bluuebunny/crossref_metadata_2025_split huggingface dataset:
Right ventricular longitudinal strain on cardiovascular magnetic resonance imaging predicts outcome in patients undergoing transcatheter mitral valve repair
Authors: Koschutnik M , Dona C , Nitsche C , Dannenberg V , Koschatko S , Beitzke D , Loewe C , Huelsmann M , Schneider M , Bartko P E , Goliasch G , Hengstenberg C , Kammerlander A A , Mascherbauer J 
Published: October 2021

Abstract

Background
The prognostic value of left and right ventricular global longitudinal strain (LV and RV GLS) derived from cardiovascular magnetic resonance (CMR) feature tracking in patients with severe mitral regurgitation (MR) undergoing transcatheter mitral valve repair (TMVR) is unknown.

Methods
Consecutive patients scheduled for TMVR underwent pre-procedural and follow-up CMR imaging including feature tracking strain analysis. Kaplan-Meier estimates and multivariate Cox-regression analyses were used to identify the prognostic impact of LV and RV GLS on CMR using a composite of heart failure hospitalization and death.

Results
A total of 62 patients (78.3±7.0y/o, 45% female, EuroSCORE II: 9.7±7.2%) with severe MR underwent CMR prior to TMVR. 23 (37%) patients presented with right ventricular dysfunction (RVD) defined by RV GLS &gt;−20% on CMR. At baseline, RVD was associated with NT-proBNP levels (9510 vs. 4064pg/mL, p=0.030). On CMR, RVD was associated with reduced left and RV ejection fraction (LVEF: 39.2 vs. 48.7%, p=0.011, RVEF: 35.1 vs. 46.7%, p&lt;0.001), as well as increased LV GLS (−14.0 vs. −19.5%, p=0.003).
A total of 18 events (12 deaths, 6 hospitalizations for heart failure) occurred during follow-up (mean 11.4±9.1months). While LV GLS was not significantly associated with outcome (HR 0.95, 95% CI: 0.90–1.01, p=0.082), RV GLS showed a strong and independent association with event-free survival by multivariate Cox-regression analysis (adj.HR 0.91, 95% CI: 0.83–0.99, p=0.033) after adjustment for relevant baseline and procedural data (EuroSCORE II, post-procedural residual MR), imaging parameters (TAPSE, LV and RVEF on CMR), and cardiac biomarkers (NT-proBNP). When compared with the “gold standard” RVEF on CMR (RVEF &lt;45%: adj.HR 0.86, 95% CI: 0.23–3.20, p=0.825) and TAPSE on echo (TAPSE &lt;17mm: adj.HR: 2.77, 95% CI: 0.72–10.70, p=0.140), only RVD (RV GLS &gt;−20%: adj.HR 5.05, 95% CI: 1.23–20.63, p=0.024) was significantly associated with the composite endpoint (Figure 1). Follow-up CMR was performed in 21 (34%) patients. RV GLS significantly improved after TMVR (−20.6 to −25.2%, p=0.016, Figure 2).

Conclusions
RV rather than LV GLS, as determined on CMR, is an important predictor of outcome in patients undergoing TMVR. At 1 year follow-up, RV function significantly improved, and thus might add useful prognostic information on top of established risk factors.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
An evaluation of patient outcomes following transcatheter pulmonary valve implantation: a meta-analysis
Authors: Saluja S , Contractor H , Wiltshire R , Mannan F , Hussain N , Abidin N , Tin L , Ali S , Saluja S , Khan K , Sobolewska J , Sood P , Anderson S 
Published: October 2021

Abstract

Background
Transcatheter pulmonary valve implantation has emerged as an effective alternative to surgery in patients with congenital Right Ventricular Outflow Tract Dysfunction (RVOT). There is demonstrable evidence that Percutaneous Pulmonary Valve Implantation (PPVI) effectively restores conduit graft viability with a consequent improvement in right ventricular pressures.

Aim
The objective of this study was to perform a meta-analysis of all previously published studies examining the outcome of PPVI and the associated early and late peri-procedural factors in patients with RVOT dysfunction. Data from procedures performed within our own centre have also been included.

Methodology
We performed a meta-analysis of all observational studies investigating early and late outcomes following PPVI. Risk ratios and risk differences were pooled in a random-effects model. The I2 statistic was used to quantify heterogeneity between studies. We searched EMBASE, MEDLINE, CINAHL, PsychInfo and Cochrane databases from their inception until 2021. Studies were included if they reported any comparative data regarding study endpoints. Primary endpoint was mean RVOT gradient. Secondary end points include pulmonary regurgitation fraction, left and right ventricular end-diastolic and systolic volume indexes, and left ventricular ejection fraction. Complication rates were considered a safety endpoint.

Results
A total of 23 studies with 1501 participants enrolled were included in the final meta-analysis. The RVOT gradient decreased significantly [weighted mean difference (WMD) = −20.32 mmHg; 95% confidence interval (CI): −22.15, −19.11; p&lt;0.001]. Mean right ventricular (RV) systolic pressures fell significantly [(WMD)= −18.4 mmHg; 95% CI: −16.4, −20.2; p&lt;0.001) and RV diastolic pressures decreased significantly [(WMD) = −6.3 mmHg, 95% CI: −4.3, −8.9; p&lt;0.001). Pulmonary regurgitation fraction (PRF) also decreased notably (WMD = −24.38%, 95% CI: −28.27, −17.32; p&lt;0.001).The incidence of infective endocarditis was 1.8% (95% CI: 0.7–3.8).

Conclusion
PPVI is an effective and safe strategy in relieving right ventricular remodelling and improving haemodynamic and clinical outcomes in patients with RVOT dysfunction. Multi-centre collaborations are essential to further determine the long-term effects of PPVI on cardiac function, exercise tolerance and quality of life in RVOT dysfunction.

Funding Acknowledgement
Type of funding sources: None.
Early results of multiple coronary artery bypass grafting on arteries less than 1.5 mm in diameter
Authors: Zaikovskii V Y , Shiryaev A A , Vasiliev V P , Galyautdinov D M , Vlasova E E , Akchurin R S , Mykimov S D 
Published: October 2021

Abstract

The widespread using of coronary artery (CA) stenting has led to the fact that nowadays coronary artery bypass grafting (CABG) is the method of choice for patients with multiple occlusions and diffuse lesions, who can be refused in surgery due to “small”, not specified in the guidelines, CA (diameter less than 1.5 mm). The use of microsurgical technique makes it possible to reconstruct small-caliber vessels, however, no detailed comparative data has been published yet.

Aim
To analyze the efficacy of CABG using microsurgical techniques for multiple CA bypass with arteries less than 1.5 mm and compare the results with coronary surgery of larger vessels in the early postoperative period.

Methods
We studied the early results of CABG in two groups of patients. The study group was represented by 100 patients with multiple coronary artery lesions with d&lt;1.5 mm, who underwent control MSCT-shuntography in the postoperative period. We formed a control group of 100 patients who underwent CABG with a target artery d&gt;1.5 mm. In all cases cardiopulmonary bypass and microsurgical technique were used.

Results
All patients underwent complete revascularization of CA, the average number of distal anastomoses was 4,3±0,5 in the study group versus 3.6±0,3 in the comparison group, p&lt;0,001. Intraoperatively in the study group significantly more often performed complex anastomoses to arteries &lt;1,5mm (47 patients vs 18, p&lt;0,001), onlay-flap anastomoses (23 vs 1, p&lt;0,001), single and multiple endarterectomies (19 vs 1, p&lt;0,001). The need for long-term inotropic support (15 cases vs 13, p=0,684), as well as prolonged artificial lung ventilation (2 vs 3, p=0,651), in hospital stage was similar in both groups. Patients from the study group more often underwent reexploration for bleeding in the early postoperative period, which was explained by a large number of complex reconstructions and prolonged on pump time, nevertheless, the difference did not reach statistical significance (4 vs 2, p=0,407). Perioperative myocardial infarction (MI) were registered in 3 (3%) and 1 (1%) cases in the study and control groups, respectively, p=0,621. All patients in the study group underwent MSCT-shuntography in the early postoperative period, according to which 8 patients (8%) had occlusion of the autovenous coronary grafts to the CA&lt;1.5mm and 4 patients (4%) - occlusion of the bypasses to CA&gt;1.5 mm.

Conclusion
CABG in patients with coronary arteries less than 1.5 mm in diameter requires complex reconstructive techniques significantly more often. Nevertheless, in the early postoperative period, it is possible to achieve comparable results in the patient groups with and without CA&lt;1,5mm in the anastomotic sites.

Funding Acknowledgement
Type of funding sources: None.
Prognostic implications of staging right heart failure in patients with significant tricuspid regurgitation undergoing tricuspid valve surgery
Authors: Galloo X , Stassen J , Butcher S C , Meucci M C , Dietz M F , Mertens B J A , Prihadi E A , Van Der Bijl P , Ajmone Marsan N , Bax J J , Delgado V 
Published: October 2021

Abstract

Introduction
Mortality of tricuspid valve (TV) surgery for severe secondary tricuspid regurgitation (TR) remains relatively high. Current guidelines advise surgery in patients with symptomatic severe TR as a concomitant procedure to left-sided valve surgery. Right ventricular (RV) dysfunction is an important prognostic marker and may appear late in the natural history of TR. How a staging algorithm of right heart failure (RHF) may impact on TV surgery outcomes has not been evaluated.

Purpose
To evaluate the impact of staging RHF on survival of patients with significant TR undergoing TV surgery.

Methods
Patients diagnosed with significant (moderate and severe) TR who subsequently underwent TV surgery, were staged into 4 groups of progressive disease according to the diagnosis of RV dysfunction and the presence of RHF: stage 1, at risk for RHF; stage 2, RV dysfunction without clinical symptoms of RHF; stage 3, RV dysfunction with symptoms of RHF, and stage 4, RV dysfunction with refractory symptoms of RHF (Figure 1). The study endpoint was all-cause mortality.

Results
A total of 279 patients (mean age 64±12 years, 49% male), were included in the analysis, of which 20 patients (7%) were in stage 1, 14 patients (5%) were in stage 2, 141 patients (51%) were in stage 3 and 104 patients (37%) were in stage 4.
The majority of the patients (266 patients, 95%) underwent TV annuloplasty. Most patients had TV surgery concomitant to left-sided valve surgery or coronary artery bypass grafting (254 patients, 91%). In per-group analysis, patients in stage 4 had significantly larger left ventricular (LV) and RV dimensions, lower LV ejection fraction and more severe diastolic dysfunction than patients in other RHF stages.
During a median follow-up of 65 [15 - 106] months after TV surgery, 145 deaths (52%) occurred. The cumulative survival rates were 88%, 77% and 60% at 1 month, 1 year and 5 years, respectively. The Kaplan-Meier curves for overall survival according to RHF stage are shown in Figure 2. Survival rates at 5 years were significantly worse in more advanced stages of RHF: 71% (stage 1 and 2), 66% (stage 3) and 49% (stage 4); log-rank chi-square: 11.302; p=0.004. Right heart failure stage was independently associated with all-cause mortality following adjustment for age, gender, LV ejection fraction, kidney function, TV annulus diameter, concomitant mitral valve surgery and time delay from diagnosis until surgery (p=0.021).

Conclusion
Patients diagnosed with significant TR may benefit from earlier referral for surgical intervention, before presenting with RV dysfunction and before the onset of symptoms of RHF.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Stages of right heart failureFigure 2. Kaplan-Meier curves for overall survival
Diffusion weight magnetic resonance imaging analisys with rapid software appication in symptomatic carotid stenosis revascularization
Authors: Sirignano P , Dezi T , Aloisi F , Pranteda C , Taurino M 
Published: October 2021

Abstract

Objectives
The aim of this study was to evaluate whether the extension of preoperative neuroradiological lesions assessed by magnetic resonance imaging (MRI) with Diffusion Weighted sequences (DWI) and Rapid processing of Perfusion and Diffusion software are potentially related to post-operative neurological outcome in patients with symptomatic carotid stenosis (SCS) treated by carotid endarterectomy (CEA).

Methods
From January 2010 to June 2020, data from 134 consecutive patients affected by SCS, presenting with transient ischemic attack (TIA), and minor or moderate stroke, and submitted to urgent CEA in a single academic center, were prospectively collected and reviewed. All SCS patients underwent independent neurological evaluation, duplex ultrasound scan, computed tomographic angiography, and DW-MRI with RAPID evaluation. RAPID evaluation was performed to assess the volume of acute ischemic brain lesion (IBL); through this method it is possible to obtain the identification of the ischemic core milliliters (mL). According with clinical presentation, and imaging studies analysis CEA endarterectomies were performed within 48 hours, within 14 days or after 14 days from symptoms onset. Outcomes for presented analysis were the post-operative new neurological event, and deathat follow-up. Timing of CEA and IBL volume at RAPID evaluation were considered as risk factor potentially influencing outcomes.

Results
Among all the 134 enrolled patients, 68 patients (50.7%) presented with TIA, 49 (36.6%) with a minor Stroke, and 17 (12.7%) with a moderate Stroke. No intraoperative death occurred in any group. Overall, 6 (4.4%) new neurological events were noted in this series, 1 minor stroke (0.7%), and 5 TIAs (3.7%). One-hundred-fifteen (86%) underwent surgery within 14 days from neurological symptoms onset (Urgent patients – U), and 19 (14%) after 14 days (Delayed patients – D); U patients were also divided in two subgroups U1 47/115 patients (35%) submitted to CEA within 48 hours from symptoms onset, and U2 68/115 patients (51%) after 48 hours. No neurological complications were noted in group D, while 5 new adverse events occurred in U1, and 1 in U2 (p=0.01). Results from MRI with DWI sequences performed in 100/134 patients (74.6%) showed positive preoperative diffusion in 62 patients. The RAPID processing ascribed a 0 value, for punctiform lesions, and a value from 2 to 77 ml for single acute lesions; average volume lesion volume was 8.6 mL. Patients were then divided into two groups according to IBL volume: 84 &lt;10 ml, and 16≥10 mL. Incidence of new neurological events was significantly higher in &gt;10ml group (18.7% vs 3.6%; p=0.02).

Conclusion
Our experience seems to suggest that the optimal time for SCS revascularization is between 48 hours and 14 days. Moreover, IBL volume &gt;10ml might greatly increase risk of postoperative adverse events occurrence.

Funding Acknowledgement
Type of funding sources: None.
Subclinical cardiac organ damage in patients with moderate to severe psoriasis treated with infliximab
Authors: Linde A , Gerdts E , Tveit K S , Kringeland E , Midtbo H 
Published: October 2021

Abstract

Background
Psoriasis is an immune mediated disease that has been associated with elevated risk of cardiovascular (CV) disease. Comorbidities, psoriasis treatment and presence of subclinical cardiac organ damage can modulate CV risk in psoriasis.

Purpose
To assess the prevalence and covariables of subclinical cardiac organ damage in patients with moderate-to-severe psoriasis on infliximab treatment.

Methods
Echocardiography was performed in 53 psoriasis patients (age 47±15 years, 30% women) and 99 control subjects (age 47±11 years, 28% women). Subclinical cardiac organ damage was defined as presence of left ventricular (LV) hypertrophy, concentric LV geometry and/or dilated left atrium. Psoriasis area and severity index (PASI) was used to assess the severity of psoriasis. Hypertension was defined as use of antihypertensive medication/history of hypertension and/or elevated ambulatory blood pressure ≥130/80 mmHg.

Results
Hypertension was the most common comorbidity, present in 66% of patients and 61% of control subjects (p=0.54). Smoking was more prevalent in psoriasis patients than controls (37% vs 17%, p=0.005), while other CV risk factors and antihypertensive treatment did not differ between groups. Subclinical cardiac organ damage was less prevalent in psoriasis patients than controls (51% vs. 73%, p=0.007, Figure). In the total study cohort, having psoriasis was associated with lower prevalence of subclinical cardiac organ damage independent of hypertension, smoking, age and sex (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.13–0.72, p=0.007) in logistic regression analysis. Among psoriasis patients, hypertension was associated with a near seven-fold increased risk of cardiac organ damage (OR 6.88 [95% CI 1.32–35.98], p=0.022) independent of age, sex and body mass index. PASI at start of treatment or current PASI was not associated with presence of subclinical cardiac organ damage.

Conclusion
Psoriasis patients on infliximab treatment had less subclinical cardiac organ damage compared with controls, suggesting that inhibition of CV inflammation may attenuate cardiac organ damage in psoriasis. Hypertension was the strongest covariable for subclinical cardiac organ damage in psoriasis patients.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the Western and South-Eastern Regional Health Authorities of Norway and Hjertefondet, University of Bergen.
Psoriasis severity and the risk of left ventricular remodelling in psoriasis patients treated with infliximab
Authors: Linde A , Midtbo H , Gerdts E , Kringeland E , Tveit K S 
Published: October 2021

Abstract

Background
Psoriasis is an immune mediated skin disorder with a great variation in disease severity. Chronic inflammation predisposes to subclinical cardiac damage like left ventricular (LV) remodelling. However, the association of psoriasis severity with LV remodelling is not known.

Purpose
To assess LV remodelling in patients with moderate to severe psoriasis treated with infliximab.

Methods
Psoriasis severity was assessed by the Psoriasis Area Severity Index (PASI) before initiation of treatment with the tumour necrosis factor α inhibitor infliximab in 53 patients (age 47±15 years, 30% women, body mass index (BMI) 29.2±5.5 kg/m2). Echocardiography was preformed after a mean follow-up of 4.9±3.8 years and compared to 99 control subjects (age 47±11 years, 28% women, BMI 29.9±3.9 kg/m2). LV remodelling was assessed from LV relative wall thickness and LV mass index by echocardiography.

Results
Both psoriasis patients and controls had high prevalence of hypertension (66% vs. 61%, p=0.54) and obesity (34% vs. 33% p=0.94). Psoriasis patients were more likely to be smokers than controls (37% vs. 17%, p=0.005), but other cardiovascular risk factors were similarly distributed. Psoriasis patients had higher LV relative wall thickness (0.38±0.09 vs. 0.34±0.07, p=0.001), but lower LV mass index (36.1±9.6 g/m2.7 vs. 40.3±9.8 g/m2.7, p=0.014), compared to controls. Having psoriasis remained associated with higher LV relative wall thickness (β 0.25, p=0.002) and lower LV mass index (β-0.20, p=0.02) in multivariable analyses after adjustment for age, sex, smoking, hypertension and BMI. In psoriasis patients mean PASI decreased from 16.1±11.5 to 0.8±0.8 during infliximab treatment, p&lt;0.001. Higher PASI at start of treatment was associated with a higher LV relative wall thickness at follow-up (Table), but not with higher LV mass index in univariable analyses. After adjusting for sex, age and hypertension, higher PASI at start of treatment (β 0.36, p=0.006) still predicted greater LV relative wall thickness at follow-up in psoriasis patients (Table).

Conclusion
Higher psoriasis severity before infliximab treatment predicted presence of adverse LV remodelling after 4.9 years treatment despite nearly complete clinical remission.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the Western and South-Eastern Regional Health Authorities of Norway and Hjertefondet, University of Bergen.
Renin-angiotensin-aldosterone system genotypes and cardiac remodeling response to essential hypertension
Authors: Mocan O , Radulescu D , Buzdugan E , Cozma A , Leucuta D C , Procopciuc L M 
Published: October 2021

Abstract

Background/Introduction
Cardiac remodeling represent a response to uncontrolled essential hypertension (EHT). The morphological response is expressed by left ventricular (LV) mass index values and/or relative wall thickness (RWT) &gt;0.42. Functionally response is expressed by isolated alteration of LV diastolic function (E/A&lt;1).

Purpose
We aimed to establish the association between anatomical and functional adaptation to EHT, with two genetic variants of the renin-angiotensin-aldosterone system (RAAS): M235T-AGT and A3123C-R2 AngII.

Methods
In 139 hypertensive subjects cohort, we determined the M235T-AGT and A3123C-R2 AngII genotypes, using polymerase chain reaction-restriction fragment length polymorphism methods. The relationship between the studied RAAS gene polymorphisms and morphological and functional cardiac remodeling was assessed by multiple logistic regressions.

Results
We found that the C/C, A/C genotypes of the A3123C-R2 AngII polymorphism were statistically significantly associated with RWT&lt;0.42 (p=0.033), so hypertensive patients carrying this genotype had a 2.7-fold increased risk to have a non-concentric type of cardiac response. The association was maintained even after adjustment for confounders - age, body mass index (BMI), systolic blood pressure (BP), and diastolic BP (p=0.008). We found statistically significant associations between LV diastolic dysfunction in hypertensive patients cohort carrying the T/T, M/T genotypes (M235T-AGT polymorphism) (p=0.037). Moreover, the association remained statistically significant even after adjustment for age, BMI, systolic BP, and diastolic BP (p=0.039). We could not identify any statistically significant associations between M235T-AGT, A3123C-R2 AngII polymorphisms, and LV mass index.

Conclusion(s)
Non-concentric type of cardiac response to essential hypertension was associated with A3123C-R2 AngII polymorphism. M235T-AGT polymorphism was found to be statistically significantly associated with alteration of LV diastolic function.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): “Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca, as part of Doctoral Research Projects (DRP) 2016