bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of mortality scores performance in transcatheter aortic valve replacement: suiting up to percutaneous intervention
Authors: Martins A , Silva P , Garcia A B , Oliveira C , Azaredo Raposo M , Abrantes A , Gregorio C , Rosa Ferreira D , Cazeiro D , Nobre Menezes M , Carrilho P , Silva Marques J , Jorge C , Cardoso P , Pinto F J 
Published: October 2024

Abstract

Introduction
As transcatheter aortic valve replacement (TAVR) is increasingly relevant for patients with severe symptomatic aortic stenosis, having a reliable procedure specific risk-prediction tool is paramount to provide high-quality care. Surgical scores as the EuroScore II and the Society of Thoracic Surgeons (STS) score II have been widely used to identify patients with high surgical risk in whom percutaneous treatment might be more favorable. However, current literature lacks a consensual specific predictive model for short-term and mid-term prognosis in patients undergoing transcatheter aortic valve implantation (TAVI).

Purpose
We aimed to access short and midterm (30 days and one year) mortality and to access the ability of a directly adapted score in estimating mortality in a real-world population.

Methods
We conducted a retrospective observational study in patients who implanted TAVR in a single center. Surgical mortality scores – EUROSCORE II and STS score II – and adapted score Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) transcatheter valve therapy (TVT) score were used to estimate mortality. Predictive abilities of these three scores were compared using area under the receiver operating characteristics (ROC) curve for 30-day and one year mortality.

Results
From January 2018 to December 2021, 416 patients were submitted to TAVR procedure in our center. The mean age was 83+-6 years old and 229 (55%) were female. 94% had hypertension, 80% dyslipidemia, 40% diabetes mellitus, 35% coronary artery disease, 32% chronic kidney disease. Mean ejection fraction was 56%.
During a mean follow-up (FUP) of 816 ± 492 days, 30-day mortality was 1,7% and after 1 year mortality rate was 12,2% (higher than reported in PARTNER 3 trial, 8,5%).
The Mean EuroSCORE was 3,4±3,2, mean STS-II 3,9±1,8 and mean value for STS/ACC-TVT score was 3,55±1,34. ROC curve analysis showed a significantly higher discriminative power of STS/ACC-TVT (AUC 0,749, 95% CI 0,681-0,818) compared with surgical scores (p=0,001) – figure 1.
We also divided population into quartiles and compared the mortality rate at 30 days and 1 year in each quartile using either STSII or STS/ACC-TVT; As can be seen in figure 2, mortality rates correlated better with the STS/ACC-TVT score than with the STS score.

Conclusion
A score adapted to a TAVI population showed better predictive capacity than traditional surgical scores. Less preponderance of previous surgical status, relevance of access site and more adapted weight of age might explain the best performance of STS/ACC-TVT score. Surgical scores are helpful in choosing treatment option, but adapted scores are better to predict pos-TAVR mortality.
Clinical outcomes according to clinical and surgical risk scores for tricuspid regurgitation
Authors: Gwak S Y , Kim K , Lee H J , Cho I S , Hong G R , Ha J W , Shim C Y 
Published: October 2024

Abstract

Background
TRIO score, the clinical risk score in significant tricuspid regurgitation (TR), and TRI-SCORE, the surgical mortality risk for tricuspid valve (TV) surgery, have been proposed. We aimed to investigate the correlation and distribution of two risk scores, and to define the clinical benefit of TV surgery in patients with low or intermediate TRIO score and TRI-SCORE.

Methods
In a total of 10,054 patients diagnosed with moderate to severe TR between January 2008 to December 2020, TRIO score and TRI-SCORE were stratified into low, intermediate, and high-risk groups. Patients of all etiologies of TR were included and patients who underwent prior tricuspid valve surgery were excluded. The clinical outcome was all-cause death.

Results
TRI-SCORE and TRIO scores were moderately correlated (r =0.39, p&lt;0.001). 9,104 (90.6%) patients (age 67 ± 14 years, 42% male) had low or intermediate TRI and TRIO score. During 12.6 ± 10.1 years, 885 (9.7%) underwent TV surgery and 1,268 (13.9%) experienced clinical outcomes. Kaplan-Meier analysis revealed significant differences in clinical outcomes according to TV surgery in both low and intermediate TRIO score patients (log-rank, p&lt;0.001) and sub-analyzed them according to the TRI-SCORE group (Figure). In multivariable Cox regression analysis, TV surgery (HR 0.37, 95% CI 0.28-0.49, p&lt;0.001) were significantly associated with clinical outcomes after adjusting confounding factors.

Conclusions
TV surgery is clinically beneficial in moderate to severe TR patients with a low or intermediate TRIO score and TRI-SCORE.
Incidence, predictors and outcomes of non-home discharge following transcatheter aortic valve implantation: a multicentre Australian experience. The NHD TAVI study
Authors: Butala A , Nanayakkara S , Navani R , Palmer S , Noaman S , Haji K , Htun N , Walton A , Stub D 
Published: October 2024

Abstract

Background
Patients undergoing transcatheter aortic valve implantation (TAVI) commonly experience non-home discharge (NHD), a phenomenon associated with increased health-care expenditure and possibly poorer outcomes. Despite its relevance to patients, post-TAVI NHD remains poorly explored in the literature.

Purpose
To characterise the incidence and predictors of NHD following TAVI, understand its impact on quality of life, and identify the proportion of patients that require long-term residential care following initial NHD.

Methods
Retrospective analysis of prospectively collected data of 2229 patients undergoing TAVI from 2010–2023 included in an Australian TAVI Registry.

Results
Median age was 82 (IQR: 78-86) years and 41% were female. 257 (11.5%) patients were not discharged home following TAVI, with incidence falling over time (R2=0.636, p&lt;0.001). Multivariable logistic regression modelling for NHD prediction was developed with excellent calibration and discrimination (C-Statistic 0.835). Independent predictors of NHD were post-procedural stroke (adjusted odds ratio [aOR] 11.1), procedure at a private hospital (aOR 3.0), living alone (aOR 2.4), vascular access site complications (aOR 2.1), frailty (aOR 1.9), age&gt;80 (aOR 1.8), hypoalbuminemia (aOR 1.8), NYHA III-IV (aOR 1.7) and hospital length of stay (aOR 1.1) (all p&lt;0.05). NHD was not associated with mortality at 30-days and less than one percent of all patients required longer-term residential care.

Conclusion
While common following TAVI, NHD does not predict short-term mortality and most patients successfully return home within 30-days. When used appropriately, NHD may serve as a brief and effective method of optimising functional status without compromising long-term independence.Predictors of Non Home Discharge
The impact of diabetes on cardiac remodelling after transcatheter aortic valve implantation
Authors: Butala A , Sehgal K , Zhou J , Stub D , Palmer S , Noaman S , Haji K , Htun N , Johnston R , Gardner E , Lynch K , Walton A , Nanayakkara S 
Published: October 2024

Abstract

Background
Transcatheter aortic valve implantation (TAVI) induces reverse cardiac remodelling, an important outcome associated with lower mortality. Diabetes mellitus (DM) is common among TAVI patients and is one of the fastest growing chronic conditions worldwide. Despite its propensity to adversely affect myocardium, the influence of DM on post-TAVI remodelling remains poorly understood.

Purpose
To characterise the influence of DM on cardiac remodelling following TAVI.

Methods
Retrospective analysis of 202 patients undergoing TAVI at an Australian tertiary centre. 12-month myocardial remodelling was compared between DM and no DM groups.

Results
Of 202 patients, median age 82 (IQR: 76, 86) years, 50% female and median STS score 3.5 (2.5, 4.9), 62 (31%) had Type II DM. A robust multivariable analysis (C-Statistic 0.83) revealed DM (adjusted odds ratio [aOR] 2.3, p=0.042) and ≥ mild post-procedural paravalvular regurgitation (aOR 2.5, p=0.027) were independent predictors of poor left-ventricular mass index regression (LVMIr). Among diabetic patients, suboptimal disease control was associated with inferior LVMIr (6% vs -9%, p=0.011), while insulin dependency was not (-3% vs 2%, p=0.489). At 12-months, no differences were found in left-atrial remodelling, left and right-ventricular function, and prosthetic valve performance between DM and no DM groups. Poor LVMIr was associated with lower survival in Kaplan Meier analysis (65% vs 85%, log-rank p=0.049).

Conclusion
Among patients undergoing TAVI, those with DM demonstrate poorer LVMIr at 12-months. Improved glycaemic control may serve as an important strategy to optimise myocardial remodelling in diabetic patients undergoing TAVI.12-Month LVMI Regression
Two different hybrid vascular access closure strategies post transcatheter aortic valve implantation
Authors: Abdelaziz M S , Landt M , Mankerious N , Kurniadi A , Alotaibi S , Belhaj B , Alali A , Toelg R , Geist V , Abdel-Wahab M , Nef H , Allali A , Richardt G , Elbasha K 
Published: October 2024

Abstract

Background
The hybrid strategy combining plug-based and suture-based vascular closure devices (VCD) was introduced as a promising technique for vascular access hemostasis after transcatheter aortic valve implantation (TAVI) with satisfactory outcomes. However, data comparing two plug-based VCDs each in the combination with a suture-based VCD, namely ProGlide/FemoSeal (P/FS) with ProGlide/AngioSeal (P/AS) VCDs, is still lacking.

Aim
To compare the 30-day outcome of the hybrid strategy using P/AS versus P/FS for vascular access site closure after TAVI.

Methods
A retrospective single Centre observational study included 608 patients recruited from a prospective TAVI registry between 2016 and 2022. The composite endpoint was defined as any VCD related major vascular complications and/or bleeding more than type 1 according to Valve Academic Research Consortium (VARC-3) criteria.

Results
The current study reported a significantly higher rate of composite endpoint in P/AS group, which was driven by higher rate of major bleeding (5.4% vs 1.4%, p=0.036). We also found a higher rate of VCD related minor bleeding in P/AS group (16.3% vs 8.1%, p=0.013). Successful access site hemostasis was achieved in 83.1% of P/FS group versus 71.7% in P/AS group (p=0.006). The presence of anterior wall calcification at the access site was significantly associated with the composite endpoint (adj OR 2.49; 95% CI (1.08 – 5.75), p=0.032).

Conclusions
The hybrid strategy for large bore vascular access closure using P/FS showed a potentially better 30-day outcomes compared with P/AS. The presence of anterior calcification at the access site carries a significant risk of VCD related complications.
Predicting cardiovascular death 1-year after transcatheter aortic valve implantation: an artificial-intelligence based risk model
Authors: Minten L , Bamps K , Bennett J , Dubois C 
Published: October 2024

Abstract

Background
Prediction of cardiovascular death after transcatheter aortic valve implantation (TAVI) remains difficult. Currently, more lower risk patients are considered for TAVI and predicting not only immediate survival, but more longer-term outcomes seems important. Most developed risk tools use standard statistical approaches and focus mainly on short-term (30 days post-TAVI) outcomes.

Purpose
The aim of this project was to identify important predictors for worse outcomes after aortic valve replacement using machine learning features. Furthermore, we want to develop and artificial intelligence (AI) -model to predict cardiovascular death 1 year after TAVI.

Methods
For our analysis we used 725 patients with severe AS that underwent TAVI between 2008 and 2022 and were included in a prospective single centre observational study. Leveraging an automated machine learning framework, we systematically evaluated various machine learning algorithms including Random Forest, AdaBoost, Neural Networks, Randomized Decision Trees and and Gradient Boosting.

Results
We constructed prediction models utilizing three feature subsets: the top 10 most important features, the top 15 most important features (Figure 1), and all available features (n=66). Our analyses yielded area under curve (AUC) values of 0.71, 0.83, and 0.92, respectively (Figure 2). The best model was obtained by Randomized Decision Trees. NYHA classification, left ventricular ejection fraction, Charlson comorbidity index, posterior wall thickness and myocardial infarction 90-days before TAVI appeared as the most influential predictors for cardiovascular death within one year after TAVI.

Conclusions
Our model was able to identify the most important features indicating high risk for patients undergoing TAVI. Using the 15-feature model, we were able to accurately predict cardiovascular death 1 year after TAVI. AI-models to predict risk can be used to better inform/select patients undergoing TAVI.
Demographics and clinical outcomes of flow-gradient patterns of aortic stenosis: an analysis of the CURRENT AS Registry-2
Authors: Taniguchi T , Morimoto T , Takeji Y , Furukawa Y , Kimura T 
Published: October 2024

Abstract

Background
Low-gradient (LG) severe aortic stenosis (AS) has not been fully characterized compared with high-gradient (HG) AS.

Methods
Among 3369 patients with severe AS enrolled in the CURRENT AS Registry-2, the current study population consisted of 3363 patients with data on left ventricular ejection fraction (LVEF) after excluding patients with LG AS without indexed stroke volume data. Patients were divided into 4 groups (LG AS with reduced LVEF: N=285, paradoxical low-flow low-gradient [LFLG] AS: N=220, normal-flow low-gradient [NFLG] AS: N=872, and HG AS: N=1986).

Results
Compared to HG AS, LG AS with reduced LVEF more often had cardiovascular comorbidities, advanced cardiac damage stages, and frailty with less extensive aortic valve (AV) calcification by computed tomography (CT), and paradoxical LFLG AS more often had atrial fibrillation, concomitant valvular disease, advanced cardiac damage stages, and frailty with less extensive AV calcification, while NFLG AS were less often symptomatic, and had comparable cardiac damage stages, and frailty with less extensive AV calcification. Patients with the 3 types of LG AS less often underwent surgical or transcatheter aortic valve replacement than those with HG AS (cumulative 3-year incidence: LG AS with reduced LVEF: 64.5%, paradoxical LFLG AS: 59.1%, NFLG AS: 54.2%, and HG AS: 87.3%, P&lt;0.001). Cumulative 3-year incidence of death or heart failure hospitalization was much higher in patients with LG AS with reduced LVEF and paradoxical LFLG AS than in those with HG AS (cumulative 3-year incidence: LG AS with reduced LVEF: 65.9%, paradoxical LFLG: 51.1%, NFLG: 35.5%, and HG: 30.5%, P&lt;0.001). After adjusting confounders, LG AS with reduced LVEF and paradoxical LFLG AS compared with HG AS were independently associated with higher risk for death or heart failure hospitalization (HR: 1.82, 95%CI: 1.49-2.23, P&lt;0.001; HR 1.43, 95%CI: 1.13-1.82, P=0.003, respectively), but not NFLG AS (HR 1.03, 95%CI: 0.88-1.21, P=0.68).

Conclusions
Aortic stenosis might be less severe in LG AS than in HG AS when assessed by the CT calcium score of the aortic valve, and each of the 3 hemodynamic types of LG AS had distinct clinical, and echocardiographic characteristics as well as clinical outcomes that were different from HG AS.Different patterns of severe AS
Gender-related differences in the timing of intervention for aortic stenosis: focus on cardiac damage
Authors: O'neill Gonzalez P , Gil C , Roman R , Luque M , Bassa R , Islas F , Gil-Abizanda S , Carnero M , Perez-Camargo D , Montero L , Jimenez P , Nombela L , De Agustin J A , Olmos C 
Published: October 2024

Abstract
Background and aim: There is an increasing awareness of gender-related differences in the management of cardiovascular diseases.
Our aim was to assess whether cardiac damage prior to intervention for severe aortic stenosis (AS) differs according to gender.

Methods
Retrospective analysis of a prospective cohort of patients with AS who underwent surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) in a tertiary care center from 2017 to 2022. Echocardiographic parameters prior to surgery were collected, and patients were classified into categories of a cardiac damage staging system. (1)
Several echocardiographic variables according to gender were evaluated.

Results
869 patients were included, of which 350 underwent TAVR and 519 were treated with SAVR. Females represented 52.4% (n=272) of TAVR patients and 37.7% (n=132) of SAVR patients.
In the echocardiogram performed before the intervention, both in the TAVR and the SAVR cohort, female patients had worse diastolic function (significantly higher values of E/e’), and greater involvement of pulmonary vasculature damage (significantly higher pulmonary artery systolic pressure and worse right ventricular-arterial coupling (Table-Figure 1).
When applying an available cardiac damage staging system (1), we documented that women were treated at a statistically significant more advanced stage compared to men (Figure 2).

Conclusions
There are gender-related differences in the timing of aortic stenosis intervention, both with TAVR and SAVR. Women are operated on at a more advanced stage of cardiac damage, particularly regarding the parameters of diastolic function and right-side damage.
These findings should be taken into account to improve intervention timing and outcomes, especially for women.Table-Figure 1Figure 2
Safety and efficacy of transcatheter aortic valve implantation (TAVI) for pure aortic regurgitation; a systematic review and meta-analysis
Authors: Ktenopoulos N , Apostolos A , Karanasos A , Drakopoulou M , Katsaros O , Simopoulou C , Oikonomou G , Kachrimanidis I , Koliastasis L , Benetos G , Tsalamandris S , Synetos A , Latsios G , Tsioufis C , Toutouzas K 
Published: October 2024

Abstract

Background
Although Transcatheter Aortic Valve Implantation (TAVI) has gained ground in the management of severe aortic stenosis (AS), evidence about its safety and efficacy for patients with pure native aortic regurgitation (AR) remains limited.

Purpose
The aim of the study is to systematically review and summarize available data regarding the safety and the outcomes of TAVI in pure AR.

Methods
This study was conducted according to the PRISMA guidelines. We systematically searched PubMed, SCOPUS, and Cochrane databases from their inception to February 1, 2024, for studies assessing the characteristics and outcomes of patients undergoing TAVI for pure AR. Primary endpoint of our systematic review and meta-analysis is the in-hospital, 30-days and 1-year mortality rates. Secondary endpoints comprised in-hospital stroke, major bleeding, and permanent pacemaker implantation (PPM) implantation. Endpoint definitions followed the Valve Academic Research Consortium 2 criteria. The cumulative incidence of primary and secondary endpoints and the corresponding 95% confidence intervals (CI) were estimated. A random effects model (DerSimonian-Laird) was used to account for heterogeneity among the included studies.

Results
Our meta-analysis included a total of 22 studies and 6,710 patients undergoing TAVI for pure-AR. Our analysis showed that patients undergoing TAVI for pure AR had 3.4% (95% CI: 2%-4.7%), 7.9% (95% CI: 5.2%-10.6%) and 15.5% (95% CI: 9.9%-21.2%) in-hospital, 30-days and 1-year all-cause mortality. In-hospital stroke occurred in 1.9% (95% CI: 1.5%-2.2%) of the patients, while 4.9% (95% CI: 3.3%-6.6%) of the patients suffered from major bleeding events. Finally, considering the PPM implantation rates, patients had a 10.7% (95% CI: 7.4%-13.9%) in-hospital incidence.

Conclusion
Our systematic review and meta-analysis shows a promising safety profile for TAVI treating pure AR. It demonstrated relatively low in-hospital, 30-days and 1-year mortality incidence, comparable to the TAVI treating severe AS, according to the existing literature. Taking into consideration that TAVI for pure-AR might be the only therapeutic option for an increasing number of patients, further studies are needed to further assess the safety and efficacy of the procedure.TAVI for pure AR mortality rates
Validation of the MIDA mortality risk score in a surgical cohort of patients with primary mitral regurgitation
Authors: O'neill Gonzalez P , Islas F , Parraga R , Gomez Lopez J A , Gutierrez E , Carnero M , Perez-Camargo D , Maroto L , Gil-Abizanda S , De Agustin J A , Olmos C 
Published: October 2024

Abstract

Background and aim
The MIDA scale is a prognostic tool for stratification of short- and long-term mortality risk in patients with primary mitral regurgitation (PMR).
The aim of this study is to validate the MIDA (1) score in our population of PMR treated with surgery.

Methods
Retrospective analysis of a prospective cohort of patients with PMR who underwent mitral valve surgery in a tertiary care center from 2014 to 2022.
The necessary parameters for calculating the MIDA Score (age, symptoms, atrial fibrillation, left atrial diameter, right ventricular systolic pressure (RVSP), left ventricular end-systolic diameter (LVESD), and LV ejection fraction (LVEF)) were collected, and the MIDA score for each patient was calculated. Thereafter, patients were classified into seven different risk groups. One year and long-term mortality during follow-up were recorded.
A logistic regression analysis was performed to evaluate the association of each parameter with outcomes. Finally, curves for the cumulative incidence of all-cause mortality according to the MIDA score were generated with the Kaplan–Meier method.

Results
A total of 349 patients were included. Mean age was 68.5 [12.4] years, 55.8% were male, and the median LVEF was 60% (55-65). Mean follow up was 3.28 (2) years.
One year mortality occurred in 29 (8.3%) patients, and long-term mortality in 59 (16.9%).
According to the MIDA score, the distribution of patients in each subgroup was as follows: score 0 (n=28), score 1-2 (n=35), score 3-4 (n=60), score 5-6 (n=99), score 7-8 (n=81), score 9-10 (n=35), score &gt; 11 (n=11). Most of our cohort was classified as intermediate-risk patients, with a median score of 6 (3-8).
In the univariable logistic regression analysis, age, symptoms before surgery and RVSP were the only MIDA parameters significantly associated with mortality (Table-Figure 1).
In our population, the discriminatory capacity of the MIDA score, was moderate, with an area under the ROC curve of 0.676 CI (0.624-0.725) for one year mortality, and 0.702 (0.651-0.749) for long term mortality. The best cut-off point for predicting one-year and long-term mortality was a MIDA score of 7.
Kaplan-Meier curves for mortality during follow-up are shown in Figure 2.

Conclusions
The MIDA score showed a fair discriminatory capacity in our surgical cohort of patients with PMR. Variables included in the score that had a significant association with mortality were age, presence of symptoms and elevated RVSP.
LV parameters included in the MIDA, which are the current class I indication for surgery, did not show a significant association with outcomes.
Different echocardiographic variables to evaluate cardiac damage in PMR are needed to achieve better stratification.Table-Figure 1Figure 2