bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of aortic valve calcium score on conductive disturbances after transcatheter aortic valve implantation: a monocentre retrospective study
Authors: Durand E , Barbe T , Fauvel C , Le Pessec G , Levesque T , Tron C , Bouhzam N , Bettinger N , Hemery T , Dacher J N , Eltchaninoff H 
Published: October 2024

Abstract

Introduction
Conductive disorders requiring permanent pacemaker implantation (PPI) remain an important issue after transcatheter aortic valve implantation (TAVI).

Aims
To assess the impact of aortic valve calcium score (AVCS) on conductive disorders requiring PPI after TAVI.

Methods
All patients who underwent TAVI with an available AVCS from the pre-procedural CT-scan report from 2016 to 2022 were included in this retrospective single-centre study. The primary endpoint was the occurrence of a conductive disorder requiring PPI at 30 days. The association between PPI and AVCS was analyzed using multivariable logistic regression and receiver operating characteristics (ROC) curves analyses.

Results
Seven hundred and sixty-one patients were included, of whom 125 (16%) patients required a PPI at 30 days. AVCS score was significantly higher in patients requiring PPI (3788 (2487-5218) vs. 3050 (2043-4367) AU, p&lt;0.001). Using multivariable analysis, pre-procedural right bundle branch block (OR=6.61, 95%CI=3.82-11.5, p&lt;0.001), first atrioventricular block (OR=1.71, 95%CI=1.03-2.83, p=0.037), the use of a self-expanding valve (OR=3.25, 95%CI=1.17-9.09, p=0.025), and AVCS &gt;4510 AU (OR=1.83, 95%CI=1.04-3.20, p=0.035) were independently associated with PPI. The area under the curve for ACVS to predict PPI was 60.3% (95%CI=54.7%-65.9%), indicating moderate discrimination. Of note, AVCS had an incremental discriminative value (C-index 0.79 vs 0.77, LR test p=0.036) over and above traditional PPI risk factors.

Conclusion
The results of our study suggest that a high AVCS is associated with an increased risk of PPI after TAVI.Central illustration
Objective functional improvement and vital prognosis after TAVR in patients with low-gradient aortic stenosis. Development of a predictive score
Authors: Veiga Fernandez G , Sainz Laso F , Lee D H , Ruisanchez Villar C , Garcia Camarero T , Cuesta Cosgaya J M , Fradejas Sastre V , Gil Ongay A , Garilleti C , Hernandez R , De La Torre Hernandez J M 
Published: October 2024

Abstract

Introduction
Patients with low-gradient aortic stenosis (mean gradient &lt; 40 mmHg) (LGAS) supose a clinical challenge because in these patients the degree of functional recovery after TAVR could be lower and their prognostic evolution more adverse. This is relevant for the optimal indication of TAVR, especially with the growing number of patients with a borderline indication due to comorbidities or advanced age with certain degree of frailty.

Purpose
To develop a clinical model to predict the response to TAVR in LGAS patients based in non invasive physiological parameters at baseline.

Methods
In a cohort of patients undergoing TAVR a prospective evaluation of multiple pathophysiological parameters was performed derived from pre- and post-TAVR assessment with echocardiography, computed tomography, and non-invasive arterial pulse wave analysis with the Sphygmocor XCEL system. Objective functional improvement 6 months after TAVR was assessed by the 6-minute walk test and NT-proBNP levels. Clinical follow-up was performed at 1 year.

Results
Of the 450 patients included, 310 showed high aortic gradient and 140 (31%) low gradient, with an objective functional improvement in 90% and 64% (p&lt;0.001) respectively, and with 1-year mortality of 4% and 12% (p=0.001). In the LGAS group, 1-year mortality was 20% in the subgroup without functional improvement and 8% (p=0.001) in the subgroup showing functional improvement. In the LGAS group, the pathophysiological parameters predictive of functional improvement were the augmentation index75 ≥ 45% (OR 4, CI 95% 1.9–11.3; p=0.006), posterior wall thickness ≤ 12 mm (OR 3.2, CI 95% 1.4–8; p=0.01) and absence of atrial fibrillation (OR 2.7, CI 95% 1.5–8.4; p=0.01). To generate a simple integer-based point score for each predictive variable, each beta coefficient was divided by the absolute value of the smallest coefficient, multiplied by 5, and rounded to the nearest integer. The values were 7, 6 and 5 respectively. Among the low-gradient population, in 55 patients with 0-6 score points the functional improvement was only 29%, while in the remaining 85 patients with 7-18 score points the functional improvement was 86% (p&lt;0.001).

Conclusions
LGAS patients account for a relatively high proportion of patients undergoing TAVR. They show less objective functional recovery, which is associated with a significantly higher mortality at follow-up. We have developed a score based on 3 variables (augmentation index75, posterior wall thickness and atrial fibrillation) that can help predict the functional and prognostic response to TAVR in these patients.
Pacing dependency after TAVI, a lasting hazard in every case?
Authors: Barbosa Sousa R , Lima M R , Felix De Oliveira A , Azevedo S , Da Silva Correia D , Domingues M , Albuquerque F , Carmo J , Brito J , Campante Teles R , Almeida M , Adragao P 
Published: October 2024

Abstract

Introduction
Atrioventricular (AV) conductions abnormalities that require permanent pacemaker (PPM) occur in up to 20% of patients after TAVI. The evolution of conduction abnormalities and the long-time pacing burden have not been fully characterized. We aim to characterize ventricular pacing burden after TAVI assessing also the impact of clinical and periprocedural factors.

Methods
Single centre retrospective registry including all consecutive patients undergoing TAVI between 01/2014 and 08/2021 that had a PPM implanted during index admission. Patients with in-hospital death were excluded. Baseline and pacing follow-up data were collected prospectively and assessed retrospectively using local electronic health records. We examined pacing burden as the percentage of ventricular pacing (VP%) and divided our cohort in 3 groups: i VP% ≤10%, ii 10% &gt; VP% &lt; 90%, iii VP% ≥90%. We assessed the difference between discharge and 1y VP% and the interaction between baseline characteristics.

Results
766 patients underwent TAVI and 109 (14.2%) were included. The median age was 84 years (IQR 80 ; 90) and 44% were male (n = 48). 19 patients (17.4%) had previous 1st degree AV block (AVB) and 37 patients (33.9%) had previous right bundle branch block (RBBB). A self-expandable valve was implanted in 78 patients (71.6%). The median time between TAVI and PPM was 2 days (1;5). Sustained complete AVB (cAVB) occurred in 85 patients (78.0%) and was the most common indication for PPM. Data on VP% at discharge was available for 102 patients (93.5%). The median VP% at discharge was 100% (99 ; 100) with 4 patients (3.7%) having ≤10% VP% and 87 patients (79.8%) having ≥90% VP%. 95 patients (87.2%) completed the 1y follow-up. The VP% decreased significantly between discharge and 1y follow-up - 8.0 (IQR -59 ; 0 / p &lt;0.05 Wilcoxon test) (Figure 1), similarly across valve type. At 1y follow-up, 20 patients (18.3%) had ≤10% VP% and 43 patients (39.4%) had ≥90% VP%. In the 18 patients (19.4%) without periprocedural sustained cAVB, 9 patients (50.0%) had ≤10% VP% and 1 patient (5.6%) had ≥90% VP%. In contrast, among patients with sustained cAVB, 11 patients (14.7%) had ≤10% VP% and 40 patients (53.3%) had ≥90% VP% (p &lt;0.05 Chi-squared) (Figure 2).

Conclusions
In this study cohort the pacing burden significantly decreased in the 1st year after TAVI. It was significantly lower in patients without periprocedural sustained cAVB which suggests that a more conservative management may be considered in a small subgroup of patients.
Temporal trends of aortic valve replacement modalities by age group in the United-States 2015 - 2023
Authors: Barghout M , Khan A , Barry C , Imran H , Ahmad K , Sharaf B , Gordon P , Ehsan A , Abbott J , Elkaryoni A , Saad M 
Published: October 2024

Abstract

Background/Introduction
Transcatheter aortic valve implantation (TAVI) has led to a paradigm shift in treating aortic stenosis (AS) across patients of all surgical-risk categories. To guide the clinical decision, the ACC/AHA guidelines recommended an age group classification; with SAVR being recommended in patients &lt; 65 years, and TAVI being favored over SAVR in patients &gt; 80 years. In patients between 65-80 years, both modalities are to be considered after shared decision making. The impact of those guidelines-derived age group classification on the contemporary AVR practice remains of interest and is dynamically changing.

Purpose
This study aims to examine the temporal trends in the modality of AVR (TAVI vs SAVR) in the U.S. among different age groups using a contemporary nationwide database.

Methods
We conducted a retrospective study using de-identified data from the Vizient Clinical Database, which gathers patient and hospital data from more than 1000 medical Centre. We analysed TAVI and SAVR procedures from October 1, 2015, to November 30, 2023, excluding patients under 18. We examined the national trends of TAVI vs SAVR in 3 age groups (&lt;65, 65-80, &gt;80 years) with AS. Trend analysis was performed using linear regression. This study was deemed exempt from the requirements of 45 CFR 46.104(d) by The Miriam Hospital Institutional Review Board given that it involved de-identified data.

Results
During the study period, 467,832 underwent AVR (TAVI n= 252,834, SAVR n= 214,998). The patient and hospital characteristics by age group are summarized in the Table. We observed a significant rise in TAVI adoption from 33.5% in 2015 to 59.96% in 2023. However, the pattern of temporal trends varied among different age groups. In patients &gt; 80 years, TAVI showed a steep rise from 69.95% in 2015 to 92.96% in 2023 (p&lt;0.002). The 65-80 years age cohort demonstrated the most pronounced growth in TAVI, rising from 26.23% in 2015 to about 60% in 2020 (p.001), after which a plateau in percentage was observed. TAVI in patients &lt;65 years has also been increasingly adopted, rising from 7.18% in 2015 to 19.12% in 2020 (p&lt;0.002), however, followed with a slight downtrend to 16.36% in 2023 (Figure).

Conclusion
In this most contemporary analysis from the U.S., we demonstrate an increase in the adoption of TAVI across all age groups over the study period, with the steepest rise observed in patients between 65-80 years of age. Since the 2020 ACC/AHA guidelines, there has been a gradual downtrend in the utilisation of TAVI in patients &lt;65 years of age indicating a possible change in practice based on scientific societal recommendations. The stabilization in TAVI percentage in the age groups 65-80 years and &gt; 80 years in the last few years may hint towards approaching equilibrium between TAVI and SAVR for these age groups.Proportions of AVR across age groups
Impact of epicardial adipose tissue and atrial functional impairment in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement
Authors: Gronwald J , Lange T , Evertz R , Backhaus S J , Kowallick J T , Hasenfuss G , Schulz A , Schuster A 
Published: October 2024

Abstract

Background
Recent studies outlined the additional prognostic value of atrial function in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). At the same time, increased epicardial adipose tissue (EAT) volumes have proven impact on atrial functional impairment in cardiovascular disease by nurturing adverse atrial remodelling.

Purpose
To explore the impact of increased EAT volumes as a potential pathomechanistic factor of atrial functional impairment in patients with severe AS undergoing TAVR.

Methods
146 patients with severe AS underwent cardiac magnetic resonance (CMR) within 48h prior to TAVR between January 2017 and June 2021. Image analyses included myocardial volume quantification as well as CMR-feature-tracking derived strain. EAT volumes were manually delineated on short axis stacks in end-diastolic cardiac phases and indexed to body surface area. Functional and morphological parameters were compared between patients with high and low EAT volumes. Associations between morphological and functional parameters and EAT were tested using a multivariable linear regression model including patient specific parameters.

Results
After dichotomization at the median of 46.5ml/m2 total EAT volume, patients were assigned to high- and low-EAT groups accordingly. There was comparable age and body mass index and similar rates of co-morbidities such as hypertension, diabetes and atrial fibrillation in both groups. We observed a higher number of male patients in the high-EAT group (36 [53%] vs. 50 [72%], p=0.018). Regarding left and right ventricular dimensions and function, no differences could be shown. Left atrial (LA) end-systolic volumes were significantly higher in the high-EAT group (29.4ml/ml² [19.7-39.4] vs. 40.9ml/ml² [30.2-59.3], p=0.008), while there were no significant differences in end-diastolic volumes. Furthermore, LA reservoir strain was significantly lower in the high-EAT group compared to the low-EAT group (18.0% [11.7-21.0] vs. 11.8% [7.7-16.4], p=0.008) and was independently associated with higher EAT volumes (p=0.018) irrespective of cardiovascular risk factors and left ventricular (LV) systolic function in a multivariable regression model.

Conclusion
In patients with severe AS undergoing TAVR, increased EAT volumes are associated with both, morphological and functional changes of the atria. As impaired atrial function was previously shown to be an important predictor of mortality in TAVR patients, those results potentially render EAT as an additional pathomechanistic link between atrial remodelling and worse outcome in TAVR patients.
One-year outcomes of transcatheter mitral valve replacement in patients with severe mitral regurgitation
Authors: Feng S , Wang S , Pan X 
Published: October 2024

Abstract

Background
Mitral valve regurgitation (MR) is a prevalent valvular heart disease, and a subset of patients face challenges in undergoing surgical treatment. Transcatheter mitral valve replacement (TMVR) has emerged as a viable option for selected patients with severe MR deemed unsuitable for traditional valve surgery.

Purpose
This study aims to evaluate the feasibility, safety, durability, and clinical outcomes of a novel transapical mitral valve system (MitraFix valve) in treating moderate to severe MR patients.

Methods
The early feasibility study of the MitraFix TMVR transapical system is a multicenter, prospective, nonrandomized study. All patients underwent evaluation by a multidisciplinary heart team and were deemed suitable for mitral valve intervention. Clinical events were adjudicated by an independent clinical events committee.

Results
From June 2021 to July 2022, 10 patients (mean age: 71.2 ± 7.4 years, 40% male) were enrolled. The mean Society of Thoracic Surgeons(STS) predicted risk of mortality was 7.5 ± 2.7%. All implants were successful, with a mean operational time of 45.2 ± 25.9 min. One patient was converted to open cardiac surgery after successfully implanting the valve due to persistent apical bleeding. At 1-year follow-up, all-cause mortality was 20%, with a cardiovascular mortality at 10.0%. Among survival patients, 87.5% of surviving patients had MR ≤1+ and 75% patients were in NYHA functional class I or II at 1 year. The overall KCCQ score significantly increased from 55.8 (42.9, 72.9) points at baseline to 77.5 (73.7, 88.6) points at 1-year follow up (P = 0.012). Left ventricular ejection fraction showed no significant change from basline (51.5%) to 1 year (50.0%) (P=0.799). No evidence of mitral stenosis or left ventricular outflow tract (LVOT) obstruction was observed.

Conclusions
The MitraFix TMVR transapical system demonstrated excellent valve function, low mortality, sustained MR elimination and clinical improvement up to one year in this study. Further studies, encompassing a larger cohort of patients and an extended follow-up duration, are needed to confirm these findings.Change in MR and NYHA functional classChange in Quality-of-Life Assessment
Neurologic recurrence after transcatheter PFO closure in patients with cryptogenic stroke
Authors: Goessinger B , Greisenegger S , Kastl S , Rosenhek R , Serles W , Hengstenberg C , Gabriel H , Schrutka L 
Published: October 2024

Abstract

Background
Patent foramen ovale (PFO) is associated with an increased risk of cryptogenic stroke, and interventional closure is recommended for secondary prevention. However, there is limited real-world data on long-term results. Our objective was to evaluate outcomes following successful transcatheter PFO occlusion.

Methods
Data from patients undergoing PFO closure for cryptogenic stroke between 2010 and 2015 were analysed to determine short- and long-term outcomes and to identify potential predictors of neurological recurrence.

Results
330 patients underwent successful PFO closure. The mean age of patients was 49 (standard deviation (SD) ±12) years, and 55.5% were male. Any in-hospital adverse event was observed in eight patients (2.4%). During a median follow-up of 9.85 (SD ±2.5) years, the combined outcome of transient ischemic attack (TIA), stroke, or death from stroke was observed in 3.6% of patients (0.38 events per 100 person-years). After 5, 10, and 12 years the percentage of patients free of the composite outcome was 97.5%, 96.2%, and 96.2% respectively (Figure 1). New onset atrial fibrillation was detected in 10 patients (3.0%). A thorough analysis of the neurologic recurrences revealed a total number of six cryptogenic strokes (1.8%). Our results revealed that the Risk of Paradoxical Embolism (RoPE) score (adjHR: 0.70, 95% confidence interval [CI]: 0.52 to 0.95; p=0.022) and the number of prior neurologic events (adjHR: 9.78, 95% CI: 2.66 to 35.99; p&lt;0.001) were strong independent predictors of future recurrent neurologic events. Kaplan Meier survival analysis stratified by number of previous neurologic events proved to be statistically significant (p&lt;0.001; Figure 2).

Conclusion
In this real-world cohort of patients with cryptogenic stroke we observed excellent safety and good efficacy of percutaneous PFO closure, similar to randomized controlled trials or other long-term cohort studies. The rate of recurrent neurological events was low, especially cryptogenic strokes. The RoPE score confirmed good predictive power; in particular, the number of previous neurological events should be taken more into account when determining the indication for closure.
Evaluation of efficacy and safety of simplified procedure for the percutaneous closure of patent foramen ovale: the Ile De France Foramen Ovale Permeable(IDFFOP) prospective, multicenter cohort study
Authors: Kamtchueng P , Hascoet S , Aldebert P , Gerardin B , Digne F , Moeuf Y , Nejjari M , Chatellier G 
Published: October 2024

Abstract
The superiority of device closure over medical therapy for the prevention of recurrent stroke in patients with cryptogenic stroke and patent foramen ovale (PFO) was reported in several meta –analyses of randomized controlled trials.
The growing number of PFO procedures requires to find alternatives to conventional guidance by transoesophageal echocardiography (TOE) needing general anesthesia.
The aim of our study was to assess prospectively the efficacy and safety of a simplified procedure based on trans thoracic echocardiography (TTE) and local anesthesia rather than TOE during PFO closure.

Methods
Design and study oversight.
The IDFFOP study was a French prospective, multicenter cohort study performed in four centers expert in TTE-guided device deployment.
All patients had a stroke history, a PFO and a large or moderate right to left shunt defined by the number of microbubbles in the left atrium ( large shunt &gt; 30, moderate : 10 to 30 microbubbles).
A(Risk of Paradoxical Embolism) score&gt;5 was required to confirm PFO imputability in stroke history. The primary end point was efficacy of TTE during the transcatheter PFO closure defined as the successful implantation of the device without malposition, without need of TOE, and absence of significant residual shunt at 3-month TTE control.
Safety was defined as the absence of any periprocedural complications.

Results
280 patients were enrolled from January 2018 to October 2020 ( male sex : 59.5%; Average age 57 years old ). Average ROPE score was 7; Cumulative immediate procedural success with the TTE-guided method was 99%, without any device embolization.
However, in 2 patients, TOE was needed to guide device deployment.
There was no severe vascular complication, or any ischaemic event during or after the procedure. 6 post-procedure groin hematomas occurred but none needed anyblood transfusion .One patient experienced a transient periprocedural atrial fibrillation.
At 3 months there were only 8 (2,8%) residual right to left shunts (3 large, 5 moderate).

Conclusion
A simplified procedure for percutaneous PFO closure based on TTE and local anesthesia is safe and effective. Randomized controlled trials should be performed to confirm these results.
Intracardiac vs transesophageal echocardiography for percutaneous LAA occlusion: a meta-analysis
Authors: Beneki E , Dimitriadis K , Soulaidopoulos S , Pyrpyris N , Dri E , Iliakis P , Sakalidis A , Koutsopoulos G , Tsioufis P , Kostakis P , Theofilis P , Aznaouridis K , Aggeli K , Tsioufis K 
Published: October 2024

Abstract

Background
Percutaneous left atrial appendage occlusion (LAAO) is typically performed under the guidance of transesophageal echocardiography (TEE) and fluoroscopy. Intracardiac echocardiography (ICE) appears to be a potential alternative to guide implantation.

Purpose
We sought to perform a meta-analysis comparing ICE and TEE for endocardial LAAO.

Methods
A comprehensive literature search was performed in PubMed and Google Scholar regarding published abstracts and manuscripts on July 1, 2023. Studies reporting clinical outcomes comparing ICE vs TEE for endocardial LAAO were included.

Results
A total of 16 studies with 123,444 patients (ICE-5,122 patients and TEE-122,667 patients) (mean age 75±4 years, 59%male) fulfilled the criteria. Five included Watchman, four included the Amplatzer Cardiac Plug/ Amulet device, and seven included both devices. There was no significant difference in CHA2DS2VASC or HAS-BLED scores between both groups. Outcomes assessed including procedural success between ICE vs TEE (risk ratio [RR], 1.01; 95% CI, 1.00-1.01), fluoroscopy time (mean difference [MD], 1.25 minutes; 95% CI, -1.63- 4.14) and total procedure time (MD, −3.74 minutes; 95% CI, − 13.42-5.94) were found to be similar between both groups. There was also no significant difference in complications including vascular complications, bleeding events, device embolization, and stroke between both groups. Of note, patients undergoing LAA closure under ICE guidance had higher risk for pericardial effusion and/or cardiac tamponade compared to those in the TEE group (RR 1.72; 95% CI, 1.32-2.23).

Conclusions
Although TEE is the gold standard for perioperative guidance of LAAO, imaging with ICE is a feasible alternative associated with similar efficacy outcomes in LAAO procedures. However, further studies needed to clarify safety of ICE as an alternative perioperative imaging technique.