bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multidomain cognitive improvement in patients with severe aortic valve stenosis undergoing transcatheter aortic valve implantation
Authors: Van Nieuwkerk A C , Hemelrijk K I , Leeuwis A E , Majoie C B L M , Daemen M J A P , Bron E E , Moonen J E , De Sitter A , Bouma B J , Harms A , Van Der Flier W , Baan J , Piek J J , Biessels G J , Delewi R 
Published: October 2024

Abstract

Background
Cognitive impairment is prevalent in one third of patients with symptomatic severe aortic valve stenosis scheduled for transcatheter aortic valve implantation (TAVI). How TAVI affects cognitive functioning in these patients remains unknown.

Purpose
The CAPITA study (CArdiac outPut, cerebral blood flow and cognition In patients with severe aortic valve stenosis undergoing Transcatheter Aortic valve implantation) assessed the effects of TAVI on cerebral lesions and cognitive functioning.

Methods
CAPITA is a prospective study of cerebral and cognitive outcomes in 148 patients undergoing TAVI. One day before and three months after TAVI, patients underwent a standardized multidomain neuropsychological assessment, and simultaneous brain magnetic resonance imaging. The primary outcome was change in global cognitive functioning as measured with z-scores. Also, we assessed the cognitive subdomains of attention/psychomotor speed, memory, language, and executive functioning. Z-scores for each cognitive domain were constructed as: (test score - mean baseline score) / standard deviation. Global cognitive function was calculated as the mean from the four domain scores.

Results
Mean age was 80.5±5.7 years, 43% was female and median STS-PROM (Society for Thoracic Surgeons Predicted Risk for 30-day Mortality) was 2.0% (IQR 1.4%-2.9%). MoCA scores improved from 23.3±3.7 to 24.4±3.3, (p&lt;0.001) and MMSE scores from 26.4±2.6 to 26.9±2.4 (p=0.01). There was an overall increase in global cognitive z-scores (0.02±0.52 to 0.15±0.48, p&lt;0.001). Cognitive domains of memory (0.03±0.77 to 0.18±0.80, p=0.003) and language (-0.07±1.07 to 0.20±0.80, p=0.02) significantly improved, whereas executive function (0.01±0.70 to 0.06±0.76, p=0.42) and attention (0.10±0.69 to 0.17±0.69, p=0.06) did not significantly change. Quality of life on the visual analogue scale improved from 66.4±15.9 to 72.9±12.8, (p&lt;0.001).
Patients in the lowest tertile of baseline cognitive functioning (i.e., those with worst baseline cognitive functioning), had the largest increase in cognitive functioning, compared with patients in the intermediate or highest tertile of baseline cognitive functioning (0.30±0.55 vs 0.09±0.27 vs 0.01±0.16, p=0.002).
Patients with &gt;0.5 SD decline in cognitive functioning (12%), had a higher volume of new white matter hyperintensities on follow-up MRI than patients with stable or improved cognitive functioning (1.26±2.96, vs 0.29±0.45 vs 0.31±0.91 mL, p=0.06).

Conclusions
In 148 patients who underwent TAVI, there was an overall improvement in cognitive functioning at three months follow-up. This improvement was consistent through different cognitive domains and most prominent in patient with lowest baseline cognitive functioning.Change in cognitive functionin
Trans catheter edge to edge repair for mitral regurgitation and left ventricular outflow obstruction in hypertrophic cardiomyopathy
Authors: Carasso S , Marmor D B , Glikson M , Shuvy M 
Published: October 2024

Abstract

Background
Based on previous reports, mitral valve transcatheter edge to edge repair (TEER) may be considered in patients with severe mitral regurgitation (MR) and left ventricular obstruction in patients with hypertrophic obstructive cardiomyopathy (HOCM) that are high risk for surgery.

Objective
We aimed to evaluate the feasibility, and immediate and short-term outcomes of mitral TEER in symptomatic patients with severe MR and HOCM.

Methods
Five patients (age 75±6, 3 men) with severe MR and HOCM with high surgical risk, and anatomy not suitable for septal ethanol ablation, who remained symptomatic despite maximally tolerated drug therapy were selected for TEER using the MitrClip system.

Result
The procedure was performed successfully on all 5 patients. Devices were deployed at the A2-P2 scallops of the mitral valve. MR severity declined from severe to mild in all patients, left ventricular outflow (LVOT) maximal gradient decreased from 140±46 to 8±5 mmHg after TEER, and was 41±32 mmHg at 4±2 month follow- up, Clinically, all patients reported improvement of their symptoms to Class I-II NYHA functional Class.

Conclusion
TEER may be a beneficial procedure for severely symptomatic patients with severe MR and obstructive HOCM on maximal tolerated medical therapy, who are not amenable to surgery because of excessive risk, old age, and frailty.Pre and Post procedure EchoPre and Post Cath
Prevalence, determinants, and impact of significant shunt after percutaneous patent foramen ovale closure
Authors: Guedeney P , Farjat-Pasos J , Dauphin C , Abtan J , Roule V , Ohlmann P , Huang F , De Ferrari G M , Gabrion P , Auffret V , Cayla G , Barsoum P , Meneveau N , Rodes-Cabau J , Montalescot G 
Published: October 2024

Abstract

Introduction
Percutaneous closure of patent foramen ovale closure is increasingly performed for secondary prevention of PFO-related arterial embolic event. The clinical significance of postclosure residual right-to-left significant shunt remains unclear.

Purpose
To describe the prevalence, determinants, and clinical impact of a significant post-closure.

Methods
The AIR-FORCE is an ongoing prospective international registry of patients undergoing PFO closure from 19 centers in France, Canada and Italy. Only patients undergoing PFO for secondary prevention of an arterial embolic event with at least one available post-closure contrast transthoracic echocardiography (TTE) with agitated saline injection and Valsalva maneuvers were analyzed. Residual shunt was categorized according to the number of bubbles in the left atrial within 3 cardiac cycles at the first available contrast TTE as small (&lt;10), moderate (10-20) or severe (&gt; 20). Determinants of the presence of moderate or severe shunt were evaluated with multivariate logistic regression and its impact on the primary outcome (stroke, transient ischemic attack or peripheral arterial emboly) was evaluated with Cox model adjusted on age and sex.

Results
A total of 2413 patients, with a median age of 49.3 [40.4-57.4] years, 56% male, undergoing PFO closure between 2001 and 2023 were included. The first contrast TTE, which was performed after a median delay of 3.4 [0.9-5.8] months, reported the presence of moderate or severe residual shunt in 214 (8.9% 95%CI 7.8-10.1) patients. Determinants of the presence of moderate or severe residual shunt at the first contrast TTE were decreased body mass index (per 1kg/m², aOR 0.96 95%CI 0.93-0.99), severe shunt prior to PFO closure (aOR 3.54 95%CI 2.25-5.55) and increased device left disc diameter (per 1mm, aOR 1.08 95%CI 1.05-1.12). With a median follow-up of 2.2 [0.9-4.9] years, a total of 60 events were reported and the presence of moderate or severe residual shunt was associated with an increased risk of the primary outcome (aHR 2.46 95%CI 1.15-5.24) (Figure 1).

Conclusions
A moderate to severe residual right-to-left intracardiac shunt is not uncommon after PFO percutaneous closure and seems to be associated with an increased risk of arterial emboly recurrence.
Transcatheter patent foramen ovale closure in patients with and without documented nickel hypersensitivity
Authors: Apostolos A , Gregoriou S , Trantalis G , Drakopoulou M , Chatzidimitriou E , Kleidona I A , Tsalamandris S , Vaina S , Aggeli C , Stratigos A , Tsioufis C , Toutouzas K 
Published: October 2024

Abstract

Background
Transcatheter PFO closure has been established as a safe and feasible approach for secondary prevention in appropriately selected patients with previous cryptogenic stroke. The two FDA-approved devices, widely used, consist of a nitinol frame; a nickel-titanium alloy. Although nickel is recognized as the primary metal causing hypersensitivity reactions worldwide, the potential occurrence of nickel hypersensitivity following PFO closure remains a subject of debate.

Purpose
The aim of this study is to investigate whether patients with nickel hypersensitivity are more susceptible to experiencing adverse events after PFO closure and to explore the potential role of device selection.

Methods
We prospectively enrolled patients undergoing PFO closure at our tertiary hospital. Before the procedure, all patients underwent nickel skin patch tests, considered the gold standard for diagnosing nickel hypersensitivity. Subsequently, patients were randomized to receive one of the two FDA-approved devices. During a three-month follow-up period, we evaluated the primary endpoint, a composite outcome including patient-reported chest pain, palpitations, headaches, and rash. Blinding was maintained for the patients, the operator, and the assessor of endpoints regarding the results of the nickel skin patch tests. The chi-squared test was utilized to evaluate the primary endpoint. Results for continuous variables are expressed as mean ± standard deviation or, for non-normally distributed variables, as median (interquartile range).

Results
Between January 2021 and November 2023, a total of 63 patients were included in our analysis. The majority were men (n=33, 52.4%) with a mean age of 46.1 ± 10.1 years. The median RoPE score was 7 (6-8). Nickel hypersensitivity was documented in 30.8% of the patients. The primary endpoint was met in 37.7% (n=23) of the total sample, with a significantly higher incidence in patients with nickel hypersensitivity than in those without (61.1% versus 27.9%, p=0.015, OR: 4.060, 95% CI: 1.275 – 12.930). No significant difference was observed when analyzing the two devices separately (p=0.096 and p=0.078, respectively). No recurrent ischemic stroke, severe anaphylactic reaction, or requirement for device surgical removal was observed in any patient.

Conclusions
Our findings indicate that patients with documented nickel hypersensitivity are more likely to develop symptoms such as chest pain, palpitations, headaches, and rash following the procedure. However, these findings do not raise major safety concerns. The completion of our study is necessary to acquire more reliable and conclusive results.
Impact of left atrial appendage closure on left atrial function: insights from the OCEAN-LAAC registry
Authors: Nonaka H , Asami M , Horiuchi Y , Tanaka J , Yoshiura D , Komiyama K , Yuzawa H , Tanabe K 
Published: October 2024

Abstract

Background
Percutaneous left atrium appendage closure (LAAC) is an effective therapy to prevent thromboembolic events among patients with atrial fibrillation (AF) (Ref 1). However, since the left atrium appendage (LAA) potentially serves as a part of the left atrium (LA) volume and a buffer for increasing LA pressure, this procedure may impair LA compliance (Ref 2).

Purpose
In this study, we sought to investigate the effect of LAAC on LA function.

Methods/Results
The OCEAN-LAAC registry is an ongoing, multicentre Japanese registry including patients who underwent LAAC in Japan (Ref 3). Among 225 patients from the registry, LA volume index (LAVI) and tricuspid regurgitation pressure gradient (TRPG) at baseline and 6 months after the procedure were analysed. In the overall population, no significant increase in LAVI (Abstract Picture 1A) and TRPG (Abstract Picture 1B) was observed (LAVI baseline vs 6 months, 55.0 [44.0, 70.0] ml/m2 vs 55.0 [42.0, 75.6] ml/m2; P = 0.31; TRPG, 25.0 [20.3, 32.0] mmHg vs 25.0 [20.0, 32.0] mmHg; P = 0.85). However, particular patients underwent an increase in LAVI (Abstract Picture 1C), and multivariable analysis showed smaller LAVI and elevated TRPG at baseline, rather than any procedural factors, were significantly associated with an increase in LAVI (Odds ratio (OR) for baseline LAVI: 0.98 [95% confidential interval (CI): 0.97 - 0.996]; OR for baseline TRPG: 1.04 [95% CI: 1.00 - 1.08]). A 5 ml/m2 increase in LAVI at a 6-month follow-up was significantly associated with subsequent heart failure hospitalization (HFH) (Hazard ratio: 3.37 [95% CI: 1.18 - 9.65]) (Abstract Picture 2A). However, this predictive value was not observed in patients with lower LAVI (≤ 55 ml/m2) at baseline; instead, it was observed in those with a baseline LAVI over 55 ml/m² (Abstract Picture 2B).

Conclusions
In summary, our study did not elucidate the negative impact of LAAC on LA function, yet demonstrated an increase in LAVI at 6 month follow-up was frequently observed in patients with lower LAVI and higher TRPG at baseline. Additionally, increase in LAVI was significantly associated with subsequent HFH, which was more evident in patients with higher LAVI at baseline.
Prevalence and prognostic value of thrombocytopenia in aortic valve replacement surgery: bioprosthesis versus mechanical prosthesis
Authors: Seoane L , Espinoza J C , Piccinini F , Furmento J , Cagnone L , Spaccavento A , Sigal A , Carugno A , Navia D , Costabel J P 
Published: October 2024

Abstract

Background
Thrombocytopenia is a frequent complication of valve surgery, and is associated with different postoperative outcomes. Concern has recently arisen about thrombocytopenia following aortic valve replacement (AVR), as some authors have reported increased postoperative thrombocytopenia with certain biological aortic valves. In adittion, it is unclear whether thrombocytopenia predicts mortality in this type of surgery.

Purpose
The aim of this study was to determine the prevalence and prognostic value of thrombocytopenia in biological and mechanical aortic valve replacement.

Methods
The study was an observational analysis of patients undergoing AVR with or without associated coronary artery bypass grafting (CABG) at a single center between October 2014 and October 2023. Cardiac Surgery database was computerized and prospectively completed. Preoperative and first 4 days postoperative platelet counts were analyzed. Thrombocytopenia was defined as platelet count &lt; 100 × 10³/mm³. To obtain comparable populations, a propensity score matching analysis was performed.

Results
A total of 1,197 patients underwent AVR with (n = 494) or without CABG (n = 703). Patients received either a mechanical prosthesis (n = 320), or a biological prosthesis (n = 877). The mean population age was 68 years (SD 6), with the majority being male (68%). Univariate analysis of the baseline characteristics of both groups of patients showed that they were not comparable. A risk-adjusted subanalysis was performed according to a propensity score (n=278). The nadir of bioprostheses was on the third postoperative day with an average of 93.8 × 10³/mm³, while in mechanical prostheses was also on the same day but with an average of 114.7 × 10³/mm³ (p: 0.001). (Figure 1) Bioprosthesis implantation was significantly associated with a higher prevalence of thrombocytopenia (72.7% vs. 45.3%, p&lt;0.001). The presence of postoperative thrombocytopenia has been associated with higher in-hospital mortality (6.7% vs. 0.9%, p=0.019); but not with other postoperative complications. (Figure 2)

Conclusions
Patients undergoing AVR with bioprostheses had a significantly higher prevalence of thrombocytopenia, and also lower platelet counts than mechanical prothesis within the first 4 postoperative days. Thrombocytopenia was associated with higher in-hospital mortality in a risk score-adjusted population.Platelet counts after AVROutcomes according to platelet count
The severity of metabolic derangement predicts survival of out-of-hospital cardiac arrest and the benefit of extracorporeal life support
Authors: Jeong D , Choi J H , Shin S D , Shin T G , Hwang S Y , Lee G T , Park J E 
Published: October 2024

Abstract

Aims
This study aimed to develop Metabolic Derangement score and validate its prognostic performance in patients with out-of-Hospital Cardiac Arrest (OHCA) and also its discriminative performance in guiding the application of extracorporeal life support (ECLS).

Methods and Results
From 5,100 patients (average age 67 years, 69% male), Metabolic Derangement score was developed to predict primary outcome (death or poor neurologic outcome, cerebral performance category ≥ 3 at day 30) from initial blood laboratory test including pH, PaCO2, PaO2, potassium, haemoglobin, lactate, and creatinine. It was created using machine learning algorithms and a training set (60%), and validated with a test set (40%). The risk of primary outcome consistently increased from 34% to 100% as the Metabolic Derangement score ranged from 0 to 7. Patients with Metabolic Derangement score ≤ 2 showed no difference in the primary outcome risk between those with or without ECLS. Conversely, those with a Metabolic Derangement score ≥3 had a lower risk with ECLS (difference of restricted mean survival time=6.5 days, 95% CI=3.3-9.6 days, ratio of restricted mean time lost=0.76, 95%CI=0.65-0.88, all p&lt;0.001). Clinical subgroup analyses showed generally consistent results. Metabolic Derangement score also outperformed OHCA-, CAHP-, and NULL-PLEASE-scores in prediction the primary outcome (p&lt;0.05, all).

Conclusions
The severity of metabolic derangement predicted the clinical outcome of OHCA, and could also identify patients likely to benefit from ECLS.Metabolic Derangement score
Relationship between renin, aldosterone, aldosterone-to-renin ratio and left ventricular mass index in young adults
Authors: Ananda R , Gwini S M , Beilin L J , Schlaich M P , Stowasser M , Young M J , Fuller P J , Adler B , Mori T A , Yang J 
Published: October 2024

Abstract

Background
Primary aldosteronism (PA), characterised by excessive aldosterone production and mineralocorticoid receptor activation, is associated with adverse cardiovascular outcomes including left ventricular hypertrophy and failure. Elevated cardiovascular risk is observed even in milder and subclinical forms of PA, especially in middle-aged and elderly populations. It is unclear if early changes in PA biomarkers can affect left ventricular mass index (LVMI), which is a strong predictor of cardiovascular diseases.

Aim
To evaluate the relationship between PA biomarkers, namely renin concentration, aldosterone concentration and aldosterone-to-renin ratio (ARR), and LVMI in young adults.

Methods
The Raine Study is a longitudinal, population-based cohort study in Western Australia that enrolled women during pregnancy. We analysed the data from the offspring of these women at age 27. Participants with PA biomarkers and LVMI measured by cardiac magnetic resonance imaging were included. Females who were on oral contraception were excluded due to its confounding effect on the ARR. We examined the relationship between LVMI and plasma renin, aldosterone, and ARR using multivariate-adjusted linear regression and used mediation analysis to test whether these relationships were dependent on systolic blood pressure (SBP).

Results
Of 758 participants, 252 (33.2%) were females and the mean (SD) age was 26.7 (0.4) years. Females had lower median plasma renin concentration (12.0 vs 15.4mU/L; p&lt;0.001) and higher median ARR (21.0 vs 15.6; p&lt;0.001) than males. There was no sex-difference in median plasma aldosterone concentration (257 vs 237pmol/L in males; p=0.143). Females had lower LVMI (52.2 vs 70.2 g/m²; p&lt;0.001) than males. A significant association between LVMI and aldosterone was detected in males (β-coefficient 0.009; 95% CI 0.001 to 0.017; p=0.027), and between LVMI and ARR in females (β-coefficient 0.098; 95% CI 0.001 to 0.196; p=0.050) after adjusting for confounders. This relationship was not mediated by brachial SBP.

Conclusion
An elevated aldosterone concentration or ARR was associated with higher LVMI in young adults, independent of brachial SBP. Long-term follow-up is required to determine if the relationship persists over time and leads to reduced cardiac function. One may speculate that an intervention trial in young adults with subclinical PA is warranted to determine the role of aldosterone blockade in preventing future cardiovascular diseases.
Exploring the association between hypertension and atherosclerotic cardiovascular disease in adults with familial hypercholesterolemia: insights from the HELLAS-FH registry
Authors: Rizos C , Liamis G , Skoumas I , Rallidis L , Garoufi A , Kolovou G , Tziomalos K , Sfikas G , Skalidis E , Kotsis V , Doumas M , Lambadiari V , Anagnostis P , Giannakopoulou V , Liberopoulos E 
Published: October 2024

Abstract

Aim
While the link between hypertension and atherosclerotic cardiovascular disease (ASCVD) is well-established, its impact on patients with familial hypercholesterolemia (FH) remains less explored. This study aims to assess the association between hypertension and ASCVD in adult FH patients.
Material-Methods: Participants from the HELLAS-FH registry were divided into two groups based on the presence or absence of hypertension. We compared demographic information, lipid profile and history of ASCVD between the two groups.

Results
The study included 2367 FH patients, of whom 602 (25.4%) had a diagnosis of hypertension. Hypertensive patients were generally older and exhibited higher rates of ASCVD risk factors such as increased body mass index (28.6 vs 26.3 kg/m2), waist circumference (98 cm in men and 97 cm in women compared with 95 cm and 88 cm in non-hypertensive counterparts), and more prevalent history of smoking (44.2% vs 35.8%) (p&lt;0.01 for all comparisons). Patients with hypertension had higher triglyceride levels (148 vs 123 mg/dL; p&lt;0.05), lower high-density lipoprotein cholesterol (HDL-C) levels (48 vs 53 mg/dL; p&lt;0.05) while total cholesterol and non-HDL-C levels were not significantly different. When adjusted for age, sex, and major ASCVD risk factors, hypertension was significantly associated with prevalent coronary artery disease (CAD) (adjusted odds ratio [OR] 3.10; 95% CI 2.29-4.19; p&lt;0.001), ischemic stroke (OR 1.89; 95% CI 1.02-3.49; p=0.04), and peripheral arterial disease (PAD) (OR 3.15; 95% CI 1.62-6.13; p&lt;0.001).

Conclusions
Hypertension is frequent and is independently associated with an increased risk of CAD, stroke, and PAD in patients with FH.