bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coronary slow-flow phenomenon in takotsubo syndrome: the prevalence, clinical determinants and long-term prognostic impact
Authors: Stepien K , Nowak K , Stepien A , Nessler J , Zalewski J 
Published: October 2021

Abstract

Background
Previous studies demonstrated that patients with takotsubo syndrome (TTS) may present with coronary slow-flow (CSF) at coronary angiography performed in the acute phase [1]. However, the exact clinical relevance and its long-term prognostic impact have not been established yet. In the only recently published study Montone et al. proved that TTS patients with CSF were characterized by a worse clinical presentation with higher rate of intrahospital complications and poor long-term clinical outcome [2].

Purpose
We sought to investigate the prevalence of CSF in TTS patients, its determinants and long-term prognostic impact.

Methods
Among 7771 myocardial infarction patients hospitalized in our center in 2012–2019 years, we identified 82 (1.1%) TTS patients with performed coronary angiography (Figure 1A). The coronary flow was assessed quantitatively with TIMI Frame Count (TFC), whereas myocardial perfusion with TIMI myocardial perfusion grade (TMPG). The clinical and angiographic characterstics of 67 TTS patients complying with MINOCA definition were compared with representative 50 non-TTS MINOCA (Figure 1A).

Results
CSF (TIMI 2) was identified in 33 (40.2%) TTS patients. CSF-TTS patients were characterized with higher TFC and worse TMPG in each analyzed coronary vessel (Figure 1B). CSF was observed in LAD artery in each patient, in 78.8% in LCx and in 33.3% in RCA, respectively. In CSF-TTS lower values of LVEF on admission (33.5 (25–40) vs 40 (35–45)%, P=0.019) as well as more frequent midventricular TTS (27.3 vs 8.2%, P=0.020), nearly normal coronary arteries (&lt;30% stenosis) (75.8 vs 49.0%, P=0.015) and coexistence of both physical and emotional triggers (9.1 vs 0%, P=0.032) were noted. Moreover, CSF was observed significantly more frequent than in non-TTS MINOCA (44.8 vs 10.0%, P&lt;0.001) with different distribution in particular vessels (P&lt;0.001). In median 55 months of long-term observation higher all-cause mortality was stated in CSF-TTS (30.3 vs 10.2%, P=0.024) (Figure 1C) without difference between TTS and non-TTS MINOCA (P=0.42) (Figure 1D). By Cox proportional hazards model the CSF was identified as an independent predictor of long-term mortality (P&lt;0.001).

Conclusions
As has been shown high proportion of TTS patients were characterized with remarkably marked myocardial perfusion abnormalities, especially in the left coronary vessels, which were associated with unfavorable long-term prognosis. Our study is the first presenting the direct angiographic, clinical and prognostic comparison of TTS MINOCA and non-TTS MINOCA patients.

Funding Acknowledgement
Type of funding sources: None. Figure 1
How did the first pandemic COVID wave affect acute myocardial infarction hospital assistance?
Authors: Pacheco A , Carvalho D , Carvalho P , Ferraz L , Briosa A , Bem Haja P , Bastos M 
Published: October 2021

Abstract

There is a general notion that the COVID pandemic has made access to adequate health care difficult. A retrospective study looked at patients with acute myocardial infarction (AMI) admitted to a hospital, including the time between admission and diagnosis, the time until treatment, and the delay in transferring to a hospital with a catheterization laboratory in the case of ST-Elevation Myocardial Infarction (STEMI).The period analysed was March to July 2019 and March to July 2020 (first Covid pandemic wave). 197 patients, 101 in 2019 (SCA19) and 96 in 2020 (SCAcov), 142 males (72%) mean age 67.3±12.6. It was observed in 2019 29 STEMI and 72 acute myocardial infarct without ST elevation (NSTEMI) na 2020 36 STEMI and 60 NSTEMI, this proportions didn't achieve statistical meaning χ2(1)=1.719, p=0.226. When compared SCA19 versus SCAcov there were no differences between groups in relation to demographic data. The clinical presentation (none, hemodynamic instability, refractory pain, arrhythmia, mechanic complication, acute heart failure) not varied between groups χ2(6)=3.42, p=0.755. When analysed, between SCA19 and SCAcov, there were no significant time difference between the admission and the electrocardiogram execution (MSCA19 = 44.78; MSCAcov = 56.84; Tweich (132.66) = −0.73, p=0.476 g Hedge = 0.71, between time of admission and time of diagnosis MSCA19 = 264.84; MSCAcov = 254.2; Tweich (188.81) = −0.34, p=0.731 g Hedge = 0.05, and the duration of hospitalization MSCA19 = 5.90; MSCAcov = 5.78 U=9400, Z=−0.263, p&lt;0.792.

Conclusion
In COVID times even with the all restrictions and contingencies lived in hospitals our results pointed to no significant changes in the variables analysed. Interestingly, in spite of no significant difference, a slightly more delay in ECG execution, higher prevalence of STEMI but a short time of diagnosis were observed.

Funding Acknowledgement
Type of funding sources: None.
High sensitivity troponin as a 60-day mortality marker in patients with COVID-19 in intensive care at a Latin American hospital
Authors: Sprockel J , Murcia A L , Rincon J M , Santofimio Z , Cardenas H M , Hernandez D , Parra J E 
Published: October 2021

Abstract

Introduction
Coronavirus disease (COVID) - 19 presents with periodic outbreaks with a large number of critical cases that overwhelm the health system. One of the objectives of screening and management is to have markers that can efficiently stratify the individual risk of experiencing adverse results. High-sensitivity troponin has been proposed as one of the possible prognostic markers.

Purpose
To evaluate the prevalence of troponin elevation and its performance for predicting 60-days mortality in patients in ICU due to COVID - 19 in a Latin American population.

Methodology
A single-center retrospective cohort study was carried out in which patients in ICU for COVID-19 confirmed by RT-PC between May and December 2020 were included. Patients with previous conditions that determined a limitation of therapeutic effort and pregnant women were excluded. The outcome was 60-days mortality. Kaplan Meier survival curves were constructed, a ROC curve was generated for the prediction of death according to troponin levels by calculating the area under the curve. Finally, a Cox proportional hazards model was generated.

Results
296 patients were included, 110 (37.2%) female, the mean age was 60 (SD 14) years and the duration of symptoms before admission to the ICU was 8.4 (SD 4.2) days. 81.4% of the patients had at least one comorbidity, 117 (39.5%) had hypertension, 65 (21.9%) had diabetes, and 63 (21.3%) had chronic lung disease. Mortality occurred in 151 cases (51%), 225 (76%) presented shock, 242 (81.8%) severe ARDS (PaO2 / FiO2 &lt;100 mmHg), 232 (78.4%) required invasive ventilatory support, and 153 (5.7%) developed acute kidney injury. The APACHE II average was 13.1 and SOFA 4.8. Troponin was positive in 118 (39.9%) patients, 29.6% of the survivors and 49.7% in non survivors. The AUC was 0.65 (95% CI 0.59–0.71) for predicting mortality (Figure 1). The Kaplan Meier curves are shown in Figure 2 with a p less than 0.001 by achieving the test. In the bivariate analysis, troponin obtained a HR of 1.94 and p&lt;0.001, but in the multivariate model it was 1.39 (95% CI of 0.21–1.56) and p of 0.12.

Conclusions
High sensitivity troponin was found to be elevated in patients hospitalized for COVID-19 in the intensive care unit who died, with regular discrimination (AUC: 0.65), even though the univariate analysis by the Cox and Kaplan Meier methods showed association with 60-days mortality, this was not maintained in the multivariate model.

Funding Acknowledgement
Type of funding sources: None. Figure 1. ROC curveFigure 2. Kaplan Meier survival curves
Does the availability of transcatheter aortic valve replacement impact inpatient outcomes after surgical aortic valve replacement? Analysis of the national inpatient sample
Authors: Hiltner E , Russo M , Chen C , Singh A , Kassotis J , Sethi A 
Published: October 2021

Abstract

Background
With the introduction of transcatheter aortic valve replacement (TAVR), the treatment of aortic stenosis (AS) has experienced a paradigm shift, altering patient selection for surgical aortic valve replacement (SAVR) over the past decade. What remains to be determined is the impact of a hospital's ability to offer TAVR, in the contemporary era, on inpatient outcomes following SAVR.

Purpose
The goal of this study was to assess inpatient mortality and the use of mechanical aortic valve replacement (mAVR) in patients undergoing SAVR at TAVR versus non-TAVR centers in the United States.

Methods
The National Inpatient Sample (2011–18), a probability sample of inpatient visits in the United States, was used to study trends in admissions for SAVR at TAVR and non-TAVR centers; in-hospital mortality was trended over time. Survey estimation commands were used to determine weighted national estimates.

Results
There were 559,365 inpatient visits for SAVR with 75.2% (95% CI 74.2%-76.2%) and 24.7% (95% CI 23.8%-25.8%) receiving bioprosthetic SAVR (bAVR) and mAVR, respectively at TAVR centers and 64.5% (95% CI 63.3%-65.6%) and 35.5% (95% CI 34.4%-36.7%) receiving bAVR and mAVR, respectively at non-TAVR centers. SAVR recipients at non-TAVR centers were older when compared to recipients at TAVR centers (68.3±0.09 vs 66.9±0.11 years p&lt;0.001). Heart failure, cardiac arrhythmias, peripheral vascular disorders, complicated hypertension and diabetes, renal failure and liver disease were more common in patients undergoing SAVR at TAVR-centers. During the study period, both crude (OR = 0.78 95% CI 0.73–0.83) and adjusted (OR = 0.79 95% CI 0.73–0.86) inpatient mortality was lower amongst SAVR recipients at TAVR centers. The utilization rates of mAVR at both TAVR and non-TAVR centers decreased over time amongst all age groups (p trend &lt;0.001).

Conclusions
Patients undergoing SAVR at TAVR centers were younger and had more co-morbidities compared to patients undergoing SAVR at non-TAVR centers. Although patients undergoing SAVR at TAVR centers had significantly more co-morbidities, inpatient mortality was lower at TAVR centers compared to non-TAVR centers. Further research is needed to determine whether the impact of a multidisciplinary cardiac approach resulted in significant differences in patient selection for SAVR, due to the availability of TAVR, influencing patient outcomes.

Funding Acknowledgement
Type of funding sources: None.
Trends in the use of mechanical and bioprosthetic aortic valve replacement in the era of transcatheter aortic valve replacement
Authors: Hiltner E , Erinne I , Singh A , Russo M , Chen C , Kassotis J , Sethi A 
Published: October 2021

Abstract

Background
The choice between a mechanical versus a bioprosthetic valve in aortic valve replacement (AVR) is based on life expectancy, bleeding risk and co-morbidities, since bioprosthetic AVR (bAVR) as compared to mechanical AVR (mAVR), are associated with a more rapid structural deterioration. However, refinements in bioprosthetic valves and the introduction of transcatheter aortic valve replacement (TAVR) (potential for valve-in-valve procedures), will most likely influence valve selection in the future. The impact of widespread transcatheter valve replacements, on the decision to use bAVR versus mAVR, in the contemporary era and subsequent outcomes remain to be determined.

Purpose
The goal of our study was to assess trends in utilization of bAVR and mAVR in the United States while, assessing in-hospital mortality over time.

Methods
The National Inpatient database (2009–18) was used to study trends in admissions for bAVR and mAVR and in-hospital mortality over time. Survey estimation commands were used to determine weighted national estimates.

Results
There were 700,896 inpatient visits for AVR with 70.1% (95% CI 69.2%-71.1%) and 29.9% (95% CI 28.9%-30.8%) visits for bAVR and mAVR, respectively. Those undergoing bAVR were significantly older, [bAVR (69.8 years) vs mAVR (62.7 years) p&lt;0.001]. Heart failure, cardiac arrhythmias, hypertension, diabetes with complications and renal failure were more common in those undergoing a bAVR. Through the course of the study period, the rates of mAVR decreased across all age groups (p trend &lt;0.001), including patients younger than 50 years (p trend &lt;0.001). Both crude (OR = 1.20 95% CI 1.13–1.27) and adjusted (OR = 1.34 95% CI 1.25–1.44) inpatient mortality was higher amongst mAVR recipients.

Conclusions
In the contemporary TAVR era, the utilization of mAVR has decreased across all age groups, including those younger than 50 years old. Although mAVR recipients were healthier with significantly less co-morbidities, inpatient mortality was higher after mAVR compared to bAVR. In addition to understanding the causes accounting for the higher mortality after mAVR, future research should focus on developing TAVR friendly bAVR; possibly enhancing our ability to perform percutaneous valve-in-valve procedures in the future.

Funding Acknowledgement
Type of funding sources: None.
Prevalence of cardiac amyloidosis in patients undergoing transcatheter edge-to edge mitral valve repair
Authors: Dona C , Nitsche C , Koschutnik M , Koschatko S , Dannenberg V , Kammerlander A , Goliasch G , Bartko P , Schneider M , Traub-Weidinger T , Hacker M , Hengstenberg C , Mascherbauer J 
Published: October 2021

Abstract

Introduction
Cardiac amyloidosis (CA) is associated with severe aortic stenosis, however, its prevalence in patients with severe mitral regurgitation in elderly patients is unknown.

Methods
Patients scheduled for transcatheter edge-to edge mitral valve repair (TMVR) were prospectively screened for CA using 99m technetium-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) bone scintigraphy and subsequent serum as well as urine free light-chain quantification in case of a positive DPD scan, defined as visual cardiac update based on the Perugini grading scale.

Results
Out of 100 patients undergoing TMVR, 28 patients (28.0%) had a positive DPD-scan (DPD+). 14 patients (14.0%) showed Perugini grade I enhancement, 9 patients (9.0%) grade II enhancement, and in 5 patients (5.0%), grade III enhancement was present. 28 patients suffered from TTR and two from AL- amyloidosis (one patient had a combination of TTR and AL-amyloidosis). When compared to patients with a negative scan (DPD-), DPD+ patients presented with similar baseline characteristics such as age (DPD- vs DPD+ 76y/o vs 77y/o, p=0.44), gender (female; 62.7% vs 50.0%, p=0.25), coronary artery disease (59.7% vs 42.9%, p=0.13), previous valve surgery (25.4% vs 14.3%, p=0.24) and atrial fibrillation (68.7% vs 78.6%, p=0.33). Also, NYHA functional class and EuroScore II were similar (NYHA ≥ III; 85.1% vs 82.1%, p=0.72, and EuroScore II 9.9±9.8% vs 7.0±4.8%, p=0.21, respectively). On echocardiography, DPD+ patients presented with more pronounced left and right ventricular hypertrophy (interventricular septum: 15mm vs 13mm, p&lt;0.01) but similar left ventricular ejection fraction (44.9% vs 42.3%, p=0.34). At 3-months after TMVR, DPD+ patients showed significant improvement in BNP serum levels when compared to DPD- patients (DPD+ vs DPD-: +315±2569pg/ml vs −2404±8696pg/ml, p=0.03), while NYHA functional class remained unchanged (NYHA improvement ≥1 class: 57.6% vs 50.0%, p=0.52)

Conclusions
In this single centre experience, CA was highly prevalent among elderly patients with severe mitral regurgitation scheduled for TMVR. TMVR in CA patients resulted in significant improvement of NT-pro BNP levels. Future studies need to clarify the prognostic relevance of CA in this specific patient population.

Funding Acknowledgement
Type of funding sources: None.
Mortality and heart failure in patients with severe tricuspid regurgitation. Risk stratification based on TR severity by CMR
Authors: Hinojar Baydes R , Gonzalez-Gomez A , Garcia-Martin A , Monteagudo J M , Alonso-Salinas G , Hernandez-Jimenez S , Fernandez-Mendez M A , Garcia De Vicente A , Jimenez-Nacher J J , Zamorano J L , Fernandez-Golfin C 
Published: October 2021

Abstract

Background
Tricuspid regurgitation (TR) is related to poor prognosis independently of the etiology. A new scale classification has been proposed to better characterize the grading of more than severe TR. Massive and torrential TR seem to have worse prognosis based on echocardiographic studies.

Purpose
To stratify patients' risk based on TR severity by CMR

Methods
Consecutive patients in stable clinical condition evaluated in the Heart Valve Clinic with significant TR (severe, massive or torrential TR) with a contemporaneous echo and CMR were included. TR severity was evaluated by vena contracta (VC) and ERO method, using EPIQ system (Phillip Medical system Andover, Massachusets) and by TR regurgitant fraction (TRF) using a 1.5 Tesla CMR Philips scanner. A combined endpoint of hospital admission due to right heart failure and cardiovascular mortality was defined.

Results
75 patients were included in this study (age 75±8 years, 75% female, 91% functional TR). According to echocardiography 75% were severe, 15% were massive and 10% were torrential TR. Patients with massive and torrential TR showed higher RV end-diastolic volume and lower RVEF. A TRF &gt;50% held the best accuracy to define massive / torrential TR. During a median follow-up of 3 years (IQR: 1.4 – 3.9 years), 39% of the patients (n=29) experienced the combined endpoint. After adjusting for age and LVEF in a multivariate Cox proportional model, TRF was independently associated with cardiovascular mortality and heart failure (hazard ratio per 1%=1.05, [1.02–1.08], p&lt;0.001). Patients were stratified in 3 groups according to TR severity. Patients with TRF ≤40% showed the lowest incidence of events and those with TRF ≥50% experienced the worse prognosis (log rank=0.001, figure)

Conclusion
Patients with massive/torrential TR are populations at higher risk of heart failure and mortality. Risk stratification strategies may identify the patients who benefit the most of intensive therapeutic treatments and intervention on the tricuspid valve. New classification scheme should be included in CMR grading scales.

Funding Acknowledgement
Type of funding sources: None. Kaplan Meier curve. Risk stratification
Prevalence and determinants of right ventricular dysfunction in patients with severe symptomatic high gradient aortic stenosis
Authors: Maltes S , Abecasis J , Mendes G S M , Padrao C , Reis C , Guerreiro S , Freitas P , Ribeiras R , Andrade M J , Cardim N , Gil V , Mendes M 
Published: October 2021

Abstract

Background
Right ventricular (RV) function in aortic stenosis (AS) has been largely neglected. Recently it was demonstrated that right ventricular impairment may be influenced by left ventricular (LV) function and afterload, well before overt pulmonary hypertension development.

Aim
To describe the prevalence of RV dysfunction in a group of patients with severe symptomatic aortic stenosis (AS) and its relation to LV function parameters and afterload.

Methods
We prospectively studied 93 consecutive patients (age: 73 years [IQR 68–77] years, 55% women) with pure severe symptomatic high gradient aortic stenosis: mean transaortic pressure gradient: 57.0mmHg [IQR 46.9–71.1]; aortic valve area: 0.72cm2 [IQR 0.61–0.88]; indexed stroke volume: 48.8±1.5 mL/m2 (11 patients with low-flow AS), preserved LV ejection fraction (EV) (LVEF: 56.0% [51.0–61.3]; GLS: −14.5% [IQR −16.1 to −10.6]), with no previous coronary artery disease and no history of cardiomyopathy. Beyond complete transthoracic echocardiography, all patients underwent cardiac magnetic resonance (CMR) for LV myocardium tissue characterization (late gadolinium enhancement and extracellular volume). Normal RV function was defined according to TAPSE ≥17mm, tricuspid annular systolic velocity ≥12cm/s, mean free wall longitudinal strain ≤−20%. Patients were divided into four groups: (0) – all three RV parameters below normal (1.1%), (1) – 1 normal parameter (12.9%), (2) – 2 normal parameters (44.1%), (3) – 3 normal parameters (41.9%). Indexes of LV systolic and diastolic function, CMR derived LV geometric remodeling, hypertrophy and tissue characterization, aortic valve disease severity and afterload were compared across the 4 groups of patients. We tried to identify predictors of RV dysfunction (group 0, 1, 2 vs. group 3) at multivariate regression analysis.

Results
Left ventricular performance parameters, diastolic and myocardial work indexes were significantly different across the groups (Figure). Neither AV severity indexes nor LV tissue characterization were distinct. At multivariate analysis only global constructive work was an independent predictor of RV dysfunction.

Conclusion
RV dysfunction is common in this group of patients with severe high gradient aortic stenosis and preserved ejection fraction. RV impairment is significantly related to several LV systolic and diastolic parameters and also to LV afterload, probably accounting for RV-LV interdependence.

Funding Acknowledgement
Type of funding sources: None.
Interventional treatment of para-valvular leaks after prosthetic valve replacement with plug devices -first results from a prospective registry
Authors: Zahn R , Kment H , Schofer J , Lubos E , Geist V , Eggebrecht H , Butter C , Wolf A , Schaefer U , Schumacher B , Schneider S 
Published: October 2021

Abstract

Background
Interventional closure of symptomatic paravalvular leaks (PVL) after surgical or interventional valve replacement by plug implantation has emerged as an alternative to surgical correction, which is associated with high morbitity and mortality rates. To date, data on procedural efficacy and clinical outcome after transcatheter closure with plugs is sparse, especially prospective data are missing.

Methods
We analysed data from a multi-center prospective registry on interventional PVL closure with plug devices.

Results
Between 06/2012 and 04/2020 55 interventions were performed with different numbers of plugs (maximal 4) in 51 patients at 9 hospitals. Interventions were performed in 15 women and 36 men at high surgical risk for repeat surgery. 48% of procedures were performed for mitral PVLs and 52% procedures were performed for aortic PVLs. Mean age of the population treated was 69±13 years and mean log. Euro-Score I was 22.5±14.2%. Patients were treated by implantation of Amplatzer Vascular Plug III (80%) and Occlutec occluders (9%). Aortic PVLs were treated using a retrograde transfemoral access, mitral PVLs were treated using either a transseptal (25/26) or transapical access (1/26) with 3-dimensional transesophageal echocardiographic and fluoroscopic guidance. Indication for PVL closure was previous surgery (n=39), high-risk patients (n=24), heart failure (n=22), age (n=20) and hemolysis (n=12). 40 patients had NYHA class III/IV at admission. Interventional closure of PVL was completely successful in 40 procedures (73%), partially successful in 7 procedures (13%) and failed in 7 procedures (13%). NYHA class I/II after PVL closure was achieved in 75% patients. However, 8 out of 12 patients with hemolysis as indication still hemolyzed at discharge. Complications occurred in 16% of patients. In-hospital mortality rate was 4% of procedures (2/51). After hospital discharge no death occurred during 30-day follow-up.

Conclusions
In this prospective interventional PVL registry inclusion rate was lower than expected. There was an equal distribution of aortal and mitral PVLs. At least partial success could be achieved in 86% of patients, with significant functional improvement in most patients. In this high risk population hospital mortaliy was low (4%), indicating that interventional PVL treatment should be the treatment of choice, when discussed by a heart team.

Funding Acknowledgement
Type of funding sources: None.