bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of atrial fibrillation on progression of tricuspid regurgitation in patients undergoing transcatheter aortic valve replacement
Authors: Yoshida T , Okuno T , Kuwata S , Miyahara D , Kai T , Sato Y , Koga M , Kida K , Ishibashi Y , Tanabe Y , Izumo M , Akashi Y J 
Published: October 2024

Abstract

Background
Recent advancements in interventional cardiology have spurred growing interest in atrial tricuspid regurgitation (TR) as a potential therapeutic target. Atrial TR, a form of secondary TR, arises from the dilatation and dysfunction of the right atrium, frequently seen in the context of atrial fibrillation (AF). While the concept is increasingly recognized, the natural history of TR in relation to AF remains incompletely understood.

Purpose
This study aims to elucidate the impact of AF on the progression of TR in patients undergoing transcatheter aortic valve replacement (TAVR).

Methods
Utilizing data from a comprehensive single-center TAVR registry, this study included patients who underwent TAVR between 2016 and 2023, excluding those with severe TR post-TAVR. Subjects were categorized based on the presence or absence of paroxysmal or persistent/permanent AF/atrial flutter (AFL). The study employed the cumulative incidence function to depict the progression to severe TR, considering all-cause mortality as a competing risk.

Results
Among 981 eligible patients, 169 (17.2%) presented with AF/AFL, with 57 (5.8%) having persistent/permanent and 112 (11.4%) paroxysmal forms. Patients with AF/AFL had a higher surgical risk, a higher prevalence of significant mitral regurgitation and TR, and a lower left ventricular ejection fraction. The median follow-up period was 366 days, with an interquartile range from 36 to 1079 days. Over a 5-year period, 11.7% of patients with AF/AFL experienced progression to severe TR, with 14.2% in those with persistent/permanent AF/AFL and 10.6% in those with paroxysmal AF/AFL, compared to merely 0.8% in patients without AF/AFL (sub-distribution HR: 7.60, 95%CI: 2.86-20.0; P&lt;0.001) (Figure 1). Multivariable Fine-Gray regression analysis showed that AF/AFL was associated with the progression of TR by at least one grade, independently of the TR grade post-TAVR and other echocardiographic parameters (sub-distribution HR: 1.38, 95% CI: 1.06-1.78; p=0.015). Other factors associated with progression included the TR grade post-TAVR (sub-distribution HR: 1.20, 95% CI: 1.05-1.38; p=0.009) and the presence of a permanent pacemaker (sub-distribution HR: 1.53, 95% CI: 1.18-1.71; p=0.001) (Figure 2).

Conclusions
The presence of AF/AFL significantly increases the risk of developing severe TR in the long-term following TAVR, underscoring the need for vigilant monitoring and potentially preemptive management strategies in this patient cohort.
Beyond 2D echocardiography: A novel multiparametric assessment of right ventricular dysfunction in transcatheter tricuspid valve repair
Authors: Doldi P , Stolz L , Weckbach L , Hausleiter J 
Published: October 2024

Abstract

Background
Patients with severe tricuspid regurgitation (TR) are heterogenous and complex in terms of etiology, comorbidities and state of disease. Right ventricular (RV) function measured by RV to pulmonary artery coupling (RVPAc) is prognostic in transcatheter tricuspid valve repair (T-TEER). However, traditional 2D echocardiographic measures have critical limitations and RVPAc fails to respect the degree of volume overload/dilation of the RV, which is a key clinical tracer for right ventricular dysfunction (RVD).

Purpose
We aimed to refine RVPAc by incorporating RV dilation, assessed by 3D echocardiography, to improve the assessment of RV dysfunction for an enhanced outcomeprediction in T-TEER patients.

Methods
We analyzed 262 patients undergoing T-TEER with complete 3D echocardiography.

Results
Despite similar RV function across groups, RV dilation (HR 1.85; 1.10, 3.12; p=0.020) and impaired RV free wall longitudinal strain (RVFWLS, HR 1.73, 1.02, 2.92, p=0.042) predicted increased 1-year mortality. A novel RVPAc parameter [RVFWLS/(3D-RVEDV*sPAPinvasive)] was developed, associating RVPA-Uncoupling with a tripled risk of death (HR 3.19, 1.7-6.0, p&lt;0.001). NYHA Class IV and the new RVPAc were independent mortality predictors after T-TEER, with the modified RVPAc showing superior predictive value over traditional RVPAc (c-index 0.68 vs. 0.57, p=0.027).

Conclusion
The novel RVPAc parameter, integrating RV dilation and function, is a powerful predictor of survival post-T-TEER, underscoring the importance of timely intervention in severe TR and RVD. 3D echocardiography plays a critical role in assessing RV dimension and function, with implications for the management and prognosis of TR patients.Central Figure
Infective endocarditis on percutaneous aortic valve prosthesis: incidence, characteristics and comparison with endocarditis on surgically implanted aortic bioprostheses
Authors: Barreiro Mesa L , Anguita Sanchez M P , Castillo Dominguez J C , Lopez Aguilera J , Gonzalez Manzanares R , Crespin Crespin M , Ojeda Pineda S , Urbano Sanchez C , Roldan Roldan A , Aguayo Cano N , Pan Alvarez Ossorio M P 
Published: October 2024

Abstract

Background
Transcatheter aortic valve replacement (TAVR) has become a first-line therapeutic measure in patients with severe aortic stenosis, especially in selected patients who present a very high surgical risk; nevertheless, this technique is becoming increasingly widespread even among patients with a lower surgical risk. Infective endocarditis (IE) is an infrequent but very serious complication in patients undergoing TAVR implantation. The aforementioned generalization of this technique means that more and more patients are at risk of developing this complication which, in addition, seems to have some particularities with respect to endocarditis in other patients.

Purpose
The aim of our study was to analyze the incidence, clinical characteristics and mortality of IE in patients with TAVR, comparing them with IE in patients with surgically implanted prostheses (SAVR).

Methods
Observational, single-center, prospective cohort study including all cases of IE diagnosed and prospectively followed up in our center from 2008 to 2022, according to Duke or ESC diagnostic criteria, depending on the era. We identified cases of IE in patients with TAVR in this period and compared their characteristics with endocarditis in patients with surgical aortic prostheses.

Results
In our center 10 cases of IE have been diagnosed in patients with TAVR. Since 2008 this procedure has been successfully performed in 778 patients, which gives an incidence of 1.29% compared to 1.68% of its surgical counterpart with a total of 24 cases of IE. The clinical characteristics of these patients are shown in the table. With the exception of mean age (p= 0.006), there were no significant differences between the two groups. In approximately half of the cases the diagnosis was made early after valve replacement (&lt;1 year after replacement). With respect to the causative microorganisms, the most prevalent agent was enterococci, followed by coagulase-negative staphylococci and staphylococcus aureus; in 17% of patients with SAVR the causative agent was not identified. The clinical evolution was similar in both groups, with a high proportion of severe complications and 50% of cardiac complications in the TAVR group. Half of the patients had a surgical indication at diagnosis, but only 50% underwent surgery. There were also no differences in mortality, which, nevertheless, was high, around 30%.

Conclusions
Despite the differences in mean age, no significant differences were found between the two groups. IE is an infrequent but serious complication in patients with prosthetic valves, with a high rate of serious complications and mortality regardless of its management.Baseline characteristics of patients
Infective endocarditis - characteristics and long-term outcomes in patients with congenital heart disease are distinct from those without congenital heart disease
Authors: Havers-Borgersen E , Oestergaard L , Holgersson C K , Stahl A , Schmidt M R , Smerup M , Koeber L V , Fosboel E L 
Published: October 2024

Abstract

Background
Patients with congenital heart disease (CHD) form a high-risk niche among patients considered at high-risk of infective endocarditis (IE). Their life-long exposure to the risk of IE, starting from birth, necessitates a nuanced approach to both prevention and treatment strategies. However, comprehensive data from an unselected nationwide cohort, including children, are lacking.

Purpose
This study sets out to compare characteristics and associated outcomes among patients with IE with and without CHD.

Methods
Using nationwide registries, all Danish patients diagnosed with IE from 1977-2021 were identified and stratified on whether they had a diagnosis of CHD, regardless of its complexity. Characteristics prior to and during admission as well as associated outcomes (i.e., in-hospital mortality, 1-year mortality, and 10-year mortality, and IE recurrence) were compared between groups.

Results
In total, 14,040 patients were diagnosed with IE from 1977-2021 including 895 (6.4%) with a diagnosis of CHD. Patients with versus without CHD were significantly younger at time of IE diagnosis (median age 38.8 years [IQR 21.2-56.4 years] versus 70.7 years [IQR 58.8-78.9 years], Figure 1) and less comorbid. Patients with versus without CHD were hospitalized due to IE for a similar period of time but more often underwent cardiac surgery during admission (44.9% versus 21.3%). The IE-related bacteremia was significantly different between groups: the most common bacteriemia in relation to IE was Streptococci (29.9%) in patients with CHD and Staphylococcus Aureus (29.9%) in patients without CHD. Patients with CHD were associated with a significantly lower risk of in-hospital mortality (6.4% versus 19.8%), 1-year mortality (10.5% versus 32.4%) and 10-year mortality (21.3% versus 58.7%) compared with those without CHD. The 10-year incidence of IE recurrence was similar among groups (p-value 0.5).

Conclusions
Patients with CHD who develop IE are distinctive from patients with IE without CHD in terms of characteristics as well as long-term outcomes. Notably, our findings stress a key point: the majority of children and adolescents with IE have a CHD. These unselected findings should help guide future preventive strategies, diagnosis, and management.
Pnn deficiency alters expressions of calcium handling proteins and impairs nuclear envelope structure in cardiomyocytes
Authors: Leu S , Ouyang P 
Published: October 2024

Abstract

Pnn is a multi-functional protein playing roles in the regulation of gene transcription, mRNA alternative splicing, as well as cell-cell connection. Previous studies suggested an association between Pnn genetic defects and arrhythmogenic right ventricular cardiomyopathy (ARVC) in human. In this study, we applied an inducible cardiomyocyte-specific Pnn depletion mouse model (Myh6-CreERT2, Pnnflox/flox) to determine the impact of loss of Pnn on cardiac structure and function in mice. Six weeks after inducing Pnn gene disruption, electrocardiographic abnormalities, ventricular dilatation, and reduced left ventricular ejection fraction (LVEF) were observed in mice with loss of Pnn in cardiomyocytes. Histopathological examinations showed that the proliferation of cardiac fibroblasts and expression of α-smooth muscle actin were increased with Pnn depletion, while the cell-cell connection between cardiomyocytes were impaired. In addition to impaired intercalated discs, loss of Pnn also altered the distribution and expression of nuclear envelope proteins and the linker of nucleoskeleton and cytoskeleton (LINC) complex proteins, such as nuclear lamins, Emerin, and SUNs, in cardiomyocytes. Microarray analysis as well as subsequent RT-PCR and Western blots also indicated that loss of Pnn regulated myocardial expressions of genes responsible for calcium handling, such as RYR2, Atp2a2, Slc8a1, and Kcnj3. Furthermore, infiltrations of macrophages and neutrophiles were observed in the myocardium with Pnn depletion, while expression levels of oxidative stress-associated proteins were also significantly regulated by Pnn depletion. In conclusion, Pnn plays an essential role in the maintenance of intercalated disc integrity and nuclear envelope structure of cardiomyocytes, while cardiomyocyte-specific loss of Pnn impairs the calcium handling and leads to arrhythmogenic dilated cardiomyopathy in mice.Cardiac MRI of mice with Pnn depletionMyocardial expression of SUN2 and Emerin
Gender-related differences in clinical characteristics of patients with hypertrophic cardiomyopathy in our city
Authors: Tosun R , Mann C , Hengstenberg C , Dalos D 
Published: October 2024

Abstract

Background
Female patients with hypertrophic cardiomyopathy (HCM) tend to display a higher rate of heart failure as well as lower survival compared to male patients. Despite this, gender-related differences in the clinical characteristics of HCM patients remain unclear.

Methods and Aim
Consecutive HCM patients were prospectively enrolled at a tertiary referral center. The primary objective of this study was to investigate and emphasize gender differences in clinical characteristics including imaging and laboratory parameters.

Results
Between May 2018 and January 2024, a total of 301 HCM patients were included, of which 41.9% were female (n=125). Female patients were significantly older and more symptomatic than male counterparts (59 years [IQR 47-67] vs. 53 years [IQR 39-61], p=0.001; New York Heart Association functional class ³III: 28.8% vs. 17.6%, p=0.002, respectively). No significant differences in body mass index were found (28.4 kg/m² [IQR 24.9-31.6] vs. 28.4 kg/m² [IQR 25.9-31.8], p=0.8).
With respect to echocardiographic parameters, although interventricular septal thickness was comparable (19.0 mm [IQR 16.0-22.0] vs. 19.5 mm [IQR 17.0-22.0], p=0.4) left atrial as well as right atrial volume index were higher in women (30.0 cm³/m² [IQR 27.0-35.0] vs. 27.0 cm³/m² [IQR 24.0-30.0], p&lt;0.001; 27.1 cm³/m² [IQR 25.4-29.3] vs. 24.7 cm³/m² [IQR 22.5-28.2], p&lt;0.001). These findings were further supported by elevated filling pressures in female patients reflected by E/e’ ratio (16 [IQR 14-22] vs. 10 [IQR 9-12], p&lt;0.001). Moreover, these patients showed more frequent left ventricular (LV) outflow tract obstruction (50% vs. 33%, p=0.029) which is accompanied by a slightly higher LV ejection fraction compared to men (69% [IQR 62-74] vs. 62% [IQR 55-67], p=0.004).
In terms of cardiac biomarkers, female HCM patients presented with higher levels of serum N-terminal pro brain natriuretic peptide (671 pg/ml [IQR 333-1613] vs. 357 pg/ml [IQR 115-959], p&lt;0,001) as well as lower concentrations of serum creatinine (0.84 mg/dl [IQR 0.75-0.95] vs. 0.98 mg/dl [IQR 0.87-1.15], p&lt;0.001) whereas no differences regarding high-sensitive troponin-T levels were observed.

Conclusion
This single-center analysis illustrates profound gender-related differences among HCM patients in Vienna. Female patients tend to present in a more advanced clinical status, rather reflecting the phenotype of heart failure with preserved ejection fraction. Whether these findings should prompt an early HCM diagnosis in female patients with unspecific symptoms, or may result in early treatment initiation of e.g. sodium-glucose-transporter 2 inhibitors, should be part of future research.
Effect of tafamidis on left atrial function in patients with transthyretin amyloid cardiomyopathy
Authors: Uemura K , Ichikawa Y , Nagai S , Takeuchi M , Nishihara Y , Takeuchi K , Oota E , Odajima S , Kintsu M , Todo S , Fukuda T , Hisamatsu E , Hirata K , Tanaka H 
Published: October 2024

Abstract

Background
Transthyretin amyloid cardiomyopathy (ATTR-CM) is characterized by the functional and structural consequences of amyloid infiltration predominantly within the ventricles, causing biventricular wall thickening. Amyloid infiltration can be observed in left atrium in ATTR-CM, however, the association of left atrial (LA) myocardial function with cardiovascular events and changes in LA myocardial function with tafamidis administration have not been elucidated.

Purpose
The aim of this study was to identify the association between baseline LA reservoir function evaluated by left atrial reservoir strain and cardiovascular events. Furthermore, monitoring the LA reservoir function before and after tafamidis administration, we also investigated the baseline factors associated with changes in LA reservoir function in patients with ATTR-CM.

Methods
We studied 55 patients with biopsy-proven ATTR-CM who were started on tafamidis in our institution between July 2019 and December 2022 (age: 76 ± 2 years, male: 93%). The primary endpoint was defined as hospitalization for heart failure or cardiovascular death during a median follow-up period of 28 ± 4 months after tafamidis administration. Furthermore, we assessed the factors associated with changes in LA function before and 25 ± 3 months after tafamidis administration for 49 patients who underwent sufficient follow-up echocardiography.

Results
During the follow-up period, 8 patients had cardiovascular death or cardiovascular hospitalization. The Kaplan-Meier curve indicated that the occurrence of cardiovascular events for patients with LA strain ≥ the median 8.6% was significantly lower than for those with LA strain &lt; 8.6% (log-rank P =0.002; Figure A). Furthermore, comparing LA strain before and after tafamidis administration, the group with worsening LA strain tended to be older (79.0 ± 2.0 years vs. 73.6 ± 3.3 years, P=0.004), have higher brain natriuretic peptide (350 ± 83 pg/mL vs. 199 ± 47 pg/mL, P=0.003), have lower global longitudinal strain (GLS) (9.8 ± 1.4 % vs. 12.6 ± 1.6 pg/mL, P=0.008), and higher relative apical longitudinal strain index (1.63 ± 0.4 % vs. 1.14 ± 0.2 %, P=0.021). The multivariate logistic regression analysis was that age, GLS and relative apical longitudinal strain index were the independent determinants for deterioration of LA strain after tafamidis administration (Figure B).

Conclusion
In our study, baseline LA reservoir function was found to be closely associated with cardiovascular events after tafamidis administration, while age, GLS and relative apical longitudinal strain index were associated with worsening LA strain after tafamidis administration. Our findings could represent an additional parameter for the effective management of patients with ATTR-CM.Figure AFigure B
The spectrum of ECG abnormalities in a large cohort of histologically proven cardiac tumors
Authors: Bavuso L L , Suma N , Marinelli V , Ciarlantini M , Casuso Alvarez M , Bela' R , Impellizzeri A , Bertolini D , Di Iuorio O , Pastore G , Ryabenko K , Foa' A , Rinaldi A , Armillotta M , Pizzi C 
Published: October 2024

Abstract

Background
Cardiac tumors represent a heterogeneous clinical scenario. The role of ECG in the diagnostic work-up remains to be investigated.

Objectives
To describe the spectrum of electrocardiographic abnormalities in a large cohort of histologically proven cardiac tumors and to evaluate potential red flags of malignancy.

Material and Methods
247 consecutive patients with histologically proven cardiac tumors and available ECG at Bologna University Hospital were enrolled. All ECGs were independently analyzed off-line using a manual caliper by two experienced cardiologists who were blinded to clinical information and histological results. In case of disagreements, a third consensus re-assessment was performed to resolve any discrepancies. Multivariable regression analysis was used to assess potential predictors of malignancy among electrocardiographic abnormalities.

Results
Of 247 patients, 98 (39.7%) had malignant tumors. Compared with patients with benign tumors, those with malignant tumors exhibited a higher heart rate, right axis deviation, greater depolarization, repolarization abnormalities and bradyarrhythmia at presentation. Regarding specific ECG features, a higher heart rate on admission (p=0.001), bradyarrhythmias (p=0.01), ischemic-like repolarization abnormalities (ST-segment deviation, both depression and elevation, and negative T-wave; p&lt;0.001) and low voltages (p=0.005) were identified as independent predictors of malignancy.

Conclusion
ECG is frequently abnormal in case of malignant cardiac tumors. Some specific electrocardiographic changes could have a supportive role in the diagnostic workup of patients with cardiac tumors by increasing the clinical suspicion of malignancy.ECG Tumors
Early detection of liver fibrosis in patients with Fontan circulation using multiparametric magnetic resonance imaging
Authors: Klauco F , Valkovicova V , Bobocka K , Kaldararova M , Jezberova M , Zigrai M , Simkova I 
Published: October 2024

Abstract

Introduction
Fontan procedure (FP), serving as the palliative intervention for complex congenital heart diseases characterized by single-ventricle physiology, precipitates a spectrum of late-stage complications. Fontan-associated liver disease (FALD) encompassing liver fibrosis (LF) which may progress to liver cirrhosis (LC) and thereby hepatocellular carcinoma (HCC) is among the most serious. Despite its importance, optimal surveillance of FALD remains undefined. Multiparametric Liver Multiscan (LMS) with corrected T1 (cT1) value emerges as a novel magnetic resonance (MRI) based non-invasive quantitative tool for liver inflammation and fibrosis evaluation. Aim of this study was to ascertain prevalence and severity of LF utilizing LMS, alongside identifying contributory risk factors for LF in adults post-FP.

Material and methods
Our cohort included 29 adult patients after FP who underwent LMS. Median age was 25y (20-43y) 54% were females. Liver morphology was assessed by ultrasound (USG) and MRI-based LMS protocol. Hepatic scoring systems, including the Aspartate Aminotransferase to Platelet Ratio Index (APRI), Fibrosis-4 (FIB-4) Index, and Model for End-Stage Liver Disease (MELD), were computed. Additionally, presence of fenestrations in the Fontan circulation, hemoglobin levels (Hb), and blood oxygen saturation both at rest and during exercise (SatO2%) were evaluated.

Results
Median cT1 was 914 (±207) ms, in 87% exceeding normal threshold . In those with elevated cT1, LF was undetected by USG in 38%. LC was identified in 27% of the cohort by USG. LC group exhibited significantly higher cT1 values (P&lt;0.001) compared to non-LC group. cT1 value &gt;933ms was associated with a sensitivity of 89% and a specificity of 80% for diagnosing LC (AUC 0.92). Significant correlation was found between cT1 values and Hb (P=0.01) and desaturation (SatO2 &lt;90%/ interventional closure of fenestration, P=0.004). Conventional liver tests and hepatic scoring systems (APRI/FIB-4/MELD) did not predict cT1 nor LC.

Conclusion
Our study confirmed that LF is almost widely prevalentamong adult patients with single-chamber circulation. Risk factors for LF are systemic desaturation (SatO2 &lt;90% or interventional closure of fenestration) and polyglobulia. However, reliable FALD surveillance remains challenging. Conventional liver assessments and scoring algorithms fall short in delineating the full scope of LF or LC. Consequently, the integration of non-invasive LMS into routine follow-up regimens is advocated, given its pronounced sensitivity for detecting subclinical FALD manifestations and predicting LC. The LMS-derived cT1 value &gt;933ms is a critical predictor for LC, underscoring its importance in guiding further patient monitoring, treatment, and facilitating early HCC detection.