bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of direct oral anticoagulants to vitamin-K antagonists as treatment for leaflet thrombosis after Transcatheter Aortic Valve Implantation (TAVI)
Authors: Ferstl P , Marwan M , Achenbach S , Bittner D O 
Published: October 2021

Abstract

Introduction
Leaflet thrombosis can occur following transcatheter aortic valve implantation (TAVI). While a frequent finding in post-TAVI CT scans, leaflet thrombosis is usually clinically silent and the decision to initiate anticoagulation depends on clinical considerations. Best treatment is unknown. We compared the effectiveness of direct oral anticoagulants (DOAC) and vitamin K antagonists (VKA) to resolve leaflet thrombosis in patients with serial CT imaging following TAVI.

Methods
Consecutive TAVI patients who had undergone routine follow-up cardiac CT after TAVI procedures were screened for inclusion in this analysis. A total of 44 patients diagnosed with leaflet thrombosis and available follow-up CT after anticoagulation therapy were identified. Leaflet thrombosis on cardiac CT was defined as presence of hypoattenuated leaflet thickening with or without leaflet motion restriction, as previously described. The indication and type of anticoagulation was according to physician discretion. We compared patients on DOAC with patients on VKA therapy for the resolution of leaflet thrombosis.

Results
Mean age of the 44 patients was 80±6 years (59% men), and the median time interval from TAVI to index CT was 107 days (IQR: 91–189 days). Overall, 39 patients (90%) showed resolution of leaflet thrombosis with anticoagulation therapy, whereas leaflet thrombosis persisted in 5 patients (10%). Resolution of leaflet thrombosis was seen in 26 out of 30 (87%) patients receiving VKA and in 13 out of 14 (93%) patients receiving DOAC, respectively. Groups did not differ regarding age (p=0.97), cardiovascular risk factors (all p&gt;0.1), creatinine levels (p=0.19) TAVI prosthesis type (p=0.54) and size (p=0.66). Also, no difference existed for duration of anticoagulation (median 103 vs. 110 days; p=0.76). The relative risk reduction for persisting leaflet thrombosis using DOACs was 46% in comparison to VKA, however with no statistical significance due to the limited number of patients (p=0.55).

Conclusion
Anticoagulation therapy resolves leaflet thrombosis after TAVI in the majority of patients. In our exploratory analysis, direct oral anticoagulants seem to be an effective alternative to vitamin-K antagonists. This result is hypothesis generating and needs to be confirmed in larger prospective trials.

Funding Acknowledgement
Type of funding sources: None.
Atrial longitudinal strain and new onset of atrial fibrillation in a cohort of hypertrophic cardiomyopathy patients
Authors: Llamas-Gomez H , Esteve Ruiz I , Romero Reyes M J , Navarro Valverde C , Molano Casimiro F J 
Published: October 2021

Abstract

Introduction
Several studies associate atrial fibrillation (AF) presence with a poor prognosis and quality of life in hypertrophic cardiomyopathy (HCM) patients. Detecting and treating AF in time prevents important comorbidities and fatal events as it is cardioembolic stroke.
Several clinical factors have been associated with AF onset, but, is there any echocardiographic parameter that helps to predict it?
Some studies associate low longitudinal auricular strain (ALS) with AF onset in other cardiopathies, like aortic valve replacement.

Purpose
The aim of this study is to analyze auricular longitudinal strain in a HCM cohort and its relation with AF onset.

Methods
Prospective study of a cohort of 146 HCM patients. We obtained the mean value of auricular longitudinal strain (ALS) in AF patients and, afterwards, we separated non-AF patients in two groups depending on this ALS mean value. We analyzed the development of AF and clinical outcomes during the follow-up from 2017 to 2020.

Results
At the beginning of the follow-up, 42 patients had AF, 50% were males, 57% had high blood pressure, 26% diabetes, 50% dyslipidemia 14% chronic renal disease, and 2% COPD. HCM risk-score SCD mean value was 2.53 (1.56–4.71).
Echocardiographic values are represented in table 1.
When comparing AF and non-AF patients, we found statistically significant differences in LA diameter and ALS. Mean ALS value in AF patients was 13%.
We followed-up the remaining 104 patients without AF during a mean time of 36±5 months. 10.6% of them developed AF during follow-up, mean time until apparition of AF 26 months (8–29).
We evaluated clinical characteristics in both groups (new AF onset or not), without significant differences between them, including LA diameter and volume. The only variable statistically associated with AF onset was ALS &lt;13% (p=0.009, OR 10).
Patients with new onset of AF had more hospitalizations due to heart failure (p=0.025, OR 8).

Conclusions
We suggest that in our cohort of HCM patients, ALS&lt;13% can predict AF onset during follow-up, regardless left atrial enlargement. This can help to detect quickly the arrhythmia so we can treat it and prevent important comorbidities and fatal events.

Funding Acknowledgement
Type of funding sources: None. Table 1Graphic 1
Sex difference in aortic valve fibrosis assessed by contrast-enhanced computed tomography in severe aortic stenosis
Authors: Myasoedova V , Fraschini E , Mostardini G , Bonfanti L , Chiesa M , De Pasquale C , Olivares P , Trabattoni D , Bartorelli A L , Andreini D , Poggio P 
Published: October 2021

Abstract

Background
Aortic stenosis (AS) is characterized by fibro-calcific remodeling of aortic valve leaflets. Progressive aortic valve calcification (AVC) occurs in both sexes and cardiac computed tomography (CT) is recognized as a high-quality technique for AVC evaluation. To date, sex-specific CT thresholds of AVC have been implemented in clinical practice since it is now recognized that women have less AVC burden than men. In addition, recent evidences indicate that women have more fibrotic remodeling of aortic valve leaflet compared to men.

Purpose
Aortic valve fibrosis (AVF) being a significant contributor to valve gradient, we sought to evaluate the difference in AVF burden between men and women with severe AS using contrast-enhanced CT.

Methods
We included 56 patients matched for age and sex with severe AS. All patients underwent Doppler echocardiography and cardiac CT before intervention. Contrast attenuation values (Hounsfield Units, HU) and contrast-to-noise ratio were measured at the level of the ascending aorta. Total AVF was assessed based on HU ranging between 30 and 350, adjusting the upper threshold by increments of 25 HU in either direction until blood pool was not highlighted. Indexed contrast-enhanced CT calcium volume (iAVC) and fibrosis volume (iAVF) were calculated dividing the volumes by the aortic annular area. Fibro-calcific ratio was calculate dividing iAVF by iAVC volumes.

Results
There was no difference between men and women in major cardiovascular risk factors, valve phenotype (bicuspid vs. tricuspid), nor pharmacological treatment. Men had higher body surface area than women (1.89±0.14 vs. 1.67±0.17 m2, respectively; p&lt;0.001), while women had lower aortic valve area than men (AVA; 0.74±0.2 vs. 0.91±0.2 cm2, respectively; p=0.007) but similar indexed AVA (0.44±0.15 vs. 0.48±0.12 cm2/m2, respectively; p=0.262). Women had significantly lower iAVC compared to men (36 [36–72] vs. 72 [67–123] mm3/cm2, respectively; p=0.03). However, iAVF was significantly higher in women compared to men (83 [78–123] vs. 63 [58–83] mm3/cm2, respectively; p=0.006). Finally, the fibro-calcific ratio, which indicates the predominance of valve fibrosis if &gt;1.0, was significantly higher in women compared to men (2.57 [2.14–7.02] vs. 0.78 [0.84–2.02], respectively; p=0.003).

Conclusions
Our study highlights for the first time a sex difference in the fibrotic content of severe AS evaluated by contrast-enhanced CT. These findings might be valuable to promote further studies on the role of sex-specific tissue composition in AS progression and outcomes.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Fondazione Gigi e Pupa Ferrari ONLUS
Outcomes of transctheter mitral valve repair in a large urban US health system
Authors: Hahn J , Hassan Virk H , Greason K , Al-Azza F , Krittanawong C 
Published: October 2021

Abstract

Background
Transcatheter mitral valve repair (TMVR) has become an important minimally invasive alternative to open surgical repair in patients with severe mitral regurgitation. As TMVR develops as an established practice, real-world outcome data is needed to guide clinical decision making as the body of literature on this topic is limited. In our study, we investigate TMVR outcomes in a large urban health system.

Methods
We retrospectively analyzed clinical data from the electronic health records of the extensive urban health system Mount Sinai Data Warehouse and analyzed all individuals who underwent TMVR. Baseline demographics were obtained as well as significant morbidity and mortality outcomes. Finally, multivariable analysis was used to determine associated characteristics with mortality.

Results
We identified 3533 patients who underwent TMVR from 2008 to 2018. The overall mortality was 3.7%. The most common comorbidities observed were heart failure (56%), pulmonary hypertension (26%), atrial fibrillation (26%) and CKD or ESRD (16%). After multivariable analyses, ischemic stroke (adjusted OR 3.46; 95% CI 1.93–5.97, p = &lt;0.001), CKD or ESRD (3.95; 2.72–5.75, p 0.01), aortic stenosis (2.23; 1.12–4.15, p&lt;0.001), and heart failure (8.18; 4.16–18.5, p&lt;0.001) were independently associated with mortality.

Conclusion
In all patients who underwent TMVR at a large urban health system, ischemic stroke, aortic stenosis, heart failure, CKD and ESRD were independently associated with mortality. Future prospective studies will be needed to further define these observed associations.

Funding Acknowledgement
Type of funding sources: None.
Trends in mortality from aortic stenosis in Europe: 2000–2017
Authors: Hartley A , Hammond-Haley M , Marshall D C , Salciccioli J D , Malik I , Khamis R Y , Shalhoub J 
Published: October 2021

Abstract

Background
Trends in mortality from aortic stenosis across Europe are not well understood, especially given the significant growth in transcatheter aortic valve replacement (TAVR) in the last 10 years.

Purpose
To describe trends in mortality from aortic stenosis in European countries from 2000 to 2017.

Methods
Age-standardised death rates were extracted from the World Health Organisation Mortality Database, using the International Classification of Diseases 10th edition code for non-rheumatic aortic stenosis for those aged &gt;45 years between 2000 and 2017. The UK and countries from the European Union with at least 1,000,000 inhabitants and at least 50% available datapoints over the study period were included: a total of 23 countries. Trends were described using Joinpoint regression analysis.

Results
No reductions in mortality were demonstrated across all countries 2000–2017 (Figure 1). Large increases in mortality were found for Croatia, Poland and Slovakia for both sexes (&gt;300% change). Mortality plateaued in Germany from 2008 in females and 2012 in males, whilst mortality in the Netherlands declined for both sexes from 2007. Mortality differences between the sexes were observed, with greater mortality for males than females across most countries.

Conclusions
Mortality from aortic stenosis has increased across Europe from 2000 to 2017. There are, however, sizable differences in mortality trends between Eastern and Western European countries. Significant plateauing or declining mortality was observed for recent years in countries with greater access to TAVR, whilst increasing trends were observed in countries with the least TAVR use. The need for health resource planning strategies to specifically target AS, particularly given the expected increase with aging populations, is highlighted.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Joinpoint regression analysis for trends in age-standardised death rates from non-rheumatic aortic stenosis for those aged &gt;45 years in Europe from 2000 to 2017. Clear squares indicate males; filled circles indicate females. The lines (dotted for males, solid for females) represent modelled trends based on joinpoint data.
Comparison of suture-based and collagen-based vascular closure devices for large bore arteriotomies- an updated meta-analysis of bleeding and vascular complications
Authors: Sohal S S , Kurpad K K , Kaur K K , Wasty N W , Tayal R T 
Published: October 2021

Abstract

Background
Large bore access procedures such as transcatheter aortic valve replacement or mechanical circulatory support devices rely on percutaneous vascular closure devices to minimize access site complications. Suture-based vascular closure devices (S-VCD) have been readily used but recently newer generation collagen-based vascular closure devices (C-VCD) have been introduced to ensure minimally invasive nature of large bore devices and prevent vascular and bleeding complications at the access site. However, large population data on outcomes of these devices is lacking.

Purpose
To compare the bleeding and vascular complications of suture-based and collagen- based vascular closure devices for large bore access.

Methods
PubMed was searched for articles on vascular closure devices using keywords, (“Vascular closure devices”) AND (“bleeding OR vascular complications”) that resulted in a total of 456 studies. Studies were included if bleeding or vascular complications as defined by Valve Academic Research Consortium-2 (VARC-2) were compared between the two types of VCDs. 6 (5 observational and 1 Randomized controlled trial) studies met the inclusion criteria. The event level data was pooled across trials to calculate Odds Ratio (OR) with 95% CI and analysis was done using Review Manager 5.4 (RevMan 5.4). Random effect model was used in RevMan 5.4 for the analysis and p value of &lt;0.05 was deemed significant.

Results
Pooled analyses from these 6 trials resulted in a total of 1,307 patients, out of which 550 received C-VCD and 757 received S- VCD. Among the patients who received C-VCD, the bleeding complications (major and minor) were non significantly lower than in patients who received S-VCD ((OR: 0.71 (0.33–1.53), p=0.38, I2=47%), (OR: 0.78 (0.40–1.50), p=0.45, I2=52%)). The vascular complications (major and minor) in patients who received C-VCD were similar to patients who received S-VCD ((OR: 0.85 (0.47–1.54), p=0.59, I2=0%), (OR: 0.92 (0.38–2.22), p=0.86, I2=37%)) (Picture 1 and Picture 2).

Conclusions
Bleeding and vascular complications after large bore arteriotomy closure with collagen based vascular closure devices are similar to suture based vascular closure devices. Therefore, collagen-based devices seem to be a feasible option to obtain hemostasis in large bore arteriotomies without increasing risk for vascular complications.

Funding Acknowledgement
Type of funding sources: None.
Impact of mitral valve anatomy suitability in echocardiographic and clinical evolution in patients referred for percutaneous edge-to-edge repair
Authors: Salinas Gallegos A , Pozo Osinalde E , Gordillo X , Jimenez Quevedo P , Mahia P , Marcos-Alberca P , Tirado G , Islas F , Macaya C , Perez-Villacastin J , Fernandez-Ortiz A , Nombela-Franco L , De Agustin J A 
Published: October 2021

Abstract

Background
Percutaneous edge-to-edge mitral repair has become an effective therapeutic alternative to surgery in high-risk patients with moderate-to-severe mitral regurgitation (MR). A traffic light system has been proposed to evaluate echocardiographic suitability for this therapy. However, few data is available regarding prognostic impact of these criteria.

Purpose
To study the impact of imaging eligibility classification in echocardiographic and clinical evolution.

Methods
We evaluated all the consecutive patients who underwent percutaneous mitral repair with the MitraClip system between 2010 and 2020 in our tertiary university hospital, excluding the redo procedures (n=1). Imaging eligibility classification was blindly made by two experts in structural heart disease. Pre and posprocedural echocardiographic measurements were reassessed and clinical events were collected from medical records.

Results
87 patients (65.5% males) with a mean age of 76±10 years were finally included. Regarding mitral valve disease, 13 (14.9%) was graded as moderate-to-severe whereas 74 (85.1%) was considered severe. MR etiology was: functional 44.8%, organic 34.5% and mixed 20.7%. Prior to the procedure the NYHA class was III or higher in 88.5% and LVEF was 44.4±15.4%. Eligibility criteria was: green (44, 50.6%), yellow (39, 44.8%) and red (4, 4.6%). The later patients, with theorical contraindication for the procedure, were excluded from analysis. Although less number of clips were needed in green morphology (1.14 vs 1.46; p=0.01), pulmonary vein flow improved more markedly (Table) in these patients. This resulted only in a slightly greater reduction in MR grade at 6 months (−2.5 vs −1.9; p=0.008). No differences were noted in follow up absolute MR grade or changes in ventricular volumes, LVEF or pulmonary artery systolic pressure. Moreover, there was no impact in MACE during the evolution.

Conclusion
Excluding contraindicated group, no relevant echocardiographic or clinical impact was noted regarding eligibility criteria for percutaneous edge-to-edge mitral repair. Thus, suboptimal patients may equally benefit from this therapy even in moderate-volume centers.

Funding Acknowledgement
Type of funding sources: None. Table 1. Postprocedural pulmonary vein flow pattern in relation with eligibility criteria
Severity of tricuspid regurgitation (TR) only based in echo parameters? The failure of guidelines. The 4A in patients with significant TR as a new clinical score to evaluate patients with TR
Authors: Gonzalez Gomez A , Hinojar R , Garcia Sebastian C , Garcia Martin A , Monteagudo J M , Fernandez-Golfin C , Zamorano J L 
Published: October 2021

Abstract

Background
Significant Tricuspid Regurgitation (TR) is associated with increased morbi-mortality. Symptoms due to TR are often insidious and not always characterized by dyspnea. Identification of symptoms and optimal timing for intervention is challenging and intervention is often preformed late. A more specific clinical classification focused on the detection of systemic congestion may help identify those who may benefit from an earlier intervention.

Purpose
To evaluate the prognostic impact of a new proposed “4A” clinical score: Asthenia, Ankle swelling, Abdominal pain or distention and/or Anorexia, in patients with significant TR.

Methods
Consecutive patients in stable clinical condition evaluated in the Heart Valve Clinic with significant TR (moderate to severe, severe, massive or torrential TR) were included. Signs and symptoms of Asthenia, Ankle swelling, Abdominal pain or distention and/or Anorexia (“4A score”) where registered, follow up was performed every 6 months. The 4A clinical score ranged from 0 (no A) to 4 (all four A's present). The difference in the 4A score between the first and last visit was determined. A combined endpoint of hospital admission due to right heart failure and cardiovascular mortality was defined.

Results
86 patients were included in this study (age 76±11 years, 70% female, 87% functional TR). At first visit, 92% were in NYHA class I or II and 77% had a 0 or 1 “4A score”. After a median follow-up of 24 months (IQR: 11–35 months), “4A score” was significantly impaired (score mean difference: 0.42±0.8) and only 59% remained with a 0 or 1 “4A score”. 32.6% of the patients (n=28) experienced the combined endpoint. The change in 4A score was a significant predictor of events (hazard ratio per unit 1.88 [1.22–2.88], p=0.004)

Conclusion
We demonstrate for the first time a new clinical score predictive of right heart failure and death in patients with significant TR.

Funding Acknowledgement
Type of funding sources: None.
SHARPEN score: an independent predictor of survival after infective endocarditis discharge
Authors: Pivatto Junior F , Sganzerla D , Terra D H , Filippini F B , Seroiska G , Dannenhauer G P , Bischoff H M , Birk L F S , Alves S G , Miglioranza M H 
Published: October 2021

Abstract

Background
Infective endocarditis (IE) presents high mortality even in patients that were adequately treated. Proper identification of these patients is imperative for better care delivery. SHARPEN score (Systolic BP, Heart failure, Age, Renal function, Pneumonia, Elevated peak CRP, and Non-intravenous drug abusers) was validated to predict in-hospital mortality due to IE; its performance in predicting survival after hospital discharge, however, has not yet been evaluated.

Purpose
To assess the SHARPEN score in predicting survival after hospital discharge due to IE.

Methods
Retrospective cohort study including all patients ≥18 years discharged after definitive IE (modified Duke criteria) admission at a public tertiary teaching hospital in southern Brazil, between 2000–16. Only the first hospitalization for IE was considered in those patients with &gt;1 admission for that reason in the studied period. The SHARPEN score was calculated at admission, and each patient was classified as low-moderate (2–10 points) or high (11–20 points) risk. Follow-up was carried out through the review of medical records, and the assessed outcome was death by any cause. Survival analysis was performed using the Kaplan-Meier curves, which were compared using the Log-rank test.

Results
A total of 135 patients (mean age: 53±17 years, 97 [72%] male) were discharged after IE episode. Staphylococcus aureus was the main etiologic agent (29 [21.5%]), and cardiac surgery was performed in 54 (40%) patients. The median SHARPEN score was 9 (IQR: 7–11 points), being classified as low-moderate risk (96 [71%]) and high risk (39 [29%]) patients, respectively. Median post-discharge follow-up was 3.4 (IQR: 0.19–9) years (682 patient-years), with 37 deaths during the period. Mean post-discharge survival was 12.4 years (95% CI: 10.7–14), significantly higher in patients classified as low-moderate risk (13.7 years) in comparison to high risk (8.4 years) (Log-rank P=0.006; Figure).

Conclusion
Patients classified as high-risk by SHARPEN score during IE admission present significantly higher mortality after discharge, despite being effectively treated for the IE episode. SHARPEN score could also be used to assess morbimortality after discharge, helping to implement special care programs for high-risk patients.

Funding Acknowledgement
Type of funding sources: None.