72, 8%). Only one readmission for underdiagnosis of IE during index hospitalization was noted on Group 2.

Conclusions
In a real-life, observational setting only a minority of patients in whom IE was suspected had a definite diagnosis. An initial TTE for suspected IE fulfilling the strict negative criteria predicts both a low probability of requesting a follow-up study and of a definitive diagnosis of IE. Further research should be performed to rationalize echocardiogram requests for suspected IE.

Funding Acknowledgement
Type of funding sources: None.
Coronary microvascular dysfunction in hypertrophic cardiomyopathy – impact from tissue characteristics to clinical manifestations
Authors: Aguiar Rosa S , Thomas B , Fiarresga A , Papoila A , Alves M , Pereira R , Branco G , Cruz I , Baquero L , Cruz Ferreira R , Mota Carmo M , Rocha Lopes L 
Published: October 2021

Abstract

Background
Coronary microvascular dysfunction (CMD) is an important pathophysiological feature in hypertrophic cardiomyopathy (HCM).

Purpose
This study investigated the role of CMD in tissue characteristics, left ventricular (LV) systolic performance and clinical manifestations in HCM.

Methods
This prospective study enrolled patients with HCM without obstructive epicardial coronary artery disease. Each patient underwent cardiovascular magnetic resonance (CMR) including parametric mapping, perfusion imaging during regadenoson-induced hyperemia, late gadolinium enhancement (LGE) and three-dimensional longitudinal, circumferential and radial strains analysis. Electrocardiogram and 24 hours Holter recording were performed to assess arrhythmias.

Results
75P were enrolled, 47 (63%) males, mean age 54.6 (14.8) years; 51 patients (68%) had non obstructive HCM, mean maximum wall thickness (MWT) was 20.2 (4.6)mm, LV ejection fraction 71.6 (8.3)%, ischemic burden 22.5 (16.9)% of LV.
Greater MWT was associated the severity of ischemia (β-estimate: 1.809, 95% CI: 1.073; 2.545; p&lt;0.001).
Ischemic burden was strongly associated with higher values of native T1 (β-estimate: 9.018, 95% CI: 4.721, 13.315; p&lt;0.001).
An association between ischemia and the extent of LGE was found (β-estimate: 2.02, 95% CI: 0.93, 3.10; p&lt;0.001). Ischemia in ≥21% of LV was associated with LGE &gt;15% (AUC 0.766, sensitivity 0.724, specificity 0.659).
In multivariable analysis, in the overall population, MWT and LGE were independently associated with ischemia, however the evidence of association between ischemia and extent of LGE became weaker (β-estimate: 1.070, 95% CI: −0.106; 2.245; p=0.074).
In subgroup analysis, the association between ischemia and LGE remained significant in individuals with MWT 15–20mm, non-obstructive HCM, female and age &lt;40 years.
The severity of ischemia was not associated with markers of LV systolic function, namely LVEF, longitudinal, radial and circumferential strain
A strong evidence of association was found between ischemia and atrial fibrillation/flutter (AF/AFL) (OR: 1.481, 95% CI: 1.020,2.152; p=0.039), but no association was verified with non-sustained ventricular tachycardia.

Conclusion
In HCM, CMD is related to the severity of LV hypertrophy. Ischemia secondary to CMD promotes fibrosis and is associated with an increase in the odds of AF/ALF.

Funding Acknowledgement
Type of funding sources: None.
Genetic regulation of myocardial fibrosis in hypertrophic cardiomyopathy
Authors: Patel V , Syrris P , Coats C , Lucena J , Lara-Pezzi E , Garcia-Pavia P , Elliott P M 
Published: October 2021

Abstract

Background
Myocardial fibrosis is a common feature of hypertrophic cardiomyopathy (HCM) but its pathophysiology has yet to be elucidated.

Purpose
In this study, we used a multiplex approach to examine the genetic regulation of pathways associated with fibrosis in patients undergoing septal myectomy.

Methods
Myocardial tissue was collected at time of surgical intervention. Control biopsy samples were obtained from the left ventricular free wall from structurally normal hearts during autopsy following non-cardiac related death. Tissue was either snap frozen in liquid nitrogen and subsequently stored at −80 degrees or collected in RNA laterTM and frozen 24 hours later at −80 degrees. Total RNA was extracted from HCM tissue samples using the Qiagen RNeasy fibrous tissues mini kit and from control samples using mirVana isolation kit (Ambion), according to the manufacturer's protocol. Quantitative PCR (qPCR) was performed on the extracted RNA using a RT. Profiler™ Human finrosis PCR Array.

Results
The study cohort comprised 22 HCM samples and 5 controls. The relative regulation of genes involved in myocardial fibrosis in patients with HCM compared to controls is shown in figure 1.
In patients with HCM, there was increased expression of genes involved in collagen synthesis. A significant two-fold upregulation in type III procollagen mRNA was observed relative to controls (p=0.013) with a similar trend identified for type I procollagen (1.5 fold up-regulation, p=0.081). The gene expression of MMP3 (−1.5 fold, p=0.029) and MMP8 (−1.8, p=0.002) which are involved in collaged degradation were downregulated in the HCM group.
The gene expression of pro-fibrotic mediators TGF-β2 (4.8 fold, p=0.008) and CCN2 (2.9 fold, p=0.021) was also significantly elevated. Within the HCM group, there was a correlation between the fold regulation of TGF-β1 (r=0.570, p=0.006; r=0.528, p=0.012), TGF-β2 (r=0.569, p=0.006; r=0.514, p=0.014) and TGF-β3 (r=0.738, p&lt;0.001; r=0.496, p=0.019) to gene regulation of type I and III procollagens respectively.
The expression of BMP-7 which has been shown to reduce myocardial fibrosis by antagonising TGF- β mediated endothelial – mesothelial transformation of fibroblasts was also down-regulated in HCM (−3.8, p=0.015).

Conclusions
Genetic expression of procollagen is significantly upregulated in patients with HCM relative to controls. TGF-β and CCN2 mediated signalling appear to be key mediators in promoting collagen expression.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Heart Hospital Charitable Grant, UK Figure 1. Gene expression in HCM
Cerebrovascular events in takotsubo syndrome: short and long-term outcome. Results from a multicenter-prospective registry
Authors: Leopizzi A , Santoro F , Mallardi A , Vitale E , Iacoviello M , Brunetti N D 
Published: October 2021

Abstract

Background
Several studies have shown that Takotsubo syndrome (TTS) secondary to neurological disorders is associated with higher rate of in-hospital complications. Imaging brain studies found that atrophy or damage of some regions and their altered connectivity with other brain regions are typical features of TTS patients.

Aim of the study
To evaluate rates of in hospital and long-term follow up events in TTS patients with history or acute cerebrovascular events (CVE).

Methods
395 consecutive patients were enrolled in a multicenter prospective registry. History, clinical data, echocardiographic parameters and in-hospital and long-term follow up events of all patients were evaluated.

Results
Prevalence of CVE among TTS patients was 9.4% (N=37). Compared to the control group, these patients were older (80±7 vs 71±12 years, p=0.01) and predominantly men (24% vs 9%, p=0.01). No differences in terms of cardiovascular risk factors and left ventricular ejection fraction at admission and discharge were found between the two groups. The prevalence of physical stressors was higher in the CVE group (67% vs 44% p=0.01).
The incidence of in-hospital adverse events was higher in the CVE group (70% vs 29%), mainly driven by higher rates of cardiogenic shock (19 vs 8%, p=0.01) and in-hospital death (19 vs 4%, p=0.01).
At long-term follow-up, patients in the CVE group had higher mortality rates (38% vs 20%, p=0.01).
Patients presenting with acute CVE, 10 out of 37 patients (27%), when compared with chronic CVE had higher in-hospital mortality rates (40% vs 11%, p=0.01).

Conclusion
TTS patients with history or CVE had higher rates of in-hospital events and death at long-term follow-up. Acute CVEs in the setting of TTS are associated with a worse prognosis.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Ospedali Riuniti di Foggia. Università di Foggia