bluuebunny/crossref_metadata_2025_split huggingface dataset:
Core laboratory versus center-reported echocardiographic assessment of the native and bioprosthetic aortic valve
Authors: Velders B J J , Vriesendorp M D , Weissman N J , Sabik Iii J F , Reardon M J , Dagenais F , Moront M G , Rao V , Fukuhara S , Gunzinger R , Brown M , Groenwold R H H , Klautz R J M , Asch F M 
Published: October 2024

Abstract

Background
The use of a central echocardiographic core laboratory (ECL) is advised to minimize measurement variation and heterogeneity in clinical trials. Insights into quantitative differences between ECL and center-reported echocardiographic assessment of the native and bioprosthetic aortic valve are lacking. We aimed to explore clinically relevant differences between these evaluations.

Methods
Data were used from the PERIcardial SurGical AOrtic Valve ReplacemeNt (PERIGON) Pivotal Trial for the Avalus valve. In this trial, patients with an indication for surgical aortic valve replacement (SAVR) due to aortic stenosis or regurgitation (AR) were enrolled. Serial echocardiographic examinations were performed at each center and reanalyzed by an independent ECL. For the bioprosthetic valve analysis, postoperative data throughout 5-year follow-up were pooled. Differences between the ECL and the centers in continuous parameters were quantified in mean differences and intraclass correlation coefficients (ICCs). Between-center differences were illustrated by plotting standardized mean differences (SMDs) between centers and the ECL for the 10 sites that implanted the most prostheses. Agreement on AR, paravalvular leak (PVL), and prosthesis-patient mismatch (PPM) classification was investigated using Cohen’s kappa coefficients.

Results
The analysis on the native aortic valve was performed on 1118 patients. The relative mean difference was largest for the left ventricular outflow tract (LVOT) area, followed by stroke volume and effective orifice area (index), with center-reported values being 11-7% higher (Table 1). High ICCs of around 0.90 were observed for peak aortic jet velocity, mean pressure gradient, and the velocity-time integral across the aortic valve. More than 5000 echocardiograms were available for the bioprosthetic valve analysis. Therein, comparable results were observed. In Figure 1, differences in assessment on center level are illustrated. The SMDs for peak velocity were between 0 and 0.5 for all centers, while there was more heterogeneity between centers for other parameters. The kappa coefficient was 0.59 (95% confidence interval [CI] 0.56, 0.63) for agreement on native AR, 0.28 (95% CI 0.18, 0.37) for PVL, and 0.42 (95% CI 0.40, 0.44) for PPM.

Conclusions
For echocardiographic assessment of the native and bioprosthetic aortic valve, agreement between the ECL and the clinical centers varies by parameter and by center. There is high agreement on continuous-wave Doppler-related measurements. On the contrary, agreement is low for parameters that involve measurement of the LVOT diameter. These results provide important context for the interpretation of aortic valve performance in studies that lack central ECL evaluation.
Clinical implications of hepatorenal function in patients undergoing percutaneous coronary intervention: insights from the SAKURA PCI2 registry
Authors: Sudo M , Murata N , Matsumoto M , Matsumoto N , Atsumi W , Tachibana E , Haruta H , Kougo T , Nomoto K , Arai M , Arima K , Koyama Y , Oiwa K , Okumura Y 
Published: October 2024

Abstract

Background
Hepatorenal function is a prognostic predictor for heart failure, cardiac surgery, and transcatheter intervention for structural heart disease. However, the clinical implications of hepatorenal function assessed by the Model for End-stage Liver Disease eXcluding International normalized ratio (MELD-XI) score is still unclear in patients undergoing percutaneous coronary intervention (PCI).

Purpose
This study aimed to clarify the association between clinical prognosis and the MELD-XI score.

Methods
We analyzed 993 patients who underwent PCI from June 2020 to July 2022 in the SAKURA PCI2 registry, a prospective multicenter registry. Patients were stratified into high (&gt;10) or low (≤10) MELD-XI scores. Primary outcome was defined as 2-year major adverse cardio or cerebrovascular event (MACCE), including all-cause death, ischemic stroke, and non-fatal myocardial infarction. Secondary outcome was defined as major bleeding according to the Bleeding Academic Research Consortium 3 or 5.

Results
Of study participating patients, 253 patients (25.5%) were stratified into a high MELD-XI score group and had a higher prevalence of the high bleeding risk than patients with a low MELD-XI score (92.5% vs. 53.7%, p&lt;0.01). Patients with a high MELD-XI score were associated with MACCE (13.1% vs. 2.7%, p&lt;0.01; adjusted HR 3.78, 95%CI 1.78-8.03, p&lt;0.01) and major bleeding (4.0% vs. 1.3%, p&lt;0.01: unadjusted HR 3.32, 95%CI 1.35-8.18, p=0.01). Moreover, these associations remained consistent in patients with chronic and acute coronary syndrome (MACCE, p for interaction=0.89; major bleeding; p for interaction=0.64).

Conclusion
A high MELD-XI score was associated with an increased risk of MACCE and major bleeding within two years. Therefore, the MELD-XI score could provide information for risk stratification in patients undergoing PCI.Outcomes
Echocardiographic evaluation of right ventricle to pulmonary artery coupling in patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis
Authors: Ananta M , Wijaya A D , Pragitara C F , Almutairi A A 
Published: October 2024

Abstract

Background
Right Ventricle to Pulmonary Artery (RV/PA) uncoupling, which depicts the inability of RV contractility to match the increasing RV afterload, has recently gained recognition as a simple echocardiography parameter to aid prognosis judgment in patients with RV dysfunction. In Aortic Stenosis (AS) patients, the extent of RV dysfunction and Pulmonary Hypertension (PH) has been linked with poor outcomes, but the prognostic value of RV/PA uncoupling in AS patients undergoing TAVI has not been well-defined.

Purpose
To investigate the prognostic value of RV/PA uncoupling and its association with echocardiographic parameters in AS patients undergoing TAVI.

Methods
We conducted a systematic search through Pubmed and Embase to include studies up to February 2024. Studies were eligible if they evaluated the prognostic performance of RV/PA uncoupling in AS patients undergoing TAVI. Random-effects model were employed to pool the adjusted Hazard Ratio (aHR) with inverse-variance weighting method or Relative Risk (RR) with 95% Confidence Interval (95% CI) using Mantel-Haenszel test for categorical outcomes or Weighted Mean Difference (WMD) for numerical outcomes. Risk of bias assessment was conducted using the Newcastle Ottawa Scale (NOS).

Results
Thirteen studies were included. Out of 4,146 patients, 55.21% were reported to have RV-PA uncoupling prior to TAVI. RV/PA uncoupling was customarily assessed with TAPSE/PASP ratio, with threshold for uncoupling ranging between &lt;0.31–&lt;0.63 mm/mmHg. Follow-up period ranged between 6–65 months. Patients with baseline RV/PA uncoupling had lower LVEF (WMD -9.94% [-4.36– -15.53%]; I2 = 78%), lower TAPSE (WMD -4.98 mm [95% CI -1.15– -8.80]; I2 = 95%), and higher PASP (WMD 19.77 [95% CI 17.02–22.51]; I2 = 0%) compared to patients with RV/PA coupling at baseline. Baseline RV-PA uncoupling was an independent predictor of all-cause mortality (pooled aHR = 2.26 (95% CI 1.36–3.76); I2 = 77%) and composite endpoint of mortality and adverse cardiac or cerebrovascular events (pooled aHR = 2.07 (1.30–3.29); I2 = 24%). However, RV/PA uncoupling was not significantly associated with a higher risk of permanent pacemaker implantation after TAVI (pooled Risk Ratio 1.02 [0.70–1.47]; I2 = 0%).

Conclusion
Pre-procedural RV/PA uncoupling emerges as an independent predictor of worse prognosis in AS patients undergoing TAVI, contributing to a better understanding of the impact of this parameter on patient outcomes.
Visual coronary artery calcium assessment on routine chest CT can readily and cheaply identify liver transplant recipients with a low cardiac risk
Authors: Groen R , Barbero F , Fischer S E , Bax J J , Tushuizen M E , Jukema J W , Coenraad M J , De Graaf M A 
Published: October 2024

Abstract

Background
Peri- and postoperative cardiac complications play an important role in survival of patients after liver transplantation (LT). However, the optimal approach for cardiac risk prediction in these patients has been debated on. LT recipients routinely receive non-gated computed tomography (CT) of the abdomen and chest to follow-up on their liver diseases. This study analyzed whether performance of coronary artery calcium (CAC) assessment on freely available scans can enhance cardiac risk stratification of LT recipients.

Methods
Consecutive LT recipients from 2008-2023 were included and analyzed retrospectively. CAC was scored visually on non-gated CT on a semi-quantitative ordinal scale and stratified in two groups according to CAC severity. Peri-operative (≤90 days) and post-operative all-cause mortality and cardiac events were analyzed. Furthermore, all-cause mortality and cardiac events were analyzed and compared between the groups with a Kaplan Meier curve and Cox proportional hazard regression.

Results
A total of 149 patients were included with a median age of 58 years. The median follow-up time was 5 years. The majority (74%) of patients had no or mild CAC. None of these patients died perioperatively due to cardiac causes, or experienced peri-operative cardiac events. The post-operative 10-year survival of LT recipients with no or mild calcifications was significantly better (p&lt;0.01) than patients with severe CAC. The 10-year cardiac event-free survival was significantly better in patients with no or mild CAC (p&lt;0.01) and the incidence increased &gt;4-fold from only 4% in patients with no-mild CAC to 18% in patients with severe CAC. Of interest, severe CAC was a significant predictor of cardiac events (HR 4.6, p=0.02), while classical cardiovascular risk factors e.g. diabetes were not.

Conclusion
CAC assessment on routinely available non-gated CT can readily enhance peri- and postoperative cardiac risk stratification of LT recipients, as it identifies a selection of low-risk individuals for having peri- and post-operative cardiac events and all-cause mortality. Thereby, reducing test burden for the patients and saving healthcare expenses.
Location-specific prognostic significance of plaque burden, stenosis, and plaque morphology in coronary artery disease
Authors: Jukema R , Teemu Maaniitty T , Nurmohammed N S , Raijmakers P G , Planken R N , Twisk J , Van Der Harst P , Cramer M J M , Min J K , Earls J , Knaapen P , Saraste A , Knuuti J , Danad I 
Published: October 2024

Abstract

Background
The prognostic significance of coronary plaque localization, percentage atheroma volume (PAV), stenosis, and plaque morphology has been underexplored.

Purpose
To investigate the prognostic significance of plaque localization beyond plaque burden, presence of stenosis and plaque morphology.

Methods
Patients with no cardiac history who underwent coronary CTA were included. PAV, maximum diameter stenosis, and plaque morphology were assessed and classified into proximal, mid, or distal segments of the coronary tree. Major adverse cardiac events (MACE) were defined as death or non-fatal myocardial infarction.

Results
Among 2819 patients 267 events (9.5%) occurred during a median follow-up of 6.9 years. PAV of the proximal segments was strongly correlated to PAV localized at of the mid (R= 0.76) and distal segments (R = 0.74, p &lt; 0.01 for both). When adjusted for traditional risk factors and presence of plaque on other locations, only proximal PAV was independently associated with MACE (3rd quartile HR 2.08, 95% 1.17–3.71, p=0.01 and 4th quartile HR 2.29, 95% CI 1.21–4.34, p=0.01). Similar results were seen for presence of stenosis. Proximal, mid, and distal PAV as a solitary metric (unadjusted) had similar predictive value for MACE with an AUC of 0.73 (95% CI 0.69-0.76) for proximal PAV and 0.72 (95% CI 0.68-0.76) for both mid and distal localized plaque). Similar results were obtained using diameter stenosis instead of PAV. The presence of low-attenuation plaque (LAP) in the proximal segments had additional prognostic value. Calcified or noncalcified PAV did not provide additional value beyond total location-specific PAV and presence of low-attenuation plaque.

Conclusions
Proximal located PAV is an independent predictor of death and non-fatal MI, while there was no incremental prognostic value of plaque localized at the mid or distal coronary segments. The presence of LAP in the proximal segments provided additional prognostic value for prediction of MACE.
Clinical experience of transapical off-pump mitral valve repair with NeoChord implantation
Authors: Kalompatsou A , Beneki E , Dimitroglou Y , Koukos M , Aggeli D , Tolis E 
Published: October 2024

Abstract

Introduction
Transapical off-pump mitral valve repair with NeoChord implantation is a novel minimally invasive surgical procedure to treat degenerative mitral valve regurgitation (MR). has gained widespread application for patients presenting with severe mitral regurgitation caused by leaflet prolapse or flail. However, there is a scarcity of data concerning the clinical experience with this device.

Purpose
This prospective study aims to assess 1-year clinical results of the Neochord Procedure in a consecutive cohort of patients.

Methods
Between March 2018 and December 2023, 38 patients with severe symptomatic degenerative MR were enrolled in the study. All patients presented with severe MR due to flail of 1 or both leaflets and they all completed postoperative echocardiographic assessment up to 1 year. We identified the primary endpoint as composed of procedural success , freedom from mortality, reintervention, recurrence of severe MR , and decrease of at least 1 New York Heart Association (NYHA) functional class at 1-year follow- up.

Results
Median age was 59 years (21% female). Acute procedure success (defined as successful placement of at least 3 neochords with reduction of residual MR to less than 2+) was achieved in all patients. The intraoperative and in-hospital mortality rate was 0%. At 1-year overall survival was 97% with the one reported death attributed to other causes. Following the procedure, almost all patients (94%) reported a decrease in NYHA functional class at 1-year follow-up along with a reduction in diuretic usage (18% of patients presented with NYHA Class I, while 76% of them presented with NYHA Class II). Moreover, 18% of patients exhibited mild MR, while 63% presented with moderate MR, and 10% had no detectable mitral leakage.

Conclusion
Transapical off-pump mitral valve repair with NeoChord implantation seem to be a safe procedure for patients. However, further investigations with a larger sample size and longer follow-up periods are warranted.
The usefulness of IVUS and OCT in patients treated with rotational atherectomy
Authors: Januszek R , Wanha W , Malinowski K P , Siudak Z , Kuzemczak M , Koltowski L , Jaguszewski M , Wojakowski W , Iwanczyk S , Silka W , Gladys K , Wacinski P , Grzegorek D , Dziarmaga M , Dascenzo F 
Published: October 2024

Abstract

Background
Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have been shown to improve clinical outcomes of percutaneous coronary interventions (PCIs) in selected subsets of patients.

Purpose
To investigate whether the use of OCT or IVUS during PCI with rotational atherectomy (RA-PCI) will increase odds for successful revascularization defined as thrombolysis in myocardial infarction (TIMI) 3 flow.

Methods
Data were obtained from the national registry of PCIs (ORPKI) maintained by the Association of Cardiovascular Interventions (AISN) of the Polish Cardiac Society. The dataset includes PCIs spanning from January 2014 to December 2021

Results
A total of 6,522 RA-PCIs were analyzed, out of which 708 (10.9%) were guided by IVUS and 86 (1.3%) by OCT. The postprocedural TIMI 3 flow was achieved significantly more often in RA-PCIs guided by intravascular imaging (98.7% vs 96.6%, p&lt;0.0001). Multivariable analysis revealed that using of IVUS and OCT was independently associated with an increased chance of achieving postprocedural TIMI 3 flow by 67% (odds ratio (OR), 1.67; 95% confidence interval (CI): 1.40–1.99; p&lt;0.0001) and 66% (OR, 1.66; 95% CI: 1.09–2.54; p=0.02), respectively. Other factors associated with successful revascularization were as follows: previous PCI (OR, 1.72; p&lt;0.0001) and coronary artery bypass grafting (OR, 1.09; p=0.002), hypertension (OR, 1.14; p&lt;0.0001), fractional flow reserve assessment during angiogram (OR, 1.47; p&lt;0.0001), bifurcation PCI (OR, 3.06; p&lt;0.0001), and stent implantation (OR, 19.6, p&lt;0.0001).

Conclusions
PCIs with rotational atherectomy guided by intravascular imaging modalities (IVUS or OCT) are associated with a higher procedural success rate compared to angio-guided procedures.
Aortic stenosis and the evolution of cardiac damage after transcatheter aortic valve replacement
Authors: Islas F , O'neill P , Gutierrez Ortiz E , Jimenez-Quevedo P , Mahia Casado P , Gil Abizanda S , De Agustin J A , Olmos Blanco C 
Published: October 2024

Abstract

Aims
Cardiac damage staging has been postulated as a prognostic tool in patients undergoing transcatheter aortic valve replacement (TAVR). The aim of our study is to show the echocardiographic and clinical outcome of patients one-year after TAVR.

Methods and results
Patients undergoing TAVR from 2017 to 2021 were included in a single-centre prospective registry. Transthoracic echocardiography was performed in all patients before TAVR and at one-year. Patients were classified according to a previously published staging model.1
496 patients (mean age 82.1±5.9 years, 53% female) were included. At baseline, Stage 0 included 24.5% of patients, Stage 1 included 42.8%, Stage 2 included 16.5%, and Stage 3 included 16.2% of patients. One-year overall mortality was 17.7% (n=88). Among patients who survived, after one-year of follow-up, the higher the baseline stage of cardiac damage, patients showed larger LVEDV (p= 0.223), LV mass (p= 0.207) and LAVI (p= &lt;0.001); higher E/e’ ratio (p= 0.284) and PASP (p= &lt;0.001). As for LVEF, at one-year; it was significantly lower the higher the baseline stage of cardiac damage (p= 0.005); the same was observed with GLS (p= &lt;0.001) and right ventricle-arterial coupling (p= &lt;0.001), Table 1.

Conclusions
The higher the stage of initial cardiac damage, the lower the possibility of morphological and functional improvement, despite undergoing TAVR. The use of staging systems and earlier intervention could help improve the prognosis of these patients.
Segmental post-PCI physiological gradients using ultrasonic or optical flow ratio
Authors: Chenniganahosahalli Revaiah P , Tsung-Ying T , Muramatsu T , Tanabe K , Kozuma K , Ozaki Y , Onuma Y , Serruys P W 
Published: October 2024

Abstract

Background
Segmental pressure gradients post percutaneous coronary intervention (PCI) may detect residual disease and potential targets for optimization. Ultrasonic flow ratio (UFR) or optical flow ratio (OFR) provide simultaneous physiological and morphological data using a single imaging catheter. Notably, both have been validated against wire based FFR

Objectives
To evaluate the utility of UFR and OFR to identify residual disease post-PCI.

Methods
The present study is a sub analysis of the ASET (Acetyl Salicylic Elimination Trial) JAPAN pilot study Phase I which showed the feasibility and safety of low dose prasugrel monotherapy following PCI in Japanese patients presenting with chronic coronary syndrome and an anatomical SYNTAX score &lt;23. Patients with complete intra-vascular imaging pullback data were included with UFR/OFR acquired in all patients post-PCI. Quantitative and qualitative assessment of IVUS or OCT pullbacks was performed by automatically delineating vessel, lumen, and stent contours every 0.5 mm using QCU-CMS (version 4.69, Division of Image Processing, Leiden University Medical Centre).
UFR or OFR was calculated using the respective IvusPlus or OctPlus software, Pulse Medical, Shanghai, China.(13)(15) All UFR and OFR tracings, and IVUS and OCT pullbacks were analyzed at the CORRIB Core lab, Galway, Ireland by two analysts blinded to clinical and procedural data. Anatomically focal lesions distal and proximal to the stent were evaluated in segments ≥5mm long. UFR/OFR virtual pullback curves were used to calculate intra-stent pressure gradients and physiologically define lesions as focal or diffuse by segmental pressure drops ≥0.05 over lengths &lt;10mm or ≥10mm, respectively.

Results
The median post-PCI UFR/OFR was 0.93 (0.88-0.96) with 69/195 vessels (35.4%) having a UFR/OFR≤0.90. There were significantly more focal anatomical and physiological lesions proximal and distal to the stent in vessels with a UFR/OFR≤0.90 versus &gt;0.90. In vessels with a UFR/OFR≤0.90 there was moderate agreement (weighted kappa=0.553, p&lt;0.001) between anatomical and physiological focal lesions proximal to the stent, whilst it was fair (weighted kappa=0.219, p=0.002) distally. In-stent gradient had poor discriminative ability to detect significant stent under-expansion. The performance of a proximal or distal virtual FFR gradient to detect proximal or distal anatomically focal disease was good (AUC–0.835 and 0.877, respectively)

Conclusions
UFR/OFR enables suboptimal vessel physiology post-PCI to be detected and helps identify the precise anatomical location with corroboration from intra-vascular imaging. Adequately powered physiology optimization trials using UFR/OFR will determine the role of combined morphology and physiological evaluation post PCI in improving clinical outcomes.