bluuebunny/crossref_metadata_2025_split huggingface dataset:
Novel risk model for one-year mortality and guidance of management strategy in isolated severe secondary tricuspid regurgitation
Authors: Wang T K M , Mentias A , Akyuz K , Kirincich J , Duran Crane A , Pettersson G B , Gillinov A M , Popovic Z B , Xu B , Griffin B P , Desai M Y 
Published: October 2021

Abstract

Background
Isolated severe tricuspid regurgitation (TR) is a challenging valve lesion to manage because of adverse prognosis, and surgery remains controversial especially in secondary etiologies. We aimed to devise a risk model to predict one-year mortality in isolated secondary TR patients, and evaluated whether risk category influenced the association between tricuspid valve surgery and survival.

Methods
Consecutive patients with isolated severe secondary TR by echocardiography during 2004–2018 were retrospectively studied. A multivariable model was developed for one-year all-cause mortality from two thirds of study patients (randomly-selected derivation cohort), and then assessed in the remaining patients (validation cohort). Associations between tricuspid valve surgery and survival were analyzed overall and in risk categories in multivariable analyses.

Results
Amongst 8575 isolated TR patients with secondary etiologies, mean age was 71.3±14.5 years and 5153 (60.1%) were female. Tricuspid valve surgery was performed in 487 (5.7%) patients, and was independently associated with improved survival during follow-up with hazards ratio 0.57 (95% confidence interval 0.41–0.81) in multivariable analysis. One-year mortality occurred in 2108 (24.6%) patients, and an additive risk score out of 14 based on independent predictors of one-year mortality is shown in the Table 1. The c-statistic for the derivation cohort was 0.712, and for the validation cohort 0.729. By risk score category, one-year mortality was 5.7% for 0–1 (low), 10.1% for 2–3 (mildly elevated), 24.3% for 4–7 (moderately elevated) and 50.9% for &gt;7 (severely elevated), as shown in Figure 1. Surgery was associated with improved survival in the three higher score categories of isolated TR patients (P&lt;0.001 to P=0.037), but did not improve survival in lower risk patients with scores of 0–1 (P=0.140).

Conclusion
We devised and validated a novel risk model which moderately discriminated one-year mortality for isolated severe secondary TR. The score may help guide decision-making for management strategy in those with elevated scores, when the under-utilized tricuspid valve surgery is associated with improved survival, and further research is necessary to apply this score for those considering for transcatheter therapies.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): National Heart Foundation of New Zealand Table 1Figure 1
Contemporary comparison of infective endocarditis caused by Candida albicans and Candida parapsilosis: a cohort study
Authors: Jeronimo A , Olmos C , Perez-Garcia C N , Ferrera Duran C , Garcia-Granja P E , Lopez Diaz J , Saez Bejar C , Sarria Cepeda C , Alcazar M C , San Roman A , Vilacosta I 
Published: October 2021

Abstract

Background
Although Candida albicans is the most frequent microorganism causing fungal endocarditis, its incidence has decreased during the last two decades, and that of non-albicans Candida species has risen. Among the last, Candida parapsilosis is of particular interest, representing the second most frequent Candida species causing IE1, 2.

Purpose
To compare the clinical course, imaging findings and outcomes among patients with IE caused by C. albicans (CAIE) and C. parapsilosis (CPIE) in order to identify organism-specific peculiarities.

Methods
From January 1998 to June 2020, all consecutive cases of CAIE and CPIE (n=16), admitted to a hospital network composed of 3 tertiary hospitals and prospectively recruited on a multipurpose database, were retrospectively analysed. All cases were evaluated by the Endocarditis Team (ET) and underwent a thorough diagnostic work-up, including blood cultures at admission, transoesophageal echocardiography (TEE) and culture of the valves extracted at surgery. Other imaging tests, such as PET/CT, were performed at the ET's discretion. Diagnosis of IE was made according to the modified Duke criteria until 20153, and the European Society of Cardiology (ESC) 2015 modified diagnostic criteria thereafter4.

Results
Eight patients were diagnosed with CAIE and 8 with CPIE. Regarding predisposing conditions, a higher prevalence of prosthetic valves was found among CPIE. Other population's baseline information is shown in Table 1. Compared to CAIE, CPIE presented a longer time from the beginning of symptoms to hospital admission (40 vs 7 days; p=0.062), but no differences regarding signs and symptoms were observed. Aortic location was the most frequent infection side in both groups, but prosthetic valve involvement was remarkably more frequent among patients with CPIE (75% vs 37.5%; p=0.315. Figure 1). CPIE also presented a higher rate of positive blood cultures at admission (100% vs 62.5%; p=0.200), persistently blood cultures 48–72 hours after antifungals initiation (100% vs 0%; p=0.021) and positive valve cultures (83.3% vs 57.1%; p=0.569). No differences regarding TEE and other imaging tests findings were observed. All patients but 4 underwent valve replacement surgery. No differences in in-hospital complications or in mortality were observed between CAIE and CPIE, even after adjusting for therapeutic management.

Conclusions
Compared to CAIE, CPIE presented a more frequent involvement of prosthetic valves, a longer course of symptoms before admission and a bigger proportion of persistently positive blood cultures. In-hospital complications and mortality were similar between the two groups.

Funding Acknowledgement
Type of funding sources: None. Table 1. Population characteristicsFigure 1. Valve involvement distribution
Clinical relevance of cardiac magnetic resonance feature tracking derived left ventricular strain in nonischemic dilated cardiomyopathy
Authors: Pozo Osinalde E , Urmeneta Ulloa J , Rodriguez Hernandez J L , Perez De Isla L , Martinez Fernandez H , Islas F , Marcos-Alberca P , Mahia P , Cobos M A , Martin Lores I , Luaces M , Gomez De Diego J J , Cabeza B , Macaya C , De Agustin J A 
Published: October 2021

Abstract

Background
Left ventricular (LV) myocardial deformation analysis with echocardiography has shown an additive value for risk stratification in nonischemic dilated cardiomyopathy (NIDCM). However, scarce data is available with the new cardiac magnetic resonance (CMR) technique feature tracking, which allows strain evaluation from conventional cine sequences.

Purpose
Our aim is to analyze prognostic relevance of FT in NIDCM

Methods
Consecutive patients with NIDCM diagnosis and CMR at diagnosis were retrospectively included. LV global longitudinal, circumferential and radial strain (GLS, GCS and GRS, respectively) were obtained from standard CMR cine sequences with a dedicated FT software. Their association with a composite endpoint (heart failure admission, implantable cardioverter defibrillator in secondary prevention, and death) was evaluated.

Results
FT derived strain was obtained in 98 patients (68±13 years, 72% males) with NIDCM, mostly idiopathic (75.5%). The vast majority showed a severely dilated LV (LVEDVi= 133.6±33.4 mL/m2) with severely impaired systolic function (LVEF= 29.5±9.6%), and in 38.8% of the cases fibrosis was demonstrated in late gadolium enhancement (LGE). During a 3.2 [2.2–4] years follow-up 25.5% had an admission due to heart failure, 5.1% received an implantable cardioverter defibrillator in secondary prevention, and 10.2% died. Only a trend towards worse GCS values (−7.1 vs −8.5%; p=0.10) was noted among patients with heart failure hospitalization. Mortality was associated with poorer GCS (−5.9 vs −7.9%; p=0.012) and GLS (−6.9 vs −9.6%; p=0.051) values, whereas GRS was not related with any prognostic variable. Exclusively GCS was associated with the composite endpoint (−6.7 vs −8.2%; p=0.035). Considering other morphological parameters with prognostic relevance (LVEF and LVEDVi), GCS was the only independent predictor (OR 1.15; p=0.038). A cut-off point &lt;−8.2% was able to identify those patients with a worse clinical evolution (Figure, Log Rank 4.6; p=0.032)

Conclusions
In our series LV myocardial deformation analysis with FT has shown prognostic relevance in NIDCM, especially GCS determination.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Diagnostic utility of genetic testing in restrictive cardiomyopathy a single refferal centre experience
Authors: Szczygiel J A , Michalek P , Franaszczyk M , Truszkowska G , Ziarkiewicz M , Gawor M , Legatowicz-Koprowska M , Walczak E , Mazurkiewicz L , Stawinski P , Jedrzejczak W W , Lutynska A , Ploski R , Bilinska Z T , Grzybowski J 
Published: October 2021

Abstract

Introduction
Restrictive cardiomyopathy (RCM) is considered to have a genetic background in approximately 50–60% of patients (pts) [1,2,3].

Purpose
The aim of the study was to assess the frequency of pathogenic gene variants in Polish patients with RCM.

Methods
Restrictive cardiomyopathy was diagnosed by transthoracic echocardiography. The analysis included all consecutive unrelated pts with RCM admitted to the cardiology department from January 2015 to December 2016. Light-chain (AL) amyloidosis was diagnosed using tissue biopsy, concentration of serum free light chains and bone marrow biopsy. A genetic test was offered to every patient without AL amyloidosis. In 4 pts coding regions of TTR or GLA genes were screened by Sanger sequencing. Next Generation Sequencing (NGS) was performed: a panel covering coding regions of &gt;4800 disease-associated genes in 18 pts and Whole Exome Sequencing (WES) in 2 pts. Classification of rare variants was made according to ACMG criteria [4].

Results
Forty-four pts were enrolled. Eighteen pts were diagnosed with AL amyloidosis. One patient was diagnosed with histologically-proven myocarditis and one patient with transthyretin (ATTR) amyloidosis declined genetic test. The other 24 pts (median age 48 yrs, 6 males) underwent genetic testing, their median values (interquartile ranges) of the following parameters were: NT-proBNP, 2508 (995–5895) pg/mL; hs-TnT, 25 (18–46) ng/L; E/A ratio, 2.5 (1.8–4.5); E wave deceleration time, 135 (98–167) ms; E/e' ratio, 16 (12–19); left ventricular (LV) posterior wall, 13 (12–14.5) mm; interventricular septum, 14 (13–17) mm and LV end-diastolic dimension, 48 (43–49) mm. Pathogenic or likely pathogenic variants were detected in 16 probands: 5 in MYH7 gene, 3 in TNNI3 gene, 2 in MYBPC3 gene, 1 in BAG3 gene, 1 in PRAKG2 gene, 2 in GLA gene and 2 in TTR gene.

Conclusions
Genetic testing is justified in every patient with RCM, in whom AL amyloidosis is excluded. The molecular diagnosis in RCM may result in causal treatment of Anderson-Fabry disease and ATTR amyloidosis or improve disease management in other types of RCM. MYH7 gene is the most common causative gene in Polish patients with RCM.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): National Institute of Cardiology
Pericardial disease in patients treated with immune checkpoint inhibitors
Authors: Gong J , Drobni Z D , Zafar A , Quinaglia T , Hartmann S E , Gilman H K , Raghu V K , Gongora C , Alvi R , Zubiri L , Nohria A , Sullivan R J , Reynolds K L , Zlotoff D A , Neilan T G 
Published: October 2021

Abstract

Background
There are limited data on the occurrence, associations and outcomes of pericardial effusions and pericarditis after treatment with immune checkpoint inhibitors (ICIs).

Purpose
To evaluate incidence of pericardial disease in patients treated with an ICI.

Methods
This was a retrospective study at a single academic center that compared 2842 consecutive patients who received ICIs with 2699 age- and cancer-type matched patients with metastatic disease who did not receive ICI (design 1). A pericardial event was defined as a composite outcome of pericarditis and new or worsening moderate or large pericardial effusion. The endpoints were obtained through chart review and were blindly adjudicated. To identify risk factors associated with a pericardial event, in a second analysis, we also compared patients who developed an event on an ICI to patients treated with an ICI who did not develop a pericardial event (design 2). Cox proportional hazard model and logistical regression analysis were performed to study the association between ICI use and pericardial disease as well as pericardial disease and mortality. An additional 6-week landmark analysis was performed to account for lead-time bias.

Results
There were 42 pericardial events in the patients treated with ICI (n=2842) over 193 days (interquartile range 64 to 411) with an incidence rate of 1.57 events per 100 person-years. There was a 4-fold increase in the risk for pericarditis or a pericardial effusion among patients on an ICI compared to controls not treated with ICI after adjusting for potential confounders (hazard ratio [HR] 4.37, 95% confidence interval [CI] 2.09–9.14, p&lt;0.001). Patients who developed pericardial disease while on an ICI had a trend for increased all-cause mortality (HR 1.53, 95% CI 0.99–2.36, p=0.05) compared to those who did not develop pericardial disease. When comparing those who developed pericardial disease after ICI treatment to those who did not, a higher dose of corticosteroid pre-ICI (&gt;0.7 mg/kg prednisone) was associated with increased risk of pericardial disease (HR 2.56, 95% CI 1.00–6.57, p=0.049).

Conclusions
ICI use was associated with an increased risk for development of pericardial disease among cancer patients and a pericardial event on an ICI was associated with a trend towards increased mortality.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): National Institutes of Health/National Heart, Lung, and Blood Institute; a gift from A. Curt Greer and Pamela Kohlberg
Left ventricular hypertrabeculation in Ebstein anomaly – a clinically significant or irrelevant problem?
Authors: Cieplucha A , Trojnarska O , Rajewska-Tabor J , Katarzynska-Szymanska A , Mitkowski P , Pyda M 
Published: October 2021

Abstract

Background
Ebstein anomaly (EA) is characterized by anomalous tricuspid valve resulting in the whole right heart's distorted anatomy. Heart failure is the most frequent complication in adults with EA. Recently more attention is also paid to the left ventricle. Some limited echocardiographic data suggest a markedly increased occurrence of the left ventricular hypertrabeculation, by some authors called a non-compacted myocardium. Currently, cardiac magnetic resonance (CMR) is a gold standard in the evaluation of hypertrabeculation. However, different diagnostic criteria and discrepancies in the study outcomes make the clinical interpretation of this phenomenon questionable and challenging.

Purpose
To determine the frequency of the left ventricular hypertrabeculation among adults with EA; to assess its association with the ventricular size and function and the markers of heart failure.

Methods
Study group consisted of 35 unoperated adults (mean age 41.9±14.8 years) with Ebstein anomaly. The study protocol included: a) cardiac magnetic resonance (CMR) with the assessment of the left ventricle (LV) and functional right ventricle (fRV), including ejection fraction (EF), end-diastolic, end-systolic, and stroke volumes indexed by body surface area (respectively: EDVind, ESVind, SVind), and presence of hypertrabeculation defined according to Jacquier (1) as trabeculation mass &gt;20% of the LV mass; b) cardiopulmonary tests with the assessment of peak oxygen consumption (peak VO2, % of predicted peak VO2), ventilation/carbon dioxide slope (VE/VCO2 slope) c) brain natriuretic peptide (BNP).

Results
Left ventricular hypertrabeculation was present in 13 (37.1%) patients.
We demonstrated no difference between patients with and without LV hypertrabeculation regarding: s

Conclusions
Left ventricular hypertrabeculation demonstrated by cardiac magnetic resonance is a phenomenon frequently occurring among adults with Ebstein anomaly. However, its presence is not associated with both ventricles' worse function nor with reduced exercise capacity. Therefore, the clinical relevance of left ventricular hypertrabeculation in this population remains questionable and requires further prospective studies.

Funding Acknowledgement
Type of funding sources: None.
Association between non-O blood group and spontaneous abortion in women with inherited thrombophilia
Authors: Poretto A , Spiezia L , Turatti G , Marobin M , Borella E , Campello E , Simioni P 
Published: October 2021

Abstract

Background
Spontaneous abortion is reported to be one of the most frequent pregnancy complications reaching a prevalence up to 15%. The association between congenital thrombophilia and pregnancy loss has been debated in several studies with conflicting results. We aimed to retrospectively evaluate the prevalence of inherited thrombophilia (i.e antithrombin, protein S and C deficiencies, factor V Leiden and prothrombin variant) in a group of women with a personal history of miscarriage. The prevalence non-O blood group, considered the most common thrombophilic condition, was concomitantly considered.

Materials and methods
A group of n. 566 women with a personal history of spontaneous abortion recruited among caregivers of patients admitted to the Medical Department of our University Hospital between December 2011 and December 2019 were enrolled. Women under 18 yrs, those with a personal history of venous and/or arterial thrombosis and with an acquired thrombophilic condition were excluded. An equally number of healthy women without a personal history of pregnancy loss acted as controls. The Odds Ratios (ORs) and 95% confidence intervals (CIs) were calculated as an estimate of pregnancy loss developing.

Results
Out of n. 566 enrolled women, n. 127 (22.4%) had an inherited thrombophilic condition. The prevalence of congenital thrombophilia was significantly higher in women with miscarriage than controls (OR 2.12; CI 95% 1.51–2.92). Non-O blood type was observed in n. 325 (57.4%) women. The prevalence of non-O blood group was significantly higher in women with pregnancy loss (p 0.01) and the association of thrombophilia and non-O blood type further increased the risk of pregnancy loss (OR 3.28; CI 95% 2.01–5.36).

Conclusions
Both inherited thrombophilia and non-O blood type should be considered risk factors for pregnancy loss. The knowledge of this information may help the clinician to better manage women with pregnancy loss. Further studies are required to confirm our findings.

Funding Acknowledgement
Type of funding sources: None.
Non-invasive risk prediction based on right ventricular function in patients with pulmonary arterial hypertension
Authors: Qaderi V , Weimann J , Harbaum L , Schrage B , Knappe D , Sinning C , Schnabel R , Blankenberg S , Kirchhof P , Klose H , Magnussen C 
Published: October 2021

Abstract

Background
Individual risk assessment in patients with pulmonary arterial hypertension (PAH) is fundamental to improve their outcome. Although right ventricular (RV) dysfunction is a major determinant of outcome in PAH, echocardiographic measures of RV function are poorly represented by current risk models.

Objective
The objective of this study was to identify echocardiographic measures of RV function, which are associated with adverse outcome and to develop a non-invasive, echocardiography-based risk score for PAH patients.

Methods
In 254 patients with PAH we analyzed functional status, laboratory results, pulmonary function and echocardiographic measures. Echocardiographic measures comprised RV chamber diameters, right atrial area, fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), 2D RV strain and pericardial effusion. We used Cox regression models to assess the association with the composite endpoint of 5-year all-cause death or lung transplantation. The analyses included a conventional model using only guideline-recommended variables and a model adding significant echocardiographic measures. Based on the final multivariable model a point risk score was derived, indicating the association with the primary outcome.

Results
Median age was 65.5 years, 33.9% were females. During a median follow-up time of 4.18 years 74 patients died (n=63) or underwent lung transplantation (n=11). In univariable analyses low systolic blood pressure (Hazard ratio [HR] 0.99, 95% Confidence Interval [CI] 0.98,1.00), NYHA functional class IV (HR 3.23, 95% CI 1.48,7.07), 6-minute walk distance (HR 1.00, 95% CI 1.00,1.00), NT-proBNP concentrations (HR 1.00, 95% CI 1.00,1.00), renal impairment (HR 0.99, 95% CI 0.98,1.00), reduced diffusion capacity for carbon monoxide (HR 0.99, 95% CI 0.98,1.00), reduced TAPSE (HR 0.90, 95% CI 0.85,0.96) and reduced FAC (HR 0.97, 95% CI 0.94,1.00) were associated with the endpoint. A multivariable, conventional risk model, including NYHA functional class, 6-minute walk distance, NT-proBNP concentrations, pericardial effusion and right atrial area, resulted in a C-Index of 0.539. Adding TAPSE and FAC to this model improved the performance significantly (C-index 0.639, p-value 0.017). This model was translated to a 12-point score with the highest weighting assigned to TAPSE, FAC, pericardial effusion and 6-minute walk distance (Figure).

Conclusion
An easily applicable score integrating non-invasive, echocardiographic parameters of RV function improves prediction of adverse outcome in PAH patients.

Funding Acknowledgement
Type of funding sources: None. Risk prediction chart
Prognostic significance of polyvascular disease in patients admitted with acute decompensated heart failure: the ARIC Study Community Surveillance
Authors: Chunawala Z , Qamar A , Arora S , Pandey A , Fudim M , Vaduganathan M , Mentz R , Caughey M 
Published: October 2021

Abstract

Introduction
The prevalence and outcomes of polyvascular disease (PVD) in patients admitted with acute decompensated heart failure (ADHF) have not been previously reported, nor is it known whether associations differ for heart failure (HF) with reduced vs. preserved ejection fraction (HFrEF vs HFpEF, respectively).

Purpose
To investigate the relationship between atherosclerotic involvement of multiple arterial territories and mortality in patients hospitalized with ADHF.

Methods
The Atherosclerosis Risk in Communities (ARIC) study conducted hospital surveillance of adjudicated heart failure in 4 US areas from 2005–2014, with events verified by physician review. Medical histories were abstracted from the hospital record. PVD was defined by coexisting disease in ≥2 arterial beds, identified by prevalent coronary artery disease, peripheral arterial disease, and cerebrovascular disease. Mortality hazards of PVD vs. no PVD were analyzed separately for HFpEF and HFrEF, with adjustment for age, race, sex, year of admission and geographic region. All analyses were weighted by the inverse of the sampling probability.

Results
Of 24,936 ADHF hospitalizations (52% female, 32% Black, mean age 75 years), 19% had PVD (22% among HFrEF hospitalizations, 17% among HFpEF hospitalizations), Figure 1. There was an increasing trend in 1-year mortality with 0, 1 and ≥2 arterial bed involvement, both for patients with HFrEF (29% to 32% to 38%; P-trend=0.0006) and HFpEF (26% to 32% to 37%; P-trend &lt;0.0001). After adjustments, PVD was associated with a 20% higher hazard of 1-year mortality in patients with HFrEF (HR=1.23; 95% CI: 1.06–1.44) and a 30% higher hazard in patients with HFpEF (HR=1.33; 95% CI: 1.09–1.63), with no significant interaction by HF type (P-interaction = 0.5).

Conclusion
Patients hospitalized with ADHF and coexisting PVD have an increased risk of death, irrespective of HF type. Clinical attention should be directed toward PVD, with secondary prevention strategies enacted to improve the prognosis of this vulnerable population.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): National Institutes of Health Distributions of arterial diseaseTrends in 1-year mortality outcomes