bluuebunny/crossref_metadata_2025_split huggingface dataset:
Natural progression of rheumatic aortic valve disease following rheumatic mitral valve intervention: 16-year single center experience
Authors: Kim S H , Park Y H , Lee S H , Lim J H , Je H G , Lim M H , Ju M H , Lee C H 
Published: October 2024

Abstract

Backgrounds and Objectives
Recognizing the natural progression of the aortic valve (AV) disease is helpful in planning the intervention of significant rheumatic mitral valve (MV) disease accompanying rheumatic AV disease. We aimed to investigate the long-term course of AV disease and the need for AV surgery in patients with rheumatic mitral valve disease who underwent MV intervention.

Methods
We retrospectively investigated the progression of AV disease with rheumatic changes following MV intervention in a single tertiary center. A total of 890 patients who underwent MV intervention for rheumatic MS or mitral regurgitation (MR) without concurrent AV intervention were initially screened for eligibility. Among them, 76 patients met the criteria for rheumatic etiology and had over a year of echocardiographic follow-up after MV intervention (64 surgery, 12 balloon valvuloplasty).

Results
The median follow-up period was 4 years (mean 5.8 years, ranging from 1 to 31 years). MS was the most common indication for mitral intervention. Overall, trans-aortic peak velocity (AV Vmax) changed from 2.2 ± 0.6 m/s to 2.4 ± 0.8 m/s, and mean pressure gradient (mean PG) changed from 11.1 ± 6.0 mmHg to 13.2 ± 8.2 mmHg. Six patients fell under severe aortic stenosis (AS) definition-wisely (Figure 1) and three of them were classified as low flow low gradient severe AS despite normal ejection fraction. Eventually, four patients were found to have true-severe AS and only one of them underwent AV surgery for severe AS per se. None of the patients with aortic regurgitation deteriorated to severe (Figure 2).

Conclusions
Only a small portion of rheumatic AV involvement progresses to severe AS after MV intervention, and performing MV intervention for severe mitral stenosis or mitral regurgitation in patients with concurrent mild or moderate AS or aortic regurgitation due to rheumatic changes might be reasonable.The changes in the grading of ASThe changes in the grading of AR
Clinical outcomes and impact of mitral valve surgery in atrial functional mitral regurgitation: the REVEAL-AFMR registry
Authors: Kagiyama N , Kaneko T , Amano M , Sato Y , Ohno Y , Obokata M , Sato K , Okada T , Tabata M , Minamino T , Hirose N , Morita K , Machino-Ohtsuka T , Delgado V , Abe Y 
Published: October 2024

Abstract

Background
The real-world impact and effective treatment strategies of atrial functional mitral regurgitation (AFMR) are poorly understood. The aim of this study was to investigate the prevalence, clinical characteristics, and the effectiveness of mitral valve surgery in AFMR.

Methods
The REal-world obserVational study for invEstigAting the prevaLence and therapeutic options for Atrial Functional Mitral Regurgitation (REVEAL-AFMR) was a retrospective cohort study conducted across 26 Japanese centers. All transthoracic echocardiography performed in 2019 were reviewed and patients with moderate or severe AFMR defined by preserved left ventricular function, dilated left atrium, and absence of degenerative valvular changes. The primary composite outcomes were heart failure hospitalization and all-cause mortality. Besides traditional multivariable regression analysis, propensity score-based time-zero matching was performed to account for immortal time bias.

Results
In 177,235 patients who underwent echocardiography, 8,867 had moderate or severe MR. Within this group, 1,007 were diagnosed with AFMR (mean age 78±10, 56% female, 80% atrial fibrillation). Of these, 113 underwent MV surgery, with 81% receiving concurrent tricuspid valve surgery. Patients who underwent surgery were younger but had more severe MR, larger left heart chambers, and a higher prevalence of heart failure than those who remained under medical therapy. During a median follow-up of 1050 days, 28% experienced the primary outcome, and 18% died. Despite a more severe disease status, only the surgical group showed a decrease in natriuretic peptide levels at follow-up and had significantly lower rate of the primary outcome (hazard ratio 0.43 [0.29-0.64], p&lt;0.001 after adjustment for 25 covariates). Propensity score-based time-zero matching also indicated a lower risk of the primary outcome in the surgical group (hazard ratio 0.39 [0.20–0.78], p=0.007). Multiple sensitivity analyses yielded consistent results. Subgroup analysis suggested a significantly greater benefit of surgery for patients with severe MR than those with non-severe MR (p for interaction=0.044).

Conclusions
Our registry revealed that patients with AFMR are typically old with predominantly with atrial fibrillation, facing poor outcomes. MV surgery was associated with fewer adverse events, a finding that should be validated in future clinical trials.
Atrial functional and ventricular functional mitral regurgitation: definitions, epidemiology, and prognostic implications
Authors: Koschatko S , Heitzinger G , Spinka G , Dannenberg V , Koschutnik M , Dona C , Jantsch C , Halavina K , Hemetsberger R , Nitsche C , Demirel C , Hengstenberg C , Goliasch G , Bartko P E 
Published: October 2024

Abstract

Background
Severe functional mitral regurgitation (fMR) can be divided into two subgroups: fMR of atrial (AfMR) and fMR of ventricular origin (VfMR). Studies on AfMR are scarce and inconsistent, lacking a uniform definition of AfMR. Hence, little is known about its epidemiology, morphological features, associated risk profiles, and prognostic implications.

Purpose
The objective of this study was to develop and test a uniform definition of fMR based on the morphological correlate and to describe demographic characteristics, detail entity-specific morphological features and to investigate the associated prognostic impact.

Methods
13052 patients with severe fMR and those at risk of severe fMR (comprising mild and moderate fMR)were included. Based on the ratio of left atrial volume (LA) to left ventricular end-diastolic volume (LVEDV), those with severe fMR (n=1163) were divided into AfMR and VfMR. The median of this ratio was used for allocation. Therefore, a LA/LVEDV ratio ≤ 0.56 indicated predominantly ventricular eccentric remodelling, whereas a ratio &gt; 0.56 indicated predominantly atrial remodelling.

Results
AfMR was more frequently observed in female patients and peak age was a decade later, compared to VfMR. AfMR was the predominant fMR subtype in patients with heart failure with preserved (76%) and mildly reduced ejection fraction (61%), but a significant proportion could be observed even in patients with heart failure with reduced ejection fraction (32%). Severe fMR was associated with excess mortality for both entities: VfMR HR 1.31 [95% CI: 1.14-1.50], p&lt;0.001, with a more pronounced impact in patients with AfMR HR 1.68 [95% CI: 1.47-1.91], p&lt;0.001; AfMR vs. VfMR: HR 1.27 [95% CI: 1.06-1.54], p=0.011. The association between fMR and excess mortality persisted even after multivariate adjustment. In both entities, ischaemic heart disease was common and resulted in a significant increase of mortality (VfMR: HR 1.67 [95% CI: 1.40-1.98], p for interaction&lt;0.001; AfMR: HR 2.10 [95% CI: 1.75-2.52], p for interaction=0.006).

Conclusion
Based on the entity-specific morphological correlate, severe fMR can be classified into AfMR and VfMR. AfMR occurs across the entire HF spectrum, is more frequently observed in elderly and female patients, and exhibits a worse prognosis than VfMR. The presence of ischaemic heart disease is associated with a near doubling of mortality in both subgroups of severe fMR.Prevalence of fMRKaplan-Meier analysis
Prevalence, characteristics, and long-term outcomes of patients with mitral annular disjunction undergoing surgery for degenerative mitral regurgitation
Authors: Lodin K , Wang A , Haby I , Ruck A , George I , Cohen D J , Braunschweig F , Haugaa K H , Svenarud P , Dalen M , Shahim B 
Published: October 2024

Abstract

Background
Mitral valve prolapse (MVP) is associated with progressive mitral regurgitation (MR) requiring surgical repair. A subset of patients with MVP may also suffer from malignant ventricular arrhythmias (VAs), especially in the presence of mitral annular disjunction (MAD).

Purpose
To assess the prevalence, associated characteristics, and long-term outcomes of patients with MVP with and without MAD undergoing mitral valve surgery for degenerative MR.

Methods
Patients with MVP and moderate-to-severe or severe degenerative MR undergoing mitral valve surgery between 2010-2022 at a university hospital in Sweden were included. MAD length was measured on echocardiograms at end-systole from the insertion of the posterior leaflet on the detached mitral annulus to the border of the bulging left ventricle. Patient demographics and clinical outcomes were collected from medical records. The primary endpoint consisted of VAs, defined as sustained- or non-sustained ventricular tachycardia or high burden of premature ventricular complexes causing hospitalizations or ablation or identified at Holter monitoring. Other endpoints included sudden cardiac death, all-cause mortality, new onset postoperative atrial fibrillation, stroke, mitral valve reoperation, endocarditis, new or worsened heart failure, myocardial infarction and implantation of permanent pacemaker or cardiac defibrillator.

Results
Of 599 patients undergoing mitral valve surgery, 96 (16%) had preoperative MAD, with a median (Q1, Q3) MAD length of 8.0 (5.0-10.0) mm. Compared with patients without MAD, patients with MAD were younger (55 vs 63 years), more likely to be female (31% vs 17%), to have diffuse myxomatous valve disease (66% vs 25%) and bileaflet prolapse (57% vs 17%). Most patients underwent mitral valve repair (84% vs 80%). No patient had residual MAD after surgical repair. At a mean follow up time of 5.8 ± 3.5 years after mitral valve repair, VAs were more common in patients with pre-operative MAD (10% vs 2% (adjusted HR 4.52, 95% CI 1.57-13.0)) (Figure 1). There were no significant differences in the risks of other clinical outcomes.

Conclusions
MAD was associated with almost a 5-fold increased long-term risk of VAs after mitral valve repair despite successful anatomical correction of MAD. These findings highlight the importance of increased awareness of VAs in patients with MAD also after mitral valve surgery.
Echocardiographic pulmonary vascular resistance in patients undergoing tricuspid annuloplasty: prognostic implications and reversibility
Authors: Zhang J , Zhu C Y , Yiu K H 
Published: October 2024

Abstract

Background
Pulmonary vascular resistance (PVR) intimately connects with right ventricular afterload and the development of secondary tricuspid regurgitation (sTR).

Objectives
We sought to investigate the prognostic roles of PVR derived from echocardiography in patients who underwent tricuspid annuloplasty (TA) for sTR.

Methods
Data from 322 patients who underwent TA [median age (interquartile range): 65.0 (59.0-70.0) years; 35.7% males] were obtained from a prospective registry to determine the impact of PVR on the composite outcome (including all-cause mortality and heart failure hospitalization). PVR was calculated by dividing the peak TR velocity by time-velocity integral of the right ventricular outflow tract and then adding 0.16.

Results
During a median follow-up of 5.2 (interquartile range: 2.2-8.2) years, 108 adverse events occurred including 48 deaths and 60 heart failure readmissions. Baseline PVR ≥ 2.0WU was independently associated with a higher risk of composite outcome (adjusted HR[KY1] [u2] :1.674, 95% CI: 1.028-2.726, P=0.038). Baseline PVR outperforms pulmonary artery systolic pressure (PASP) and the ratio of tricuspid annulus plane systolic excursion to PASP in terms of outcome prediction, with pronounced improvement of global model fit, reclassification, and discrimination. In 150 patients who received echocardiograms after surgery, the presence of post-operative PVR ≥ 2.0WU (n=20, 13.3%) was independently associated with the composite outcome (adjusted HR: 2.621, 95% CI: 1.292-5.319, P=0.008).

Conclusion
PVR measured on echocardiography is an independent determinant of clinical outcomes in patients undergoing TA. The inclusion of echocardiographic PVR assessment may provide valuable additional information for patient selection and risk stratification in this population.Kaplan-Meier CurveChange of PVR after Surgery
Mortality and heart failure in patients with severe tricuspid regurgitation. Impact of RV volumes and function by CMR.
Authors: Hinojar Baydes R , Ramos N , Rodriguez Palomares J , Eiros R , Barreiro M , Calero M J , Rodriguez S , Gutierrez L , Galian L , Garcia-Sebastian C , Monteagudo J M , Garcia-Martin A , Gonzalez-Gomez A , Fernandez-Golfin C , Zamorano J L 
Published: October 2024

Abstract

Background
Beyond symptoms, right ventricle (RV) dilatation and dysfunction are established criteria for intervention in patients with significant tricuspid regurgitation (TR); however defined thresholds to support intervention are lacking. As a result, the optimal timing for intervention remains controversial and it is commonly undertaken at a late stage.

Purpose
To describe prognostic cut-off values of RV size and function by Cardiac Magnetic Resonance in a multicentre cohort of patients with at least severe TR.

Methods
The study enrolled patients with at least severe TR assessed by 2D echocardiography who underwent a contemporary cardiac magnetic resonance (CMR) study. Conventional parameters of biventricular volume and function were assessed in all patients. A combined endpoint of hospital admission due to heart failure (HF) and all-cause mortality was defined.

Results
318 patients with severe TR recruited from 5 tertiary care hospitals were included in this study (70 ± 11 years, 67% female, 73% NYHA I or II). Regarding the etiology, 10% were primary TR, 1% CIED-related TR, 46 % atrial secondary TR and 43% ventricular secondary TR. After a median follow-up of 28 months (IQR: 10-54 months), 42% of the patients (n=134) experienced the combined endpoint (n=113 were admitted due to HF, n=61 died). After adjusting for age, NYHA class, comorbidities, type of TR and LVEF in a multivariate Cox proportional model (LR Chi-Square: 88.01, p&lt;0.001), RV-EDV and RVEF were independently associated with all-cause mortality and heart failure (adjusted HR for RV-EDV per ml/m2 =1.008 [1.005-1.012], p&lt;0.001 and RVEF HR per 1%=0.961 [0.942-0.981], p&lt;0.001). Thresholds of RV-EDV ≥ 93 ml/m2, RV-ESV ≥ 39 ml/m2 and RVEF ≤ 58% held the best accuracy to predict outcomes (figure). In multivariable analysis, prognostic cut-off values of RV-EDV, RV-ESV and RVEF was associated with 1.91, 2.03, and 1.76-fold increased risk of HF or all-cause mortality respectively (RV-EDV HR: 1.91 [1.34-2.71], p&lt;0.001, RV-ESV HR 2.03 [1.42-2.89], p&lt;0.001 and RVEF HR1.76 [1.25-2.49], p=0.001).

Conclusion
RV size and function are crucial for determining optimal timing for TR intervention. CMR remains the gold standard to assess RV remodeling. Cut-off values of RV volume and function by CMR are defined in a multicentre cohort of patients based on outcome data; proposed thresholds differ from those previously established by echocardiography.Kaplan Meier curves
Predictors of progression to significant atrial functional tricuspid regurgitation in patients with paroxysmal or persistent atrial fibrillation
Authors: Song S S , Kang J M 
Published: October 2024

Abstract

Background
Atrial functional tricuspid regurgitation (atrial TR) has received growing recognition as a TR entity with a distinct cause owing to its independence from valvular tethering as the predominant mechanism underlying TR. Atrial fibrillation (AF) is highly prevalent in patients with AFTR and is considered a major contributor to its development. However, evidence on predictors of progression to significant atrial function TR in patients with diagnosed AF is lacking.

Methods
At a single tertiary university hospital, we studied 11445 patients who underwent echocardiograms at least 1 year apart between 2010 and 2023. Patients with moderate or greater TR at the initial examination (n=432) were excluded to ensure that only subjects with confirmed progression to atrial functional TR were included. Only those with EF &gt; 50%, no other moderate or severe valve stenosis or regurgitation, no valve surgery, and RVSP &lt; 40mmHg were subsequently identified (n= 8159). Patients diagnosed with AF 3 months before or after the echocardiogram were included. The final analysis included 629 patients, 44 progressed to moderate or worse TR during follow-up.

Results
The mean age of the patients was 68 (62-74) years and 57% were male. The mean time to progression to severe TR was 5.7 years. There was no difference in left ventricle size, ejection fraction of LV, right atrium, and right ventricle size on the initial echocardiogram between the group that progressed to significant TR (group 1) and the group that did not progress (group 2). LA diameter (LAAP), LAV(LA volume), and LAVi were significantly larger in group 1. In particular, the Kaplan-Meier graph of TR progression divided into two groups based on LAV 75ml and LAVi 45ml/m2 showed a significant difference, and in particular, LAVi was a significant predictor compared to other factors.

Conclusion
In patients with AF, the most common cause of atrial functional TR, an initial LAVi &gt;45ml/m2 was shown to be a predictor of progression to significant TR.cumulative survival rate
Predictors of debulking devices use by coronary artery calcification classification using cardiac CT
Authors: Nakano Y , Okutsu M , Sadamatsu K , Nagata T , Serikawa T , Hasegawa K , Fujimoto Y , Yamada S , Takahashi Y , Kurogi K , Masuda N , Nakano M , Torii S , Tanabe M , Matoba T 
Published: October 2024

Abstract

Background
Multi-slice computed tomography (CT) is useful for the non-invasive detection and quantiﬁcation of coronary calcium burden. However, a definitive parameter based on CT imaging for predicting the need for debulking devices, such as rotational atherectomy (RA) and orbital atherectomy (OAS), has yet to be established.

Purpose
We aimed to develop a calcification risk score using cardiac CT to predict the use of debulking devices during coronary intervention.

Methods
In this retrospective, multi-center, observational study in Japan, patients who underwent percutaneous coronary intervention (PCI) were screened. Inclusion criteria were (1) cardiac CT within 6 months prior to PCI, (2) moderate or severe coronary calcification detected on CT, and (3) de novo lesions in a native coronary artery. A total of 349 lesions in 343 patients from 13 hospitals, there were 124 lesions that were treated with debulking devices and 225 lesions without debulking devices. Cardiac CT images were analyzed for circumferential degree, longitudinal length, intracoronary distribution of calcification, peak density, mean density, vessel bend and presence of bifurcation lesions. Data from a random two-thirds (the derivation cohort, n=247) were used to develop a new risk prediction model, which was then tested in the remaining one-third (the validation cohort, n=102). Odds ratios and the risk prediction model were developed using a logistic regression model. The predicted risk was translated into a simplified scoring system (Figure 1A).

Results
RA was used in 111 lesions and OAS in 23 lesions. Factors selected in the model included circumferential degree (≥270°: 3 points), bifurcation (2 points), longitudinal length (≥8mm: 1 point), and mean density (≥600 HU: 1 point) (Figure 1B). This model demonstrated good discrimination (c-statistic=0.772) and calibration (Hosmer–Lemeshow χ²-statistic=0.885; P=0.64) in the validation cohort (Figure 2).

Conclusions
The new prediction model based on cardiac CT performed well in predicting the need for debulking devices. This could serve as an objective tool to support a clinical decision to use debulking devices even in cases where intravascular imaging is not applicable.Study flow and Cardiac CT calcium scoreDiscrimination and Calibration
HFpEF is associated with a higher risk of hospitalization or death in men undergoing transcatheter edge-to-edge tricuspid valve repair
Authors: Walther E , Groeger M , Schneider L , Rottbauer W , Kessler M 
Published: October 2024

Abstract

Aims
There are fundamental differences between women and men regarding the pathophysiology and etiology of tricuspid regurgitation (TR) as well as underlying comorbidities. The aim of this study was to analyze differences between female and male patients undergoing transcatheter edge-to-edge tricuspid valve repair for TR (T-TEER) and to identify gender-specific predictors of adverse outcome.

Methods and Results
In this monocentric study 197 consecutive patients (96 women and 101 men) undergoing T-TEER at our university heart center were included. Prevalence of heart failure with preserved ejection (HFpEF) was higher in women than in men (63% vs. 37.3%; p=0.001) whereas men more often had heart failure with reduced ejection fraction (HFrEF; 62.7% vs. 37%; p=0.001). Women had more severe symptoms (86.2% in New York Heart Association (NYHA) class III-IV vs. 72.3% in men; p=0.022). Device success rates (p=0.64), procedural characteristics (e.g. number of clips, p=0.17) and postprocedural results (TR grade post clip, p=0.1) were comparable. One-year mortality did not differ between genders (5.9% in women, 8.6% in men; p=0.53). Likewise, no significant difference could be found with regard to heart failure hospitalizations within one year after T-TEER (20.3% in women, 18.8% in men, p=0.82). Strikingly, prevalence of HFpEF was substantially higher than of HFrEF in men that reached the combined endpoint of one-year mortality or rehospitalization for heart failure (61.5% vs. 38.5%; p = 0.08). In women, no relevant difference could be found (27.0% vs. 32.4%; p=0,623).
To identify gender-specific predictors of the combined endpoint, a cox regression analysis was performed. In men, HFpEF emerged as an independent predictor (HR 2.703; 95% CI 1.069 – 6.837; p = 0.036). In women, NYHA functional class proved to be an independent risk factor (Hazard Ratio (HR) 3.362; 95% confidence interval (CI) 1.085 – 10.415; p=0.036) for the combined endpoint whereas HFpEF was not associated with adverse outcome (HR 0.865, 95% CI 0.259 – 2.885, p=0.81).

Conclusions
Women undergoing T-TEER were more symptomatic and had higher prevalence of HFpEF compared to men. Nevertheless, HFpEF emerged as an independent predictor of the combined endpoint of one-year mortality or rehospitalization for heart failure only in men. NYHA functional class independently predicted adverse outcome in women.