bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of mitral valve regurgitation severity on clinical outcomes in patients with severe aortic stenosis undergoing TAVI
Authors: Jimenez Franco V , Sanchez Vega J D S V , Rajjoub E A R A , Pardo A P S , Garcia C G S , Amores M A L , Salido L S T , Mestre J L M B , Sanchez A S R , Zamorano J L Z G 
Published: October 2021

Abstract

Background
Significant mitral regurgitation (MR) is among the most common cardiac diseases associated with severe aortic stenosis (AS). It is frequently caused or exacerbated by increased left ventricular diastolic pressure and/or diameter, with consequent stretching of the mitral annulus and reduction of leaflet coaptation. Transcatheter aortic valve implantation (TAVI) has been established as an alternative treatment in patients with severe AS, with a prevalence of MR that ranges from 3–37%, but in this setting is typically left untreated. Prognostic clinical impact of concomitant MR in patients undergoing TAVI on outcomes is not clear and conflicting results have been reported.

Purpose
We sought to investigate the clinical impact of significant MR (≥2+) on mortality at 1-year follow-up in a group of patients with severe aortic stenosis that underwent TAVI procedure. Secondary objective was to evaluate the rate of re-hospitalization during that time.

Methods
From July 2010 to December 2019 information was gathered from a total 400 patients with severe aortic stenosis who underwent successful TAVI procedure at a University Hospital. We performed a monocentric, non-randomized, observational and prospective study that evaluated clinical outcomes following TAVI in patients with severe aortic stenosis and significant MR (≥2+; Group A) compared to those with mild or absent MR (&lt;2+; Group B). The primary end point was the percentage of all-cause mortality at 1-year follow-up. Secondary end point was the rate of re-hospitalization following TAVI procedure at 1-year follow-up.

Results
The mean age of the global population (n=400) was 83±7 years and 243 were females (60.7%). Among the total sample, 72 (18%) patients had baseline moderate to severe MR (Group A) and were compared to the remaining 328 patients with mild or absent MR (Group B). At one-year follow-up, we observed a statistically significant higher all-cause mortality in 10 (22.3%) patients from Group A compared to 10 (6.7%) in Group B (p=0.05). The rate of re-hospitalization was significantly higher (p=0.01), occurring in 38.8% (85) of patients in Group A compared to 25.9% (28) in Group B.

Conclusion
Baseline significant MR (≥2+) in patients with severe aortic stenosis that underwent TAVI was associated with higher all-cause mortality and re-hospitalization at 1-year follow-up. To date, it is not clear whether this association is related to MR severity or if is simply a marker of worst prognosis. Further studies are warranted to reproduce these results.

Funding Acknowledgement
Type of funding sources: None. Kaplan-Meier estimates of survival
Clinical and haemodynamic effects of percutaneous edge-to-edge mitral valve repair in atrial versus ventricular functional mitral regurgitation
Authors: Claeys M J , Debonnaire P , Bracke V , Bilotta G , Shkarpa N , Vanderheyden M , Coussement P , Vanderheyden J , Van De Heyning C , Cosyns B , Pouleur A C , Lancellotti P , Paelinck B , Ferdinande B , Dubois C 
Published: October 2021

Abstract

Background
Atrial functional mitral regurgitation (A-FMR) is a novel entity characterized by a MR due to atrial remodeling but with preserved left ventricular (LV) systolic function.

Purpose
To assess the clinical and haemodynamic impact of percutaneous edge-to-edge mitral valve repair with MitraClip in patients with A-FMR as compared to ventricular (V)-FMR.

Methods
MR grade, functional status (NYHA class), and major adverse cardiac events (MACE= all-cause mortality or hospitalization for heart failure (HF)) were evaluated in 52 A-FMR patients (pts.) and in 307 V-FMR pts. who underwent MitraClip implantation in 7 Belgian centers. In a subgroup of 56 pts (10 A-FMR and 46 V-FMR) haemodynamic assessment during a symptom-limited exercise echocardiography was performed before and 6-month after intervention.

Results
MitraClip implantation resulted in similar MR reductions in A-FMR and V-FMR (MR grade ≤2 at 6-month in 94% versus 82%, respectively (p=0.08)) and was associated with improvement of functional status in both groups (NYHA class ≤2 at 6 months in 90% versus 80%, respectively (p=0.2)). Serial haemodynamic assessment revealed that the cardiac output at 6-month was significantly higher in A-FMR pts. both at rest (5.1±1.5 L/min versus 3.8±1.5 L/min, p=0.002) and during peak exercise (7.9±2.4 L/min versus 6.1±2.1 L/min, p=0.02). Also the reduction in systolic pulmonary artery pressure (sPAP) was more pronounced in A-FMR: Δ sPAP at rest – 13.1±15.1 mmHg versus – 2.2±13.3 mmHg (p=0.03). During a follow-up period of 1.3±1.2 years MACE rate was significantly lower in A-FMR versus V-FMR with an adjusted OR of 0.46 (95% CI 0.24–0.88, see figure), which was mainly driven by a reduction in HF hospitalization.

Conclusion
Percutaneous edge-to-edge mitral valve repair with MitraClip is at least as effective in A-FMR as in V-FMR in reducing MR. But, the haemodynamic and clinical impact is stronger in A-FMR pts.

Funding Acknowledgement
Type of funding sources: None. MACE in A-FMR versus V-FMR pts
Long-Term survival and functional status in patients with elevated mitral valve pressure gradient after transcatheter mitral valve repair
Authors: Koell B , Ludwig S , Weimann J , Waldschmidt L , Schofer N , Seiffert M , Schirmer J , Westermann D , Reichenspurner H , Blankenberg S , Lubos E , Conradi L , Kalbacher D 
Published: October 2021

Abstract

Background
A growing number of patients are currently treated for severe mitral regurgitation (MR) using a transcatheter mitral valve repair (TMVr). In clinical routine, the potential risk of elevated post-procedural mitral valve pressure gradient (MPG) may prohibit optimal MR reduction driven by the avoidance of additional clip implantations. Thus, the unfavorable impact on survival and functional outcome of increased MPG in patients undergoing TMVr is currently debatable.

Methods
In this single-center, prospective study, survival and functional outcome of 780 consecutive patients with severe MR undergoing TMVr between September 2008 and January 2020 were investigated. After exclusion of patients with unsuccessful procedure and those lost to follow-up, data of 676 patients with a median follow-up time of 5.26 (5.11, 5.51) years were analyzed. MPG was determined by transthoracic echocardiography at discharge and considered elevated in excess of 4.5 mmHg. Kaplan-Meier analysis as well as multivariable Cox regression models were performed for the impact on elevated MPG on 5-year outcomes for the subgroups of functional MR (FMR) and degenerative MR (DMR). The primary outcome measure was a combined endpoint of death or rehospitalization for congestive heart failure.

Results
Among 676 patients undergoing TMVr (mean age 74.6±8.5 years, 59.0% male, median STS Score 3.9 [interquartile range 2.5; 6.0]), 179 (26.4%) patients had elevated MPG &gt;4.5 mmHg. FMR was present in 426 (63.0%) patients. In the overall patient cohort, Kaplan-Meier and Cox Regression analyses could not demonstrate significant differences for the combined endpoint (p=0.99). In contrast, subgroup analysis according to MR etiology indicated a significant adverse influence of elevated MPG on the combined endpoint as well as functional outcome in patients with DMR, but not with FMR (Figure 1). After adjustment, multivariate Cox Regression analysis showed an inferior prognosis in patients with DMR and elevated MVPG &gt;4.5 mmHg (hazard ratio 1.79 [1.17, 2.72], p=0.0069, Figure 2).

Conclusions
TMVr-patients with DMR and measurable elevated post-procedural MVPG face an inferior prognosis and reduced functional outcomes compared to patients with FMR.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Artificial intelligence to improve decision making in transcatheter aortic valve implantation
Authors: Hofmann F J , Hofmann S , Doerr O , Blachutzik F , Keranov S , Widmann L , Boeder N F , Hamm C , Nef H M , Kim W 
Published: October 2021

Abstract

Background
The current state of the art in the diagnosis and treatment of cardiovascular diseases has been based on evidence resulting from traditional trials as well as years of clinical experience. Due to interindividual differences and a huge number of possible cofounders, in interventional cardiology a linear algorithm is usually not able to precisely estimate individual risk, therapy, or outcome. With the technological evolution in deep machine learning (ML) and artificial intelligence (AI), clinicians may now address aspects that might not have been investigated previously, as supercomputers may handle the plethora of data that are generated as part of treatment. Ultimately, treatment recommendations and decisions may be made on a personalized level.

Purpose
The aim of this study was to apply AI to routine clinical practice to improve decision making in transcatheter aortic valve implantation (TAVI) to determine the best type and size of prosthesis personalized for each patient with pre-procedural risk stratification.

Methods
All patients included in the study were undergoing TAVI. To predict the clinical outcomes we applied a random forest classification, a ML method with high interpretability. For baseline data 58 features were chosen, including valve type and size used. After removing highly collinear features with a certain variance inflation factor, feature selection was based on impurity-based feature importance as well as permutation importance. The performance of the estimators was evaluated by a five-fold nested stratified cross-validation. To evaluate the model ROC and mean AUC scores were chosen.

Results
A total of 3882 patient datasets were included in this trial. The baseline characteristics were consistent with a high cardiovascular risk typical of this collective. Device success was achieved in 83.3%, pacemaker implantation was necessary in 12.2%, and aortic valvular insufficiency was observed in 2.5%. The 30-day mortality was 3.4% and one-year mortality was 12.7%. The mean AUC for the outcome parameters device success, aortic valvular insufficiency, any pacemaker operation, and 30-day and one-year mortality after five-fold cross validation were 0.61±0.03, 0.71±0.04, 0.66±0.04, 0.67±0.03, and 0.69±0.01, respectively.

Conclusions
We report preliminary data concerning a promising method to improve decision making in the context of TAVI evaluation and planning using ML algorithm. We showed the feasibility with acceptable AUC values for all outcome parameters. Thus, the integration of AI in TAVI strategy planning process offers a valuable tool providing patient focused personalized therapy.

Funding Acknowledgement
Type of funding sources: None.
The management of severe aortic stenosis during the COVID-19 pandemic: an observational study comparing TAVI and SAVR
Authors: Akhtar M , Shafi A , Khanna V , Mukhopadhyay S , Patel K , Ozkor M , Baumbach A , Mathur A , Kennon S , Awad W , Mullen M M 
Published: October 2021

Abstract

Introduction
Outcomes and characteristics of patients with severe aortic stenosis (AS) treated during the COVID-19 pandemic is unknown.

Methods
This was a single-centre observational study of patients undergoing AS treatment with transcatheter (TAVI) or surgical (SAVR) therapy during the first-wave of the UK COVID-19 pandemic compared to a control cohort undergoing treatment in 2019.
Demographics, baseline echocardiogram, CT, procedural characteristics and outcome data were collated. The primary outcome was 30-day all-cause mortality. The secondary endpoint was duration of post-procedural hospitalisation.

Results
319 patients were recruited - 122 underwent intervention during the pandemic [73 TAVI; 49 SAVR] and 197 in 2019 [127 TAVI; 70 SAVR].
In 2020, TAVI patients had a higher Euroscore II (p&lt;0.001) but there were no differences in procedural complications or mortality [p=0.16] compared to TAVI 2019 cases. Duration from TAVI to discharge was shorter in 2020 (p&lt;0.001).
SAVR 2020 patients had similar baseline profile [p=0.48], surgical characteristics, mortality (p=0.68) and duration from SAVR to discharge compared to those in 2019.
During the pandemic, TAVI patients were older (p&lt;0.001) and had a higher Euroscore II (p&lt;0.001) than SAVR counterparts. TAVI patients had reduced 30-day mortality [0 (0%) vs 3 (6%); p=0.06] and were discharged more rapidly post-intervention than SAVR patients [median 1 [1] vs 7 [4] days; p&lt;0.001) translating into shorter hospitalization (p&lt;0.001).

Conclusions
TAVI and SAVR can be safely delivered with predictable resource utilisation during a pandemic. Despite the TAVI cohort incorporating higher risk, older patients, outcomes were at least as good as SAVR with a shorter length of post-procedural hospitalisation.

Funding Acknowledgement
Type of funding sources: None. Procedural Complications TAVI/SAVRDuration to discharge post TAVI/SAVR
Left atrial dynamics in the hemodynamic response during exercise in patients with asymptomatic severe aortic stenosis
Authors: Sugimoto T , Bandera F , Generati G , Alfonzetti E , Guazzi M 
Published: October 2021

Abstract

Background
The hemodynamic impact of left atrial (LA) dynamics in aortic stenosis (AS) in relation to cardiopulmonary response to exercise has never been studied. We aimed at investigating the link between LA function vs hemodynamics and prognosis in asymptomatic severe AS patients.

Methods
A total of 106 patients: 76 asymptomatic severe AS patients (aortic valve area (AVA) &lt;1.0 cm2 or AVA index &lt;0.6 cm2/m2) and 30 gender-matched control subjects underwent cardiopulmonary exercise testing combined with Echo-Doppler with assessment of LA strain. AS patients were divided into 4 groups according to peak aortic jet velocity (PV), mean pressure gradient (MPG), stroke volume index (SVI), and left ventricular ejection fraction (LVEF).

Results
Normal-flow low-gradient AS (NFLG: PV &lt;4 m/s and MPG &lt;40 mmHg, SVI &gt;35ml/m2, LVEF ≥50%, N=23), High-gradient AS (HG: PV ≥4 m/s or MPG ≥40 mmHg, LVEF ≥50%, N=23), Paradoxical low-flow low-gradient AS (PLFLG: PV &lt;4 m/s and MPG &lt;40 mmHg, SVI ≤35ml/m2, LVEF ≥50%, N=18), and Classical low-flow AS (CLF: LVEF &lt;50%, N=12) had a higher LA volume index than Control (Control 22±6, NFLG 38±12*, HG 33±9*, PLFLG 33±11*, and CLF 49±15* ml/m2, *P&lt;0.05 vs Control). In PLFLG and NFLG AS, LA strain at rest (21±9 and 26±13%) and during exercise (26±12 and 31±14%) were decreased compared to Control (37±8% at rest, 43±11% during exercise) but LA strain was increased from rest to exercise (P&lt;0.001). HG and CLF AS had no increase in LA strain (31±15 and 19±10% at rest, 28±15 and 18±9% during exercise) (figure). In Cox proportional hazards analysis, age and gender adjusted hazard ratio for the composite end point (aortic valve replacement, hospitalization for heart failure, and all-cause mortality) of changes in LA-strain from rest to exercise (1% increase) was 1.05 (95% CI 1.00 to 1.09, P=0.044) among AS patients.

Conclusions
In asymptomatic severe AS, the study of LA functional adaptation to exercise plays a key role in the hemodynamic unfavorable cascade signaling major adaptive differences in dynamics during physical challenge. Overall, LA dynamics provides prognostic information also in AS patients.

Funding Acknowledgement
Type of funding sources: None.
Long-term morphological appearance of transcatheter valves left in the ascending aorta after valve dislocation during transcatheter aortic valve implantation
Authors: Frumkin D , Pietron M , Kind A , Leistner D , Krackhardt F , Laule M , Brand A , Knebel F , Lembcke A , Landmesser U , Stangl K , Dreger H 
Published: October 2021

Abstract

Background
Transcatheter valve embolization and migration (TVEM) is a potential complication of transcatheter aortic valve implantation (TAVI) (1). Registries suggest low incidence but clinical relevance due to increased acute and mid-term mortality with the majority embolizing in the aorta. However, there is little data on potential late complications such as leaflet and stent thrombosis or aortic wall alterations by migrated valves.

Purpose
The aim of our study was to analyze the incidence and clinical characteristics of TVEM in a large single center cohort of TAVI patients and to examine dislocated valves by ECG-gated computed tomography (CT).

Methods and results
Between July 2009 and May 2020, 40 TVEM occurred in 3387 TAVI procedures performed in our center (1.18%). TVEM was defined according to Valve Academic Research Consortium-2 (VARC-2) criteria (3). Majority of TVEM were left in the ascending aorta (31 ascending, 3 arch, 1 descending aorta). 90% of TVEM occurred with a self-expanding valve (SEV), with no difference between older and newer valve generations, 10% with a ballon-expandable valve. Analyzing a TAVI sample cohort (n=200), horizontal aorta (p&lt;0.001, OR 11.7, 95% CI: [3.9:34.8]), defined as aortic angulation &gt;48°(4), as well as the use of SEV (p&lt;0.001, OR 12.8, 95% CI: [3.1:53.9]) were identified as a predisposing risk factor for TVEM. OR in SEV was severely increased when isolating the analysis for patients with horizontal aorta only (p=0.003, OR 23.75, 95% CI: [2.8:129]). No other predisposing risk factors were identified in this cohort. Out of 35 patients still alive, 6 patients were willing to participate in our imaging sub-study. CT exams were performed on average 47 months after TAVI (IQR 50 months [25%Q: 16.8, 75%Q: 72.8]). We detected no leaflet or stent thrombosis, yet CT identified pin protrusions in the aorta in 3 out of 6 patients.

Conclusions
TVEM is a rare complication of TAVI. TVEM was significantly associated to the use of self-expanding valves and the presence of horizontal aorta. CT did detect pin protrusions in several cases which could bear the possible risk of perforation but showed no signs of long-term damage.

Funding Acknowledgement
Type of funding sources: None. Representative CT images after TVEM
Effect of concomitant atrioventricular valve regurgitation on the outcome after transcatheter aortic-valve implantation
Authors: Drakopoulou M , Karmpalioti M , Simopoulou C , Oikonomou G , Apostolos A , Toskas P , Soulaidopoulos S , Stathogiannis K , Synetos A , Latsios G , Tsioufis C , Toutouzas K 
Published: October 2021

Abstract

Background
Many patients undergoing transcatheter aortic valve implantation (TAVI) have concomitant mitral regurgitation (MR) of moderate grade or more. The impact of coexistent tricuspid regurgitation (TR) remains to be determined.

Methods
Patients with severe and symptomatic aortic stenosis [effective orifice area (EOA)≤1cm2] referred for TAVI at our institution were consecutively enrolled. Prospectively collected demographic, laboratory and echocardiographic data were retrospectively analysed. Patients were divided into 4 groups according to MR and TR severity pre-procedurally: no/mild MR and TR, moderate/severe MR, moderate/severe TR, moderate/severe MR and TR. Primary clinical endpoint was all-cause mortality, as defined by the criteria proposed by the Valve Academic Research Consortium2.

Results
A total of 244 consecutive patients were enrolled in the study: 148 (60.7%) patients no/mild MR and TR, 32 (13.1%) moderate/severe MR, 35 (14.3%) moderate/severe TR, 29 (11.9%) moderate/severe MR and TR pre-procedurally. There was significant difference in pre-procedural pulmonary artery systolic pressure (PASP) among groups (no/mild MR and TR: 40.8±10 mmHg, moderate/severe MR: 46.6±11.2 mmHg, moderate/severe TR: 49.9±13mmHg, moderate/severe MR and TR: 59.8±15.2mmHg, p&lt;0.0001). The Kaplan–Meier curves for 2 year mortality showed that the severity of TR was associated with poor survival. Interestingly, patients with moderate/severe MR and TR had the worse survival (no/mild MR and TR (91.2%), moderate/severe MR (78.1%), moderate/severe TR (62.9%), moderate/severe MR and TR (62.1%), p&lt;0.0001).

Conclusion
The presence of concomitant moderate or severe mitral and tricuspid valve regurgitation was associated with the higher mortality. This suggests that a thorough evaluation of the mechanisms underlying concomitant mitral and tricuspid valve regurgitation should be performed to determine the best strategy for avoiding TAVI-related futility.

Funding Acknowledgement
Type of funding sources: None.
Rheumatic myocarditis: a poorly recognized etiology of left ventricular dysfunction in valvular heart disease patients
Authors: Emer Egypto Rosa V , Lopes M P , Spina G S , Soares Jr J , Salazar D , Romero C E , Lottemberg M P , De Santis A , Pires L J N T , Goncalves L F T , Fernandes J R C , Sampaio R O , Tarasoutchi F 
Published: October 2021

Abstract

Background
Heart failure is present in about 10% of patients with acute rheumatic fever (RF), and several studies showed that cardiac decompensation in RF results primary from valvular disease, and not due to primary myocarditis. However, literature is scarce in this topic and a recent case series showed that recurrent RF could cause ventricular dysfunction even in the absence of valvular heart disease.

Purpose
To evaluate clinical, laboratory and echocardiographic profile of rheumatic fever patients with confirmed myocarditis diagnosis using Fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET/CT) or Gallium-67 cardiac scintigraphy.

Methods
Clinical, laboratory and imaging characteristics of 25 consecutive patients with diagnosis of myocarditis, using 18F-FDG PET/CT or gallium-67 cardiac scintigraphy (Figure 1A and 1B, respectively), and RF reactivation according to revised Jones Criteria, were evaluated. Patients underwent 3 sequential echocardiograms: (1) baseline, (2) during myocarditis and (3) post- corticosteroid treatment, and were divided according to the presence (Group 1) or absence (Group 2) of reduced left ventricular ejection fraction (LVEF) during myocarditis episode.

Results
Median age was 42 (17–51) years, 64% had more than 40 years and 64% were women. Comparing patients in Group 1 (n=16) with Group 2 (n=9), there was no demographic, echocardiographic or laboratory difference between groups, except for NYHA III/IV heart failure (Group 1: 100.0% versus Group 2: 50.0%; p=0.012) and LVEF (30 [25–37] versus 56 [49–62] %, respectively; p&lt;0.001), as expected. Group 1 patients had significant reduction of LVEF during carditis with further improvement after treatment (Figure 1C). There was no correlation between LVEF and valvular dysfunction during myocarditis. Of all patients, 19 (76%) underwent 18F-FDG PET/CT, with positive scan in 68.4% and 21 (84%) underwent Gallium-67 cardiac scintigraphy, with positive uptake in 95.2%, both with no difference between groups.

Conclusion
Myocarditis due to rheumatic fever reactivation can cause left ventricular dysfunction despite of valvular disease, and is reversible after corticosteroid treatment.

Funding Acknowledgement
Type of funding sources: None. Figure 1