bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic impact of lean diabetes mellitus on aortic stenosis
Authors: Ong J , Leow A , Ching K , Kong W , Yeo T C , Sia C H , Poh K K 
Published: October 2024

Abstract

Background
Obesity and type 2 diabetes mellitus (DM) has traditionally been thought to coexist. Lean DM is a distinct condition defined by body mass index (BMI) &lt; 25, associated with elevated insulin resistance, rapid beta-cell failure, absence of ketosis and malnutrition. Lean DM has been linked to poor cardiovascular outcomes, but remains an understudied entity in valvular heart disease.

Purpose
This study aims to demonstrate the prognostic implications of lean DM on aortic stenosis (AS).

Methods
Between 2011 to 2021, 700 consecutive patients with index echocardiographic diagnoses of aortic stenosis were stratified into 4 groups, namely lean (BMI &lt; 25) DM, lean non-DM, obese (BMI &gt; 25) DM, and obese non-DM. Demographics, co-morbidities, echocardiographic findings and clinical outcomes were collected. Clinical outcomes were compared using Kaplan-Meier curves and a multivariate Cox regression model was constructed.

Results
396 (56.6%) patients were female, and 435 (62.1%) patients were of Chinese ethnicity. 279 (39.9%) patients had DM, of whom 155 (55.6%) patients had lean DM. The mean BMI in the lean group was 21.4 ± 2.4 kg/m² compared to 29.5 ± 4.9 kg/m² in the obese group. Irregardless of BMI, higher proportions of DM patients were on baseline antiplatelets and statins compared to non-DM patients. Echocardiographically, obese DM had smaller indexed left ventricular volumes and mass - left ventricular end diastolic volume index (LVEDVi) (65.7 ± 21.7 ml/m² vs. 70.8 ± 23.6 ml/m², p = 0.002) and left ventricular mass index (LVMi) (115.7 ± 31.9 g/m² vs. 116.3 ± 36.5 g/m², p = 0.401) compared to lean DM respectively. Obese DM was associated with more cardiovascular risk factors compared to lean DM in terms of hypertension (91.9%, n = 114 vs. 89.0%, n = 138, p &lt; 0.001), hyperlipidaemia (82.3%, n = 102 vs. 73.5%, n = 114, p &lt; 0.001) and chronic kidney disease (50.8%, n = 62 vs. 45.5%, n = 70, p &lt; 0.001). On the contrary, lean DM was associated with more cardiovascular sequelae of acute myocardial infarction (36.8%, n = 57 vs. 24.2%, n = 30, p &lt; 0.001) compared to obese DM. AS patients with lean DM experienced the highest significant all-cause mortality (71%, n = 110 in lean DM vs. 58.9%, n = 73 in obese DM vs. 49.1%, n = 86 in obese non-DM vs. 65%, n = 160 in lean non-DM, p &lt; 0.001) compared to all other groups. On the contrary, AS patients with lean DM had the lowest heart failure incidence (17.4%, n = 27 in lean DM vs. 23.4%, n = 29 in obese DM vs. 33.1%, n = 58 in obese non-DM vs. 23.2%, n = 57 in lean non-DM, p = 0.009). On multivariate analyses adjusted for age, comorbidities, and echocardiographic parameters, lean DM was an independent predictor of worse all-cause mortality in AS patients (HR 1.60, CI: 1.19 - 2.16, p = 0.010).

Conclusion
Lean DM in AS patients was associated with worse all-cause mortality. Lean DM was a prognostic marker of all-cause mortality in patients with AS.Figure 1
Late iodine enhancement quantification by computed tomography: a comparison study against cardiac magnetic resonance imaging
Authors: Garcia Sebastian C , Monteagudo Ruiz J M , Antonana Ugalde S , Carrion Sanchez I , Hinojar Baydes R , Garcia Martin A , Martinez Vives P , Casas Rojo E , Jimenez Nacher J J , Moreno Planas J , Zamorano Gomez J L , Fernandez-Golfin Loban C 
Published: October 2024

Abstract

Introduction
Cardiac computed tomography (CT) has emerged as a promising alternative to cardiac magnetic resonance (CMR) for myocardial characterization. However, the quantification of late iodine enhancement (LIE) and its threshold values have not been previously reported. The Full Width Half Maximum (FWHM) technique established a cut-off value of 50% of the maximum intensity signal to quantify late gadolinium enhancement (LGE) in CMR. Nevertheless, the distinction between healthy and fibrotic myocardium in CT is less pronounced, prompting the need for specific threshold values for accurate quantification of LIE with this technique.

Purpose
Our primary aim was to validate and determine the optimal cut-off values for quantifying LIE using cardiac CT.

Methods
We included consecutive patients who underwent both LIE and LGE within a period of less than 2 months. Late enhancement quantification was performed using a commercially available software (figure 1). The FWHM technique was applied for LGE quantification. Various signal density cut-off values (70%, 75%, 80%, 85%, and 90%) were explored for LIE quantification. The total myocardial mass, total scar mass and scar proportion were calculated. The Intraclass Correlation Coefficient (ICC) was computed for each of the specified cut-off values.

Results
From November 2022 to February 2024, 58 patients underwent cardiac CT with LIE. Among them, 17 patients (48 (33;59) years; 13 (68,4%) male) had concomitant LGE and were included in the final analysis. The most common indication for CT was myocardial infarction with non-obstructive coronary arteries (52,9%).
The total myocardial mass by CT was 108.83 ± 21.69 g, while the total myocardial mass by CMR was 100.33 ± 25.19 g. The ICC between both techniques was good (0.78, p=0.001).
A cut-off value of 75% for the CT showed the strongest correlation with the CMR, both for total scar mass and scar proportion. Total scar mass was 9.43 ± 8.29 g for CT and 10.7 ± 8.46 g for CMR, with an ICC of 0.68 (p=0.01). Scar proportion was 9.97 ± 8.26% for CT and 11.09 ± 9% for CMR, showing a good correlation (ICC 0.73, p=0.006).

Conclusion
Late iodine enhancement quantification by cardiac computed tomography is feasible. A signal density threshold of 75% showed the strongest correlation with the cardiac magnetic resonance.Example of late iodine enhancement
Symptoms trend in patients with obstructive hypertrophic cardiomyopathy treated with disopyramide
Authors: Todde G , Lupo Dei L , Polizzi R , Gabrielli D , Canciello G , Romano S , Borrelli F , Halasz G , Ordine L , Pacella D , Bossone E , Lombardi R , Esposito G , Re F , Losi M A 
Published: October 2024

Abstract

Background
In obstructive hypertrophic cardiomyopathy (HOCM) medical intervention becomes necessary when symptoms coexist, whereas invasive septal reduction therapy (SRT) is indicated in presence of NYHA class &gt;II, although optimized medical therapy. Thus, if SRT is avoided by medical therapy patient should be considered responder. However, due to inconsistency on definition of responders, effectiveness of medical therapy among data are conflicting. In addition, only short follow-up (FU) is available for analyses.

Purpose
To address this, we conducted a retrospective analysis in two HCM centers, both defining responders based on guidelines recommendations.

Methods
62 symptomatic HOCM patients (43% women, age 52±14 years) with LVOTG ≥50 mmHg at rest or during provocation, were recruited from two HCM Italian centers. Disopyramide was added as second-line therapy. Responders were those reaching at least NYHA class II, if &gt;II at baseline and those reaching NYHA class I or with stabilization of symptoms if in NYHA II class at baseline.

Results
At FU, (mean 4.4 years, IQR 1.1-6.6 years), 47 patients (76%) were responders, whereas 15(24%) patients were no-responders. Changes in NYHA class from baseline to follow-up are reported in the Figure. There were no differences at baseline of clinical and echocardiographic data between responders and no-responders, whereas at FU responders showed a significant lower LVOTG than no-responders (43 ±32 vs 66 ±28 mmHg, respectively, p=0.013), with LVOTG &lt;50 mmHg more represented in responders than in no-responders (75% vs 25%, respectively; p=0.004) (Figure). No side effects indicating discontinuation of the therapy were recorded.

Conclusion
Patients treated with disopyramide as second-line therapy showed a reduction in symptoms in a quite long-follow-up, avoiding SRT in up to 70% of them. Patients who might benefit the most from the therapy are those who reached LVOTG &lt;50 mmHg during treatment.
The comparison of echocardiographic and serum parameters between Sapien 3 Ultra Resilia and Sapien 3 at one month
Authors: Kanehama N , Ninomiya R , Tosaka K , Yoshizawa M , Hashimoto N , Kumagai A , Fusazaki T , Morino Y 
Published: October 2024

Abstract

Background
Sapien 3 Ultra Resilia (S3UR) is the latest balloon-expandable valve for transcatheter aortic valve replacement (TAVR). Compared to Sapien 3 (S3), previous model of balloon-expandable valve, the leaflets are modified to anti-calcification tissue and the outer skirt becomes 40% higher with textured polyethylene terephthalate. However, it is unknown how these structural changes affect echocardiographic and serum parameters after TAVR.

Purpose
To compare impacts of these design changes on relevant echocardiographic and serum parameters between S3UR and S3 in the short term.

Methods
Patients with severe aortic valve stenosis who underwent TAVR with S3 or S3UR were included in this study. Echocardiographic parameters and blood samples were retrospectively collected at discharge and at 1 month post-procedure. Echocardiographic outcomes included mean pressure gradient (PG), effective orifice area index (EOAi), and paravalvular leak (PVL) grade. Hemolytic anemia indicators, specifically lactate dehydrogenase (LDH) and hemoglobin (Hb), were also assessed. Findings suggestive of hemolytic anemia at 1 month were defined as "an increase in LDH level of ≧200 IU/L as well as a decrease in Hb level of ≧1.0 g/dL from pre-procedure."

Results
Among 443 patients (S3: April 2020-March 2023, S3UR: April 2023-December 2023), 339 patients (S3: n=270, S3UR: n=69) were available for this study. The mean PG was significantly lower in the S3UR group compared to the S3 group at discharge and at 1 month (Figure 1A). On the other hand, the EOAi was similar between the two groups at discharge and at 1 month (Figure 1B). Although the prevalence of none/trace PVL was significantly higher in the S3UR group at discharge, this difference disappeared at 1 month (Figure 1C). LDH levels were significantly increased from pre-procedure to 1 month in both groups (Figure 2A). The median of ΔLDH (1 month – pre-procedure) and %change of LDH (ΔLDH/ pre-procedure) were significantly higher in the S3UR group. The prevalence of hemolytic anemia at 1 month was also significantly higher in this group (Figure 2B).

Conclusion
At 1 month, S3UR demonstrated superiority in mean PG but equivalence in EOAi and PVL grade compared with S3. Although both S3UR and S3 showed significant increase in LDH from pre-procedure to 1 month, hemolytic anemia was experienced more frequently in S3UR cases. Further evaluation will be needed to assess the potential clinical impacts of these differences.
Association between silent cerebral embolism and cognitive alterations following transcatheter aortic valve replacement in bicuspid versus tricuspid aortic valve patients
Authors: Huang Y , Fang Z , Zhou S 
Published: October 2024

Abstract

Background
Silent cerebral ischemic lesions (SCILs) is a common magnetic resonance imaging (MRI) finding in severe aortic stenosis patients post - transcatheter aortic valve replacement (TAVR). We evaluated the association between SCILs and cognitive alterations in patients with bicuspid aortic valve (BAV) versus tricuspid aortic valve (TAV) post-TAVR.

Methods
This study enrolled 100 consecutive TAVR (45 with BAV and 55 TAV). DW-MRI and neurocognitive evaluation (MoCA score) were performed at baseline, discharge, and 1- and 12-month post-discharge.

Results
Ninety-two out of the 100 patients (92%) exhibited cognitive dysfunction at baseline. Post-TAVR, overall cognitive function significantly improved, the average MOCA score increased from 18.69±6.74 to 22.18±6.30. During the 1-year follow-up, 54 patients demonstrated improved cognitive function, and the number of patients with moderate-to-severe cognitive dysfunction (MoCA score &lt; 18) significantly decreased from 32 to 16. Prevalence of SCILs was 14% and 72% at baseline and discharge, respectively. New SCILs were observed in 60 patients at discharge, distributed across all vascular territories, averaging 4 lesions with a total volume of 215.4±195.4mm3. Although no significant correlation existed between total volume of new SCILs and cognitive changes post-TAVR (R=-0.133, p=0.206), patients with SCILs still displayed significant cognitive improvement (MoCA score from 18.4±6.6 to 22.0±7.1), whereas patients who developed large SCILs (lesion diameter &gt;9) showed less improvement compared to those with small or median SCILs (number of patients who had cognitive improvement: 32 vs. 52, p&lt;0.05). Cognitive function improvement post-TAVR did not significantly differ between BAV and TAV patients, MoCA scores were comparable (BAV group, n=45, from 18.63±6.68 to 21.88±6.80 vs. TAV group, n=55, from 18.73±6.81 to 22.42±5.80; p&gt;0.05). DW-MRI revealed more new SCILs in BAV patients post-TAVR compare to TAV patients (235 lesions vs. 150 lesions, respectively). In BAV patients, SCILs primarily manifested in small and medium sizes (224 lesions), despite more severe calcification (valvular calcium volume 956.5±644.0 mm vs. 634.4±508.0 mm3; p=0.028). The number of large lesions was similar in the two groups (11 in BAV group and 10 in TAV group).

Conclusion
TAVR demonstrates positive effects on improving cognitive function in aortic stenosis patients, despite common occurrence of SCILs in both BAV and TAV patients. Cognitive function post-TAVR was comparable between BAV and TAV patients. The cognitive improvement from TAVR may be less impacted by small- and medium-sized SCILs, while severe SCILs might impede or diminish the cognitive benefits of TAVR.table
Mortality rates in patients undergoing urgent versus elective transcatheter aortic valve replacement: a systematic review and meta-analysis
Authors: Apostolos A , Ktenopoulos N , Chlorogiannis D D , Konstantinou K , Katsaros O , Drakopoulou M , Tsalamandris S , Karanasos A , Latsios G , Synetos A , Aggeli C , Panoulas V , Tsioufis C , Toutouzas K 
Published: October 2024

Abstract

Background
Patients with severe aortic stenosis (AoS) often present with acute heart failure and compensation, leading frequently to cardiogenic shock. Transcatheter Aortic Valve Replacement (TAVR) has been recently performed as a bailout treatment in such patients. The aim of our meta-analysis is to compare urgent TAVR to elective procedures.

Methods
We systematically screened three databases searching for studies comparing urgent versus elective TAVR. Primary endpoint is the 30-days mortality. Secondary endpoints included in-hospital mortality, device success, periprocedural vascular complications, 30-day stroke, 30-day acute kidney injury (AKI), permanent pacemaker implantation (PPM), moderate or severe paravalvular leakage and 30-day bleedings.

Results
Seventeen studies were included, with a total of 84,495 patients. Urgent TAVR was associated with an increased risk for 30-days mortality (RR: 2.53, 95% CI: 1.81 – 3.54), in-hospital mortality (RR: 2.67, 95% CI: 1.94 – 3.68), periprocedural vascular complications (RR: 1.91, 95% CI: 1.28 – 2.85) and AKI (RR: 2.83, 95% CI: 1.93 – 4.14), compared to elective procedure. No differences were observed in the rest secondary endpoints.

Conclusions
Urgent TAVR was associated with higher in-hospital and 30-day mortality, possibly driven by the increased incidence of AKI and vascular complications in urgent TAVR. The results highlight the importance of early TAVR in stable AoS patients.
Morphologic differences in atrial and ventricular secondary tricuspid regurgitation by computed tomography
Authors: Chua A P A , Lopez Santi P , Sarrazyn C , Wu H W , Bax J J , Ajmone Marsan N 
Published: October 2024

Abstract

Background
Differences in the mechanism behind atrial (ASTR) and ventricular (VSTR) secondary tricuspid regurgitation cause distinct remodeling in the tricuspid valve annulus (TA), right atrium (RA) and right ventricle (RV). Although these morphological changes have been described by echocardiography, computed tomography (CT) can provide better spatial resolution and detailed anatomical information particularly when planning valvular interventions.

Purpose
To compare the morphologic characteristics of the TA, RA and RV between ASTR and VSTR as measured by CT.

Methods
Patients with at least moderate secondary TR and who underwent CT were selected as follows: for the ASTR group (n=32), patients referred for atrial fibrillation (AF) ablation; for the VSTR group, patients referred for transcatheter aortic valve implantation, and which were further subdivided according to the presence of AF (with AF [n=51] and without AF [n=68]). Multiparametric echocardiographic approach was used to define TR severity. CT dataset were analyzed in diastole using a dedicated software for the following parameters: TA area, perimeter, antero-posterior (AP) and septal-lateral (SL) diameters, eccentricity index, annulus depth (to assess TA saddle shape), and RA and RV dimensions and volumes (Fig. 1).

Results
TR was more severe in VSTR, as 55% and 43% of patients had severe to massive TR in the VSTR group with and without AF, respectively, as compared to 12% in the ASTR group (p&lt;0.001). The TA area was significantly larger in the ASTR and VSTR with AF patients (Fig.2), with a trend towards a more circular annulus by eccentricity index. Annulus depth was lower (flatter) in ASTR compared to both VSTR groups. For the RA, annulus to roof distance was larger in VSTR patients with AF, but the diameter width was wider for both ASTR and VSTR with AF. Indexed RA volume was larger in the VSTR with AF compared to both ASTR and VFTR without AF. The RV, on the other hand, showed a wide base and narrow mid in the ASTR group, both a wide base and mid in the VSTR group with AF, and slightly narrower base and wider mid in the VSTR without AF. RV base-to-mid ratio was lower for both VSTR groups compared to ASTR, but volumes did not significantly differ. RA-to-RV-volume ratio, however, was higher for the ASTR and VSTR with AF.

Conclusion
Remodeling of the TA and right chambers differ significantly between TR etiologies. ASTR is characterized by a larger and flatter TA, a widened RA and RV base, narrow RV mid, and almost proportional RA-to-RV volumes. VSTR remodeling differs with the presence of AF, as those without AF have a smaller and deep TA, smaller RA, a proportional dilatation of RV diameters, and a larger RV compared to RA. Differentiating these patterns may be useful to guide future interventions.
Effect of patient prosthesis mismatch on clinical outcomes following surgical aortic valve replacement
Authors: Lewin S , Budgeon C , Courtney W , Ng P , Graham G , Waller L , Butcher S , Gilbert T , Briffa T , Sanfilippo F , Hillis G , Ihdayhid A 
Published: October 2024

Abstract

Introduction
Patient prosthesis mismatch (PPM) after surgical aortic valve replacement (SAVR) occurs when the valve’s effective orifice area (EOA) does not allow appropriate cardiac output to meet demand, causing increased transvalvular gradients. The literature is conflicting regarding the effect of PPM on long-term mortality and other adverse outcomes.

Purpose
To characterise the effect of PPM on all-cause mortality, cardiovascular death, heart failure hospitalisation and major adverse cardiac events (MACE; a composite of cardiovascular death, myocardial infarction, and stroke) following SAVR, stratified by sex.

Methods
This retrospective cohort study uses data from the Western Australia Heart Valves Study linked to administrative health data and includes all patients who underwent SAVR in Western Australian public hospitals between 2010-2020. PPM was defined according to the Valve Academic Research Consortium 3 criteria. The indexed EOA was derived from body surface area and published in-vivo EOA’s calculated for each prosthesis model and size.

Results
During the study period 1837 patients underwent SAVR (mean age 65 ± SD 14 years, 31% female). Median follow-up was 3.76 years (IQR 1.73-6.62). A mechanical prosthesis was implanted in 579 (32%) patients. Moderate or severe PPM was present in 250 (14%) patients, whilst no significant PPM was present in 1587 (86%) patients. Compared to those without significant PPM, patients with PPM were older (69 ± 14 vs 64 ± 11 years; p&lt;0.001); included more women (101/250; 40% vs 459/1587; 29%; p&lt;0.001) and were more likely to have bioprosthetic SAVR (213/250; 85% vs 1045/1587; 66%; p&lt;0.001). The presence of PPM (moderate or severe vs no significant PPM) was associated with increased all-cause death (Hazard Ratio (HR) 1.74, 95% CI 1.09-2.75), cardiovascular death (HR 2.44, 95% CI 1.33-4.48) and MACE (HR 1.89, 95 CI 1.17-3.04) in females in adjusted analyses, but not males (table). The presence of PPM was not associated with heart failure hospitalisation, overall or in either sex.

Conclusion
The presence of moderate or severe PPM is associated with increased all-cause death, cardiovascular death, and MACE in females only. These results highlight the importance of patient selection, valve choice and operative technique to minimise PPM, particularly in female patients.Table 1
Outcomes of CT- or CMR-guided TAVR according to sex: a secondary analysis of the randomized TAVR-CMR trial
Authors: Oberhollenzer F , Lechner I , Reindl M , Tiller C , Holzknecht M , Von Der Emde S , Binder R K , Klug G , Bauer A , Mayr A , Reinstadler S J , Metzler B 
Published: October 2024

Abstract

Background
Previous studies have reported sex differences in pre-procedural imaging characteristics of patients undergoing transcatheter aortic valve replacement (TAVR) evaluation. Whether these differences affect the outcome of computed tomography (CT)-guided or cardiac magnetic resonance (CMR)-guided TAVR has not been studied.

Objectives
This analysis aimed to evaluate sex-based differences in imaging findings and outcomes in patients undergoing TAVR for severe aortic valve stenosis.

Methods
This was a secondary analysis of the TAVR-CMR trial, a randomized clinical trial comparing TAVR planning by CT or CMR. Outcomes (based on the Valve Academic Research Consortium (VARC)–2 definition) with each imaging strategy were compared according to sex.

Results
Of 380 patient randomized into the TAVR-CMR trial, 194 (51.1%) were female and 186 (48.9%) were male. Of these, 267 patients eventually underwent TAVR (133 women (49.8%) and 134 men (50.2%), p=0.457). Imaging findings differed between the sexes for both imaging modalities. The comparison between CT and CMR to assess the access route and landing zone showed no difference in both women and men (all p&gt;0.05). Implantation success was not significantly different between imaging strategies for both women (84.7% (CT group) vs. 93.2% (CMR group), p=0.11) and men (95.7% (CT group) vs. 93.8% (CMR group), p=0.61). All-cause mortality at 6 months was not significantly different between imaging strategies for both women (10.2% (CT group) vs. 8.1% (CMR group), p=0.68) and men (4.3% (CT group) vs. 9.4% (CMR group), p=0.24).

Conclusions
This secondary analysis has confirmed sex-related differences in pre-procedural imaging characteristics, with no influence of the imaging modality used. Similar outcomes were observed in both female and male patients when the TAVR was guided by either a CMR or a CT scan.