bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors for mitral regurgitation improvement in patients with pure severe aortic regurgitation undergoing transcatheter aortic valve replacement: when can kill two birds with one stone?
Authors: Lin D , Pan W , Zhou D 
Published: October 2024

Abstract

Objective
Transcatheter aortic valve replacement (TAVR) has been recognized as a significant treatment for pure severe aortic regurgitation (PSAR). Part of patients with PSAR concurrently suffer from functional mitral regurgitation (FMR). Whether TAVR could improve FMR in patients with PSAR and the predictors have not yet been clarified. This study aims to explore predictors of FMR improvement in patients with PSAR undergoing TAVR and subsequently provide evidence for further clinical therapy.

Method
Patients with PSAR and FMR who underwent TAVR at Zhongshan Hospital Affiliated with Fudan University were enrolled from June 2021 to August 2023. Depending on whether FMR improved one month post-TAVR, they were divided into groups with or without FMR improvement. The baseline data, imaging results, and follow-up data of the patients were collected.

Result
This study included 75 patients, among whom 38 patients had improved FMR and 37 patients did not. Compared to patients without FMR improvement, more patients in the FMR-improved group were diagnosed with renal insufficiency (10.8% vs. 0%, p=0.018), left bundle branch block (8.1% vs. 0%, p= 0.037), and less right bundle branch block (0% vs. 10.5%, p=0.017). The transthoracic ultrasound examination showed that patients with FMR improvement were prone to have lower left ventricular ejection fraction (LVEF) and larger left ventricle end dimension diastole (LVEDd). A higher proportion of patients in the FMR-improved group were found to have had more moderate to severe FMR (28.9% vs. 2.7%, P=0.029). In both groups, the degree of aortic regurgitation was significantly improved during the 1-day and 1-month follow-ups post-TAVR (p&lt;0.001). No significant differences were found in the incidence of postoperative adverse events between the two groups during the short-term follow-up.

Conclusion
FMR improvement is observed in approximately half of PSAR patients undergoing TAVR. A higher FMR degree, lower LVEF, and hypertension before TAVR are independent predictors of FMR improvement.Figure 1 AR and MR post TAVRTable 1 Logistic regression
Acute changes in right ventricular geometry and function following transcatheter tricuspid valve interventions
Authors: Bartkowiak J , Weckbach L T , Dernektsi C , Stolz L , Kothieringer C M , Fabian A , Szijarto A , Chong-Nguyen C , Stocker T , Brugger N , Kovacs A , Praz F , Hahn R T , Hausleiter J 
Published: October 2024

Abstract

Background
Little is known about acute changes in right ventricular (RV) function and geometry following transcatheter tricuspid edge-to-edge repair (T-TEER) or transcatheter tricuspid valve replacement (TTVR). Pressure-strain-volume loop-derived myocardial work metrics showed associations with myocardial energetics and contractility in conditions accompanied by volume overload, suggesting their potential utility in patients with tricuspid regurgitation (TR).

Purpose
To define acute changes in RV volumes and RV myocardial work following T-TEER and TTVR using conventional and pressure-strain-volume derived RV work metrics.

Methods
In this multicenter, observational study, 3D echocardiographic datasets and invasively acquired RV pressures were collected before and after transcatheter tricuspid valve procedure. Using dedicated software (ReVISION, Argus Cognitive) 3D RV volumes and strains were quantified and decomposed to longitudinal, radial and anterio-posterior motion. Forward stroke volume (SV) was calculated by subtracting TR volumes from RV 3D end-diastolic volume (EDV) and end-systolic volume (ESV) difference. Three-dimensional pressure-strain-volume loops were constructed and global RV work-index (RV-Wi) was calculated. Changes in RV parameters before and after the intervention were compared using paired-samples t test.

Results
Of 37 patients included in this study (65% male), 20 underwent T-TEER and 17 underwent TTVR. Compared to T-TEER patients, patients undergoing TTVR had higher prevalence of torrential TR at baseline but also achieved a higher reduction in TR volumes after the intervention (44 ± 11 ml vs 60 ± 16ml; p = 0,001). Following T-TEER there was a significant reduction in RV EDV (240 ± 93 ml vs 200 ± 80 ml; p &lt; 0.001) and increase in SV (55 ± 34 ml vs 68 ± 26 ml; p = 0.036). Following TTVR there was a significant increase in RV ESV (121 ± 46 vs 146 ± 48, p = 0.003) and no significant change in SV (47 ± 24 ml vs 55 ± 20 ml; p = 0.143). There was significant reduction in RV strain and ejection fraction (EF) (all p &lt; 0.001) primarily driven by reduction of radial motion component in both groups. RV-Wi increased in 35% (7/20) of T-TEER patients and in 18% of (3/17) TTVR patients.

Conclusion
An acute reduction in RV EF was observed in all patients and was mainly caused by decrease in RV EDV in T-TEER patients and increase in RV ESV in TTVR patients. Despite decrease of conventional metrics of RV function in both groups, an increase in RV-Wi was observed in 27% of all patients.Baseline and follow-up characteristicsCentral Figure
Characterization of tricuspid regurgitation in patients following left bundle branch pacing
Authors: Fernandez M A , Quispe Santos J F , Menduina Gallego I , Alonso-Martin C , Leta Petracca R , Li C H 
Published: October 2024

Abstract

Background
Pacemakers placed in the right ventricle apex can lead to mechanical and electrical dyssynchrony. There is a growing interest in more physiologically stimulating techniques, and in this context, left bundle branch pacing (LBBP) emerges as an option. In this pacemaker, the lead is positioned perpendicular to the septum approximately 15-20 mm below the tricuspid valve annulus, and the helix is advanced towards the left side (Image 1). There is limited data on the incidence of new-onset tricuspid regurgitation (TR) or deterioration of pre-existing TR following the implantation of this type of pacemaker.

Purpose
To characterize the incidence of TR or deterioration of pre-existing TR after LBBP and to determine if there are predictors of a higher degree of TR.

Methods
All patients who received a pacemaker with LBBP between January and October 2023 were consecutively recruited. A transthoracic echocardiogram following the implantation of the pacemaker was performed to assess the size and function of right heart chambers, degree of TR and position of pacemaker lead.
Continuous variables are expressed as mean ± SD or median [IQR] and categorical variables as absolute (%).

Results
There were 31 implants with a mean age of 73.4±8.7 years and 42% women. Nine patients (22.5%) had atrial fibrillation, and 7 patients (23%) had known coronary artery disease. The main indication for implant was a complete AV block (63.3%). Two patients had TR greater than moderate before the implantation of the pacemaker.
Mean time elapsed between implantation and follow-up echocardiogram was 5.8 months. The distance between the lead-implanted site to the tricuspid annulus (Lead-TA distance) was 26.7±10.5 mm, mean lead depth in the interventricular septum (IVS) was 7.7±1.8mm and the IVS thickness at the lead-implanted site was 10.6±2.1 mm. Overall, TR worsed less than 1 degree after the lead implant (table 2) and was significantly related with the Lead-TA distance (TR worsed 0.3 degrees in Lead-TA distances shorter than 26.7mm and TR reduced 0.2 degrees in Lead-TA distances longer than 26.7mm, p=0.037).

Conclusions
In the short term following the implantation of an LBBP pacemaker the distance from the lead to the tricuspid annulus has an acute impact on tricuspid regurgitation, with TR worsening at short Lead-TA distances and TR improving at longer distances.
Prognostic value of MELD-XI score and hemodynamic parameters in patients undergoing transcatheter tricuspid valve intervention
Authors: Edlinger C , Schlegl J , Bannehr M , Lichtenauer M , Kuecken T , Krutz A , Paar V , Neuss M , Haase-Fielitz A , Butter C 
Published: October 2024

Abstract

Background
Hepatorenal dysfunction is a strong prognostic predictor in patients with tricuspid regurgitation. Patients are often hospitalized with acute heart failure due to volume overload and peripheral hypoperfusion. End-organ dysfunction is associated with the development of right ventricular failure related to hemodynamic changes such as low cardiac output and passive congestion from increased right ventricular filling pressures.

Purpose
This study aimed to investigate the prognostic value of hepatorenal dysfunction using the Model for End-stage Liver Disease (MELD) Score, the modified version of the score, MELD-XI, and of parameters determined during right-heart catheterization in patients undergoing transcatheter tricuspid valve intervention.

Methods
In this single-center prospective cohort study, data from patients undergoing edge-to-edge repair or heterotopic minimal invasive tricuspid valve repair were analyzed. Serum creatinine, INR and bilirubin were measured and the MELD score as well as the MELD XI score was calculated. All patients underwent right heart catheterization before the intervention. Receiver operator characteristics with calculation of the area under the curve (AUC) were performed to determine the predictive value of MELD (XI) score and hemodynamic parameters for the combined endpoint of rehospitalization due to decompensated heart failure and mortality within 3 months.

Results
Data from 36 consecutive patients were analyzed. 28 patients underwent edge-to-edge repair and 8 patients heterotopic minimal invasive tricuspid valve repair. Mean age of patients was 80.2 ± 5.9 years; 33.3% (12/36) were male. Baseline characteristics are shown in table 1. Rehospitalization due to decompensated heart failure occurred in 9/36 patients (25%). Mortality within the first 3 months was 11% (4/36). The predictive value for the composite endpoint of the modified MELD IX score was AUC 0.82 (95 % CI 0.63-0.99; p=0.009), while the conventional MELD score had an AUC of 0.77 (95 % CI 0.55-0.99; p = 0.059) (figure 1). RV pressure (AUC 0.84, 95% CI 0.66-1.00, p= 0.012) and RA pressure (AUC 0.83, 95% CI 0.67-0.98, p=0.016) showed a good predictive value for the composite endpoint (figure 2). The combination of MELD XI (at admission) and RV or PA pressure improved the AUC (MELD XI + RV: AUC 0.85; MELD XI + PA: AUC 0.84).

Conclusion
In this pilot-study, the modified MELD XI score, as indicator of hepatorenal dysfunction, was identified as a potential marker for short-term outcome after interventional tricuspid valve treatment.
Preliminary results from the Polish Infective Endocarditis Registry (POL-ENDO): time to change clinical approach?
Authors: Orzech J , Zatorska K , Grabowski M , Jaworska Wilczynska M , Milkowska M , Kowalik I , Kukulski T , Lesiak M , Surdacki A , Hryniewiecki T 
Published: October 2024

Abstract
Background/Aims: Infective endocarditis (IE) is a severe valve disease associated with high morbidity and mortality. The aim of this preliminary study was to evaluate the profile and treatment outcomes of IE in Poland based on the POL-ENDO registry.

Methods
A prospective cohort, multicenter, observational study - the POL ENDO registry - of IE patients from 134 hospitals in Poland recruited between August 2022 and August 2023 was performed. We evaluated demographic, clinical, imaging, and treatment outcome data. A comparison of the Polish patients with those assessed in the ESC-EORP EURO-ENDO registry was performed.

Results
Among a total of 880 IE patients, 622 were male (70.7%). The POL-ENDO participants were older (61.4±16.7 years vs. 59.25±18.03 years, p=0.001). Native valve IE (NVIE) occurred more often in Poland (82.3% vs. 56.6%, p &lt;0.001). Transthoracic echocardiography (TTE) was performed more frequently in Poland (93.6% vs. 89.8% p&lt;0.001). New imaging techniques (CT/MRI/PET/SPECT) were less frequently used in Poland (CT: 53.2% vs. 41.3%, p&lt;0.001; MRI: 18.7% vs. 6.4%, p&lt;0.001). Heart failure (HF) occurred more often in Poland as inhospital complication (31.4% vs. 14%, p&lt;0.001). Surgical treatment was less performed in Poland (51.2% vs. 36.9%, p&lt;0.001). Inhospital mortality was higher in Poland (21% vs. 17%, p=0.008).

Conclusion
Polish patients with IE were significantly older and more comorbid. New imaging techniques are less frequently used in Poland. Echocardiography was performed more frequently in Poland as the diagnostic mainstay. Surgical treatment was significantly less frequent in Poland. Inhospital mortality in Poland is greater. The change of clinical practice in Poland should be considered.
Impact of mandatory preoperative dental screening on infective endocarditis in patients undergoing surgical valve replacement
Authors: Krasniqi L , Mortensen P , Ravn E J , Tofterup M , Terkelsen C J , Andersen N H , Modrau I , Stokbro K , Povlsen J A , Gerke O , Hallas J , Clavel M A , Riber L P , Dahl J S 
Published: October 2024

Abstract

Background
Guidelines recommend preoperative dental screening (PDS) prior to surgical valve replacement (SVR) to reduce risk of prosthetic valve infective endocarditis (IE). However, limited data support these recommendations.

Purpose
Investigate the effect of mandatory PDS on risk of IE in patients undergoing SVR.

Methods
A total of 1,207 patients undergoing SVR in Western-Denmark from 2020 to 2022 were included in this observational study. Patients were considered based on two applied PDS practices: mandatory PDS (MPDS), and no routine referral PDS (NPDS). Outcome data were retrieved from Danish registries and adjudicated using medical records. The primary endpoint was incidence of IE. Secondary endpoints were all-cause mortality, and the composite endpoint of IE and all-cause mortality. Key endpoints were also analyzed in a propensity score-matched (PSM) population.

Results
Of 805 patients in the MPDS, 93% (n=751) underwent subsequent PDS, compared to 5% (n=21) among 402 patients in the NPDS. Patients in the MPDS were older with higher rates of coexisting co-morbidities. During a median follow-up of 2.6 years (interquartile range 1.9-3.2 years), 3.3% (n=40) developed IE. The yearly incidence IE rate was higher in MPDS compared with NPDS (1.5% vs. 0.7%; p=0.08). All-cause mortality rate was higher in the MPDS (2-year mortality of 6.2% vs 2.3%, p=0.02) as well as the composite endpoint (p&lt;0.01). Differences in IE rates, all-cause mortality, but not composite endpoint were abolished in 370 propensity score-matched patients.

Conclusion
Risk of IE was low regardless of PDS practice. MPDS prior to surgery did not alter the risk of IE or all-cause mortality in patients undergoing left-sided SVR in Denmark.Kaplan-Meier plot
Oral step-down antibiotic treatment in patients with prosthetic valve endocarditis; a POETry substudy
Authors: Pries-Heje M , Hjulmand J , Lenz I , Hasselbalch R , Povlsen J A , Ihlemann N , Tofterup M , Oestergaard L , Wienberg M , Christiansen U , Bruun N E , Fosboel E , Moser C , Iversen K , Bundgaard H 
Published: October 2024

Abstract

Background
Oral step-down antibiotic treatment (PO) was included in the 2023 ESC guidelines for treatment of infective endocarditis. In the nationwide POETry study(1), the use PO in patients with left-sided infective endocarditis (IE) was examined in Denmark, showing that almost half of possible candidates with left-sided IE received PO, with no signs of increased treatment failure.

Purpose
The aim of this study was to examine the prevalence and outcomes in patients with left-sided prosthetic valve IE (PVE) who recieved PO, compared to patients who recieved conventional intravenous antibiotic treatment only (IV).

Method
Patients with a left-sided PVE, diagnosed between May 2019 and December 2020 in Denmark were included retrospectively. Data was collected by medical chart review. Patients were followed for 6 months. Patients were considered possible candidates for PO if they had left-sided PVE with one of the following bacterial pathogens: Staphylococcus aureus, Enterococcus faecalis, any streptococci or coagulase-negative staphylococci. Patients were excluded if he/she died or were discharged as terminally ill prior to end of antibiotic treatment. The composite outcome consisted of I) embolism, II) non-planned heart valve surgery, III) relapse of bacteremia or IV) all-cause mortality, from end of antibiotic treatment until end of follow-up. Comparisons of primary outcome and all-cause mortality was analyzed with log-rank test.

Results
In total 158 patients (median age 77 years (IQR: 69-81, 42 female (23%)) with PVE were considered possible candidates for PO, of which 70 (45%) were switched to PO. Patients who received PO more often had diabetes (PO: 27% vs IV: 14%, p=0.03) and were more often non-surgically managed (PO: 86% vs IV: 71%, p =0.02). Median length of stay was reduced by 22 days (PO: 26 days IQR: 17-44 vs IV: 48 days, IQR: 43-61, p&lt;0,001). After 6 months follow-up primary outcome had occurred in 7 (10%) patients who received PO and in 13 (15%) who received IV (p=0.34, Figure, panel A). Prevalence of all-cause mortality in patients who received PO was 4% (n=3) compared to 13% (n=11) for patients who received IV (p=0.07, Figure, panel B). There was no difference in the prevalence of primary outcome according to bacterial pathogen.

Conclusion
In patients with left-sided PVE who were potential candidates for oral step-down treatment, about half were switched to PO, with a relevant reduction of in-hospital length-of-stay of 22 days. There was no difference in the prevalence of primary outcome or all-cause mortality after 6 months between the two groups. These results support the safety of PO treatment for patients with PVE after stabilized infection.
Mechanical thrombectomy is associated with worse outcomes in infective endocarditis: a retrospective cohort study
Authors: Barlas R , Pana T , Myint P , Mamas M A 
Published: October 2024

Abstract

Background
Acute Ischaemic stroke (AIS) is a common complication in infective endocarditis (IE) and associated is with high mortality. There is a paucity of data evaluating mechanical thrombectomy (MT) in patients with AIS secondary to IE. Our retrospective cohort study aimed to quantify the efficacy and safety of MT in this patient population.

Methods
The National Inpatient Sample (NIS) was utilised. We obtained data from 2004 – 2019. We included all patients who had AIS and IE. We excluded patients who received thrombolysis. Those who received mechanical thrombectomy were compared to those who did not. Odds ratios were calculated using logistic regressions. We adjusted for multiple confounders. Outcomes included inpatient mortality, long length of stay (&gt; 4 days), discharge status (normal vs ‘other’) and intracranial haemorrhage.

Results
The sample population consisted of 22,6390 patients (mean age 69, 52.3% female). ME was performed on 496 (2.2%). Patients with IE who received MT had a greater odds of death compared to those who did not (OR 1.91 95% CI 1.00 – 3.67). In addition, they had a greater odds of intracranial bleeding (OR 4.47 95% CI 2.78 – 7.20). Length of stay and neurological outcome did the significantly differ. We performed a sub-analysis, which included patients who had received thrombolysis in addition to MT. This did not modify the results for mortality and intracranial bleeding outcomes.

Conclusion
Mechanical thrombectomy was associated with increased mortality and intracranial bleeding in patients who have AIS associated with IE. While acknowledging the limitations of observational data, we therefore advise caution when considering mechanical thrombectomy in this patient population.
Enhancement of the Mayo Clinic Genotype Predictor Score using Cardiac MRI
Authors: Ferreira Felix I , Karlinski Vizentin V , Patel M , Bos M M , Geske J B , Giudicessi J R , Ackerman M J , Arruda-Olson A M 
Published: October 2024

Abstract

Introduction
Hypertrophic cardiomyopathy (HCM) is the most prevalent heritable cardiomyopathy typically transmitted in an autosomal dominant fashion. There is growing importance in identifying genetic test positive patients given its prognostic value. The Mayo HCM Genotype Predictor Score has been extensively validated for assessment of patient’s pre-test probability for genotype positive HCM and helps guide clinical decision-making based on clinical and echocardiographic variables. Herein, we evaluated the role of cardiac magnetic resonance (CMR) to enhance the genotype predictor score.

Purpose
Evaluate performance of the Mayo Clinic HCM Genotype Predictor Score using CMR variables, and develop an updated, CMR incorporated score.

Methods
Retrospective analysis was conducted on 175 unrelated HCM patients with at least 1 MRI and a HCM genetic testing seen at the Mayo Clinic between April 2004 and April 2018. Phenotyping information was obtained through review of electronic medical records. The original Mayo HCM Genotype Predictor Score was calculated using both echocardiography and clinical variables. An updated score was created incorporating CMR-specific variables. Diagnostic accuracy of the models was assessed thought Receiver Operating Characteristic (ROC) curves.

Results
Overall, 108 (62%) were males with a mean age at CMR of 51 ± 18 years. The yield of positive genetic test for the echocardiogram-derived Mayo HCM Genotype Predictor Score ranged from 38% for patients with -1 point to 100% for patients with 4 or 5 points. There was a significant incremental increase in diagnostic yield between score subgroups (p &lt; 0.01) with an AUC of 0.659 (Figure 1A). Similar findings were observed using CMR variables (AUC of 0.697; Figure 1B). Univariate and multivariate analysis identified late gadolinium enhancement (LGE) as a strong predictor of a positive genetic test (OR 3.72; p=0.002), and it was added to the original score to create a new version. The Updated Mayo HCM Genotype Predictor Score predicted a positive genetic test ranging from 25% for patients with -1 point to 100% for patients with 5 or 6 points (p &lt; 0.01). There was a significant increase in diagnostic accuracy when compared to the original score (AUC 0.724 vs 0.679; p=0.03; Figure 1C).

Conclusion
Using LGE, the updated CMR-based Mayo HCM Genotype Predictor score provides a simple and improved tool to aid in genetic counseling for HCM patients.