bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic impact of left ventricular ejection fraction improvement after transcatheter aortic valve replacement
Authors: Reichl J , Stolte T , Pfenniger A , Boeddinghaus J , Leibundgut G , Kaiser C , Nestelberger T 
Published: October 2024

Abstract

Introduction
Transcatheter aortic valve replacement (TAVR) has become an efficient and save alternative to surgical aortic valve replacement (SAVR). While severe aortic stenosis as well as severe aortic regurgitation (AR) is known to negatively impact left ventricular ejection fraction (LVEF), prior studies have shown that TAVR can lead to improvement in LVEF. So far, little is known about the prognostic implication of LVEF-improvement as a sole predictor of outcomes.

Purpose
The aim of this study was to assess the prognostic significance of early LVEF improvement in patients undergoing TAVR.

Materials and Methods
Patients undergoing TAVR in a large tertiary university hospital have been consecutively included in a large prospective registry. Transthoracic echocardiography (TTE) was performed at baseline, after TAVR before discharge, at 1 month and annually thereafter. Significant LVEF improvement was defined as &gt;10% relative increase of LVEF at 30 days compared to baseline LVEF. Primary outcome was all-cause mortality at 5 years. Secondary outcome were major adverse cardiovascular events (MACE), including death, non-fatal myocardial infarction, stroke, bleeding and unplanned re-interventions of the aortic valve.

Results
Among 1481 patients undergoing TAVR between September 2011 and June 2023, LVEF at baseline and at 30 days was available in 1013 patients. 665 patients (65.6%) had normal LVEF at baseline, whereas 348 patients (34.4%) had a reduced LVEF. Of these, 137 patients (13.5%) showed significant improvement of LVEF ≥10%) after 30 days, while 266 patients (26.3%) showed no significant LVEF-improvement (&lt;10%). The combined patients with persevered LVEF at baseline had significantly better outcomes than those with impaired EF (p=&lt;0.001). LVEF improvement was not associated with mortality at 5 years (p= 0.51), however with lower MACE rate at 5 years (p=0,024).

Conclusion
Normal LVEF before TAVR is an independent predictor for improved outcomes. In addition, early improvement of LVEF is associated with beneficial outcomes in patients undergoing TAVR.Course of LVEF after TAVROutcomes after TAVR
Predisposing and precipitating factors of post-operative delirium after transfemoral TAVI
Authors: Steinhaus K , Neuschaefer S , Beuthner B E , Waeschle R , Toischer K , Hasenfuss G , Puls M 
Published: October 2024

Abstract

Background
Transcatheter aortic valve implantation (TAVI) represents the treatment of choice for aortic stenosis (AS) patients at higher age (&gt; 75y) or with relevant comorbidities. Post-operative delirium (POD) is a frequent complication which has been associated with worse outcome. Thus, preventive options are highly needed. The aim of our single-center study was to investigate predisposing and precipitating factors of POD after transfemoral TAVI, with a focus on the influence of anaesthesia.

Methods
Risk factors for POD after TAVI were analysed in 2 merged cohorts of 480 study patients (43% women; mean age 80 years), enrolled in 2017-2022 (n=375, TAVI in 95% in general anaesthesia) and in 2022-2024 (n=105, TAVI in 91% in local anaesthesia). Incidence of POD was evaluated retrospectively by nursing documentation, medical records, and DRG coding. The association of demographics, comorbidities, echo parameters, procedural parameters, anaesthesia, and peri-procedural complications with POD incidence was investigated.

Results
In total, 29 patients (6%) developed POD, with a tendency towards a lower incidence in the later cohort (6.7% vs. 3.8%; p=0.28). Regarding baseline characteristics, patients experiencing POD were more likely to be male (p=0.03), frail (Katz Index &lt;6, p=0.049), and to suffer from low-gradient AS (p=0.005 for paradoxical, p=0.02 for classical low-flow, low-gradient AS; see also fig. 1A). Total procedure time was significantly longer in patients with POD (median, 86 vs. 62 min, p=0.004; fig 1B), and a tendency towards a more frequent implantation of other than ballon-expandable valves could be observed (p=0.07). Concerning the role of anaesthesia, POD did not differ significantly after general anaesthesia (n=24/360, 6.7%), conscious sedation (n=1/19, 5.3%), and local anaesthesia (n=4/100, 4%) (p=0.38). Regarding procedural complications, POD patients were characterized by lower minimum hemoglobin post-TAVI (9.3 vs. 10.1 g/dl, p=0.05; fig. 1C) and higher incidences of intra-procedural resuscitation (11% vs. 2%, p=0.03), cerebrovascular accidents (10% vs. 2%, p=0.04) and new permanent pacemaker implantations (25% vs. 10%, p=0.02).
In POD patients, long-term survival after TAVI was significantly reduced, with a median survival of only 2 years (Kaplan-Meier curves in fig. 2; p=0.001).

Conclusions
POD after TAVI stays common and unfavourable. The role of anaesthesia seems less pronounced than expected. Total procedure time and relevant anaemia after TAVI emerged as most important modifiable risk factors. Future research is warranted, since strategies to reduce precipitating factors for POD may have a significant impact on post-TAVI outcomes.Selected risk factors for PODConsequence of POD: Reduced Survival
Transcatheter aortic valve implantation in failed bioprosthetic or native valves: a systematic review and meta analysis
Authors: Kaddoura R , Dakhil Z , Ahmed A , Al-Hijji M 
Published: October 2024

Abstract

Background and purpose
Currently, there is no comparative assessment of pooled clinical outcomes between valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) for either failed transcatheter or surgical bioprosthetic aortic valves (TAV or SAV) and native aortic valve TAVI (NV-TAVI) for aortic stenosis. Thus, this systematic review investigated the clinical outcomes of ViV-TAVI compared with NV-TAVI.

Methods
A meta-analysis was conducted according to Cochrane Handbook and the PRISMA statement. A systematic literature search was performed, using EMBASE and MEDLINE from inspection to December 25, 2023, to explore the comparative outcomes between ViV-TAVI and NV-TAVI. RStudio software was used to calculate pooled odds ratio (OR) with 95% confidence intervals (CI). Random-effects model was used to allow a more conservative assessment.

Results
Eighteen cohort studies (n=65,350) met eligibility criteria. Studies were categorized into 2 groups according to initially implanted bioprosthetic valve: TAV-in-TAV (5 studies, n=14490) and TAV-in-SAV implantation (13 studies, n=50860). Each ViV-TAVI group was compared with NV-TAVI.
TAV-in-TAV implantation: There were no significant differences in all-cause mortality or stroke rates at ≥ 12 months between groups. The follow-up period was 12 months in all studies except in one (i.e., 24 months). Sensitivity analyses, by removing that study, did not show difference for both outcomes [(OR=1.25, 95%CI: 0.72-2.18) and (OR=1.14, 95%CI: 0.59-2.20), respectively].
TAV-in-TAV implantation was associated with higher rates of permanent pacemaker (PPM) insertion (OR=1.78, 95%CI: 1.10-2.88) within 30-day of follow-up. PPM insertion rate remained higher by 34% (OR=1.34, 95%CI: 1.02-1.76) even after removing the study that reported PPM insertion during index admission. Early conversion to open heart surgery and coronary occlusion (OR=3.75, 95%CI: 0.99-1417) did not differ between groups.
TAV-in-SAV implantation: TAV-in-SAV implantation did not significantly reduce the risk of all-cause mortality, but stroke risk was reduced by 19% at ≥ 12 months follow-up. Sensitivity analyses by removing the studies with 24 months follow-up yielded comparable results [(OR=0.88, 95%CI: 0.64-1.21) and (OR=0.81, 95%CI: 0.70-0.94), respectively].
TAV-in-SAV implantation was associated with lower rates of PPM insertion compared with NV-TAVI (OR=0.33, 95%CI: 0.17-0.62) within 30-day of follow-up. The risk remained significantly lower by 69% (OR=0.31, 95%CI: 0.10-0.92) upon removing the studies that reported PPM insertion during the index admission. Early conversion to open heart surgery and coronary occlusion (OR=1.88, 95%CI: 0.82-4.32) did not differ between groups.

Conclusion
In comparison with NV-TAVI, TAV-in-TAV implantation was associated with higher PPM insertion rates, whereas, TAV-in-SAV implantation was associated with lower stroke and PPM insertion rates without an impact on mortality.
Long-term outcomes after transcatheter aortic valve implantation: derivation and validation of the long-TAVI prediction model
Authors: Wenzl F A , Savvoulidis P , Wang P , Al-Och T , Yakupoglu H Y , Sukumar S , Baumann F , Davies M , Dalby M , Kabir T , Panoulas V , Mirsadraed S , Kalogeropoulos A P , Luescher T F 
Published: October 2024

Abstract

Background
Identification of high-risk individuals after transcatheter aortic valve implantation (TAVI) is essential to personalized care. Established risk models require a plethora of variables, fail to account for biomarker dynamics and imaging parameters, mostly focus on the short term, and offer limited predictive performance.

Purpose
We aimed to develop an easily applicable prediction model for long-term mortality or heart failure (HF) admission following TAVI.

Methods
Patients undergoing TAVI at a high-volume university centre in the United Kingdom (n = 990) were recruited into a prospective cohort study. Enrolled patients were divided into a development cohort (07/2007 – 12/2016) and a validation cohort (01/2017 – 11/2018) and followed for up to 15.1 (median 5.3, interquartile range [IQR] 2.8 – 7.4) years. Patient characteristics along with pre- and post-procedural imaging results and brain natriuretic peptide (BNP) levels before the procedure and at 3 months were recorded. A clinical risk score for long-term mortality and HF admission (i.e., Long-TAVI risk score) was derived using Cox regression and evaluated using time-dependent area under the receiver operating characteristics curve (AUC).

Results
Age at presentation was 79.8 (standard deviation [SD] 8.9) years, 961 (99.0%) patients had signs of heart failure, left ventricular ejection fraction was 52 (SD 11.2), and pre-TAVI BNP levels were 298.0 (interquartile range [IQR] 159.0 – 571.5) pg/mL. High BNP levels at presentation (higher vs. lower than 400 pg/mL: HR 1.50, 95% CI 1.17 – 1.92, P &lt; 0.001) and dynamic changes in BNP with the first 3 months (low/high vs. low/low: 2.61, 95% CI 1.17 – 5.86, P = 0.020; high/high vs. low/low: 2.41, 95% CI 1.26 – 4.64, P = 0.008) were independent predictors mortality or HF admission. The simple 8-item Long-TAVI score accounts for periprocedural BNP dynamics and shows good discrimination (AUC 0.76, 95% CI 0.72 – 0.79) and calibration in the development cohort performing similarly well in the external validation cohort (AUC 0.70, 95% CI 0.63 – 0.77). Long-TAVI significantly outperformed the logistic EURO score (AUC 0.56, 95% CI 0.52 – 0.59, P &lt; 0.001).

Conclusion
Both pre-TAVI BNP levels and periprocedural BNP trajectories are independently associated with long-term outcomes after TAVI. Accounting for clinical characteristics, imaging parameters, and circulating BNP levels, the newly developed Long-TAVI risk score achieves high performance and provides the first prediction model for long-term mortality or HF admission. Long-TAVI represents a novel tool for personalized risk assessment in patients undergoing TAVI.Correlation at baseline A) and FUP B)Score performance A) and risk groups B)
Leveraging mixed reality in mitraclip implantation: A preliminary case series toward a pilot study
Authors: Hecko J , Jiravsky O , Januska J , Hudec M , Precek D , Gajdusek L , Ranic I , Neuwirth R , Sknouril L 
Published: October 2024

Abstract

Introduction
The advent of mixed reality (MR) technology, particularly when combined with Hololens 2.0 and specialized software for three-dimensional DICOM image visualization, offers a promising avenue for enhancing the precision and spatial awareness in interventional cardiology procedures. This case series aims to preliminarily evaluate the impact of MR on MitraClip implantation processes, setting a foundation for an ensuing comprehensive pilot study.

Methods
We conducted a comparative analysis within a case series of four MitraClip implantations, categorizing them into two groups based on the utilization of MR support. We examined procedural efficiency, radiation metrics (SKIA and DAP), and operator stress indicators, including cortisol levels, heart rate variability, QTc interval, and subjective assessments through NASA TLX, STAI Y, and SSQ questionnaires.

Results
Initial findings from the MR-assisted procedures suggest a notable improvement in procedural efficiency and a reduction in operator stress. Specifically, MR use was associated with shorter procedural times (ranging from 60 to 130 minutes) and lower radiation exposure, with SKIA durations between 15.5 and 40.5 minutes. Moreover, operators in the MR group showed reduced cortisol levels (8.2-9.2 mmol/L), indicating decreased physiological stress. Heart rate variability analysis further supported superior stress management among MR-supported operators.
Subjective evaluations reinforced these physiological findings. NASA TLX scores in the MR group (13-20) markedly contrasted with those in the control group (30-45), signifying a significant reduction in perceived workload. SSQ scores remained minimal, implying good MR tolerability, and STAI Y scores (30-35) were lower than those in the control group (40-50), highlighting reduced anxiety levels during MR-assisted procedures.

Conclusion
This explorative case series lays the groundwork for a forthcoming pilot study, revealing MR's potential to not only streamline MitraClip implantation but also to alleviate operator stress. Both objective and subjective data advocate for expanded research to definitively ascertain MR's benefits in cardiac interventions, promising to refine procedural workflows and enhance patient outcomes. This series acts as a stepping stone towards a larger-scale evaluation that could solidify MR's role in the future of interventional cardiology.Operator's View and Technology PreviewFunction diagram
Right ventricular-pulmonary artery coupling and clinical outcomes after mitral transcatheter edge-to-edge repair: A meta-analysis
Authors: Theofilis P , Mantzouranis E , Vlachakis P K , Sakalidis A , Soulaidopoulos S , Tsioufis K 
Published: October 2024

Abstract

Introduction
Mitral transcatheter edge-to-edge repair (TEER) has gained prominence in the realm of cardiovascular care, as it has been proven to improve patient prognosis and quality of life. While the primary focus of such interventions is the mitral valve itself, understanding the broader impact of right ventricular function and pulmonary artery dynamics is crucial for a comprehensive assessment of clinical efficacy and patient outcomes. A newly recognized index, right ventricular-pulmonary artery (RV-PA) coupling, reflects the RV's ability to handle pulmonary afterload and is associated with adverse outcomes.

Purpose
This meta-analysis consolidates findings from diverse studies to systematically evaluate the association between RV-PA coupling parameters and the success of mitral TEER.

Methods
We conducted a systematic literature search for studies assessing RV-PA coupling indices at baseline in patients undergoing mitral TEER. We recorded the year of publication, method of RV-PA assessment, and the proposed cutoffs. The primary outcome of interest was the combined primary endpoint of included studies at maximal follow-up and the adjusted hazard ratios of RV-PA uncoupling were extracted if they were available. Secondary outcomes included mortality and post-operative mitral regurgitation at follow-up. Pooling of the hazard ratios was conducted according to a random effects model. I2 was chosen as the measure of between-study heterogeneity, with values exceeding 50% being significant.

Results
We identified a total of 316 studies, of which 8 were ultimately selected for data extraction and inclusion in the meta-analysis after screening of title/abstract/full-text. All but one study utilized the Tricuspid Annular Plane Systolic Excursion/Pulmonary artery systolic pressure (TAPSE/PASP) as the method of RV-PA assessment. According to the results of the meta-analysis, the presence of baseline RV-PA uncoupling was associated with a 2.3-fold increased risk of facing the combined primary endpoint at maximal follow-up (Figure, Panel A). All-cause mortality was also approximately 2.2-fold higher in cases of RV-PA uncoupling (Figure, Panel B). Finally, post-operative MR was 1.4-fold higher in cases of RV-PA uncoupling (Figure, Panel C). Significant between-study heterogeneity was detected in all the examined endpoints.
Conclusion: This meta-analysis indicates that RV-PA uncoupling at baseline represents an important prognostic marker in patients undergoing mitral TEER.Figure
The impact of multimorbidity on cardiac remodelling in the UK Biobank
Authors: Shyam-Sundar V , Nicholls H , Chadalavada S , Vargas J , Slabaugh G , Mohiddin S , Petersen S , Aung N 
Published: October 2024

Abstract

Background/Introduction
Previous work has suggested that multimorbidity is associated with higher all-cause mortality and cardiovascular mortality in the UK Biobank (UKB). The impact of multimorbidity on cardiac remodelling as measured by cardiovascular magnetic resonance (CMR) has not been studied in large cohorts.

Purpose
To determine if CMR biomarkers act as surrogates for adverse cardiovascular outcomes in multimorbidity.

Method
We analysed 44957 UKB participants who had CMR. Self-reported cancer (UKB field ID 20001) and non-cancer illnesses (UKB field ID 20002) were used to calculate comorbidity count with multi-morbidity defined as 2 or more illnesses. The predictive value of comorbidity count (exposure counts measured in quintiles) on CMR traits (outcomes) was evaluated using a univariable and multivariable generalised linear model. Covariates included sex, age, BMI, smoking status, regular alcohol intake, and the Townsend deprivation index, a measure of socioeconomic deprivation. The first model utilised univariable regression without covariates with subsequent iterations including age and sex and then all covariates. An interaction term was included for age and sex and a quadratic term for age in the models. CMR outcome measures were indexed left ventricular mass (LVM), indexed left ventricular end diastolic volume (LVEDV), indexed left ventricular end systolic volume (LVESV), indexed left ventricular stroke volume (LVSV), left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), and indexed maximal left atrial volume (LA). The absolute value of GLS was used in the regression models. Variance inflation factor testing was used to check for collinearity. Analyses were completed using R v4.1.1.

Results
Median comorbidity count was 2. The burden of long-term conditions in this population of European ancestry with largely healthy individuals is lower than in other large population cohorts. Table 1 summarises multivariable analyses for comorbidity count, LVM and GLS. Due to high collinearity relating to age in the model, we centred age around the mean. LVM was higher with multimorbidity (top quintile Beta 0.63 (95% CI 0.23 to 1.04), P = 2.21x10-03). GLS was lower with multimorbidity (top quintile Beta -0.29 (95%CI -0.42 to 0.16), P = 8.10x10-6). LA volume was lower with multimorbidity (top quintile Beta -0.63(95% CI -1.22 to 0.04), P = 3.53 x 10-2). LVEF and other volume measures were not associated with multimorbidity.

Conclusion
Multimorbidity in this large cohort was associated with adverse cardiac structural and functional remodelling on CMR. These include a lower global longitudinal strain and higher LV mass.
Coronary bypass surgery guided by multislice computed tomography angiography in a low surgical risk population
Authors: Serruys P W , Kageyama S , Pompilio G , Andreini D , Pontone G , Mushtaq S , La Meir M , De Mey J , Tanaka K , Doenst T , Teichgraber U , Schneider U , Puskas J , Narula J , Onuma Y 
Published: October 2024

Abstract

Background
In patients with three-vessel disease and/or left main disease, selecting revascularization strategies based on coronary computed tomography angiography (CCTA) has a high level of virtual agreement with treatment decisions based on invasive coronary angiography(ICA).(1)

Purpose
The FASTTRACK CABG trial aims to assess the feasibility and safety of using CCTA and FFRCT as guidance for planning and performing CABG in patients with 3VD and/or LMCAD.

Methods
In this multicentre study, coronary artery bypass grafts (CABG) were planned and performed based on CCTA without knowledge of ICA. CABG strategy was recommended by a central Core laboratory assessing the anatomy and functionality of the coronary circulation. The primary feasibility endpoint was the percentage of operations performed without access to the ICA. The primary safety endpoint was graft patency on 30-day follow-up CCTA. Secondary endpoints included topographical adequacy of grafting, major adverse cardiac and cerebrovascular events (MACCE), and major bleeding events at 30 days. The study was considered positive if the lower boundary of confidence intervals(CI) for feasibility ≥75%.(2)

Results
The study enrolled 114 patients with a mean (standard deviation) anatomical SYNTAX Score and Society of Thoracic Surgery score of 43.6 (15.3) and 0.81 (0.63), respectively. Three patients did not undergo CABG due to the patient’s preference for percutaneous treatment (n=1) or lack of graft material. Unblinding ICA was required in one case, yielding a feasibility of 99.1% (95%CI: 95.2%-100%). The concordance and agreement in revascularization planning between the ICA- and CCTA-Heart Team was 82.9% with a moderate kappa of 0.58 (95%CI:0.50-0.66). The concordance and agreement in revascularization planning between the CCTA-Heart Team and actual treatment was 83.7% with a substantial kappa of 0.61 (95%CI:0.53-0.68). The 30-day follow-up CCTA was performed in 102 (91.9%) of the 111 operated patients, which showed an anastomosis patency rate of 92.6%. At 30 days, the incidence of MACCE was 7.2% whereas major bleeding was 2.7%.

Conclusions
CABG guided by CCTA is feasible and has an acceptable safety profile in a selected population of complex coronary artery disease.