bluuebunny/crossref_metadata_2025_split huggingface dataset:
A high-risk late gadolinium enhancement pattern is associated with arrhythmic events in patients with dilated cardiomyopathy
Authors: Zulet Fraile P , Ferrandez Escarabajal M , Islas F , Travieso Gonzalez A , Restrepo A , Goirigolzarri J A , De Agustin Loeches A , Vilacosta I , Olmos Blanco C 
Published: November 2023

Abstract

Introduction
Myocardial fibrosis constitutes a substrate for the development of ventricular arrhythmias in patients with non-ischaemic dilated cardiomyopathy (DCM). Late gadolinium enhancement (LGE)-cardiac magnetic resonance (CMR) imaging represents a powerful tool for arrhythmic risk stratification. Moreover, arrhythmic risk is determined by the extent and localization of LGE.
A high-risk LGE pattern, defined as the presence of epicardial, transmural or septal plus free-wall LGE, has been recently associated with a higher incidence of arrhythmic events comparing with other LGE patterns.

Purpose
To evaluate the prevalence of a high-risk LGE pattern in patients with DCM and its association with arrhythmic events.

Methods
From 2014 to 2021, all patients (N = 229) with DCM were prospectively evaluated in our tertiary care hospital. 174 patients underwent a 1.5 Tesla scanner CMR as part of the diagnostic workup and were included in the present study.
The primary endpoint was a composite of sudden cardiac death or sustained monomorphic ventricular tachycardia.

Results
Mean age of our cohort was 61 years (standard deviation 14.5), and 64.2% were male. Median follow-up was 41 (interquartile range 26-62) months.
LGE was present in 96 (55.2%) patients of our cohort (LGE+), and a high risk LGE pattern was found in 41 (42.7% of all LGE+ patients). LGE was more frequently located in the basal segments (78.6%). Mid-wall septal LGE was found in 46.9% of LGE+ patients, and it was the most common pattern. 21.4% of LGE+ patients had combined septal and free-wall LGE, 23.5% had epicardial LGE and 13.3% had transmural LGE.
Baseline characteristics of LGE+ patients with and without a high-risk LGE pattern are shown at the Table.
The incidence of ventricular arrhythmic events during follow-up was 31.7% in patients with a high-risk LGE pattern, and 9.1% in LGE+ patients but without a high-risk pattern (p=0.005). In patients without a high-risk LGE, including LGE- patients and LGE+ patients with other LGE patterns, incidence of ventricular arrhythmic events was 8.3% (p&lt;0.001). The survival free curves for the combined arrhythmic endpoint comparing LGE+ patients with and without a high-risk pattern are shown in the Figure.

Conclusion
The presence of a high-risk LGE pattern in patients with DCM its associated with a higher incidence of ventricular arrhythmic events, comparing with LGE+ patients without a high-risk pattern. We suggest that this high-risk pattern should be taken into account when performing arrhythmic risk stratification in patients with DCM.TableFigure
Impact of cardiac staging classification in transcatheter aortic valve implantation for major subtypes of severe aortic stenosis
Authors: Nakase M , Okuno T , Tomii D , Lanz J , Praz F , Stortecky S , Windecker S , Pilgrim T 
Published: November 2023

Abstract

Background
Staging classification to quantify the extent of extra-aortic valve cardiac damage is recognized as a useful prognostic tool in patients undergoing transcatheter aortic implantation (TAVI) for aortic stenosis (AS). However, this classification has not been validated in each AS subtype.

Objectives
The present study aimed to investigate the prognostic impact of staging classification in patients with four major AS subtypes.

Methods
In a prospective TAVI registry, patients were classified into high gradient AS (HG-AS), classical low flow low gradient AS (LFLG-AS), paradoxical LFLG-AS, and normal flow low gradient AS (NFLG-AS). Five-year mortality was compared between early stage (stage 0, 1, or 2) and advanced stage (stage 3 or 4).

Results
Among 1,507 patients undergoing TAVI, 812 patients had HG-AS, 186 patients had classical LFLG-AS, 277 patients had paradoxical LFLG-AS, and 232 patients had NFLG-AS. There were much difference in the distribution of cardiac stage among AS subtypes; advanced stage accounting for 54.3% in HG-AS, 58.6% in NFLG-AS, 62.5% in paradoxical LFLG-AS, and 80.6% in classical LFLG-AS. Patients with advanced stage had higher all-cause mortality compared with early stage in HG-AS and paradoxical LFLG-AS (HRadjusted 2.00; 95% CI 1.44-2.78 and HRadjusted 2.15; 95% CI 1.43-3.21), but not in classical LFLG-AS and NFLG-AS (HRadjusted 1.17; 95% CI 0.70-1.95 and HRadjusted 1.43; 95% CI 0.90-2.27).

Conclusions
Early stage was associated with a reduced risk for five-year mortality in patients with HG-AS and paradoxical LFLG-AS, while there was comparable mortality between early and advanced stages in patients with classical LFLG-AS and NFLG-AS.
The efficacy and safety of novel oral anticoagulants versus vitamin k antagonist in transcatheter aortic valve replacement patients with indications for anticoagulation
Authors: Abella J , Vestal M 
Published: November 2023

Abstract

Introduction
Thrombotic events from atrial fibrillation, clinical and subclinical leaflet thromboses continue to be a major concern in Transcatheter Aortic Valve Replacement (TAVR) patients despite technological advancement and operator expertise. The proportion of TAVR patients who have or eventually develop indications for anticoagulation is not negligible and thus may warrant oral anticoagulants. However, the choice of anticoagulation is this select patients remained debatable. Thus, this study was conducted to determine whether current collective data support the efficacy and safety of novel oral anticoagulants (NOACS) versus vitamin K antagonists (VKAs).

Purpose
Oral anticoagulation (OAC) is necessary but the patients who needed it the most have baseline high bleeding risks. Anticoagulation carries a high bleeding risk especially among majority of a typical post TAVR patients with indications for anticoagulation. The paucity of data among asian TAVR patients were propensity to bleed are prevailing issues with anticoagulation owing perhaps to genetic or race predisposition and lower body weights or BMI compared to non-Asian counterparts. Currently the high court is still out to settle the optimum choice of anti-thrombotic therapy after TAVR. With TAVR now being performed in our local setting, we find this a relevant issue, hence we conducted a meta-analysis.

Methods
A literature search from Pubmed, Embase, and Cochrane databases for relevant RCTs and observational studies published until February 2022 were conducted. The pooled estimates of all-cause mortality, stroke and major bleeding events were measured using RevMan version 5.4.1 software.

Results
Eleven eligible studies (9 observational studies and 2 RCTs) allocated 29,156 TAVR patients with indications for anticoagulation either to receive NOACS (n = 11,718) or VKAs (n = 17,468). The effect estimate using random effects model showed no significant differences in all-cause mortality (RR 0.79, 95% CI 0.42–2.25, p = 0.07), stroke (RR 0.96, 95% CI 0.54–2.79, p = 0.70), and major bleeding events (RR 0.82, 95% CI 0.48–1.44, p = 0.08) between the NOACs and VKAs treatment arms.

Conclusion
NOACs demonstrated non-inferiority over VKA in reducing all-cause mortality, stroke and major or life-threatening bleeding events in TAVR patients with indications for anticoagulation.
Three-year outcomes following transcatheter versus surgical aortic valve replacement in younger, low surgical risk patients with severe aortic stenosis
Authors: Modine T , Tchetche D , Van Mieghem N , Huang J , Forrest J , Reardon M 
Published: November 2023

Abstract

Background/Introduction
Prior randomized studies in patients with severe aortic stenosis at low risk for surgery have shown comparable 3-year outcomes with transcatheter aortic valve implantation (TAVI) and surgery. Less is known about the intermediate term outcomes in younger (&lt;75 years) patients at low risk for surgery treated with TAVI or surgery.

Purpose
To compare 3-year clinical outcomes in younger (&lt;75 years) patients with severe aortic stenosis and low risk for surgery randomly assigned to TAVI or surgery.

Methods
The Evolut Low Risk randomized trial treated 1414 patients at low surgical risk with a supra-annular, self-expanding TAVI or surgery. Patients less than 75 years of age were selected for this analysis. The primary endpoint was the 3-year occurrence of all-cause mortality or disabling stroke (Kaplan-Meier estimates). Serial echocardiographic outcomes were also compared through 3-year follow-up.

Results
703 younger (mean age, 69 years) low-surgical risk (STS PROM, 1.6%) aortic stenosis patients were treated with TAVI (N=352) and SAVR (N=351). At 3 years, the primary endpoint of all-cause mortality or disabling stroke was not different between TAVI (5.7%) or surgery (8.0%, p=0.241). TAVI was associated with lower incidence (0.6%) of disabling stroke compared with surgery (2.9%, p=0.019) and atrial fibrillation (13.3%) compared with surgery (36.4%, p&lt;0.001) while surgery was associated with lower incidence of pacemaker implantation (7.1%) compared with TAVI (21.0%, p&lt;0.001). Valve reintervention rates were low in both groups (1.5% with TAVI; 1.5% with surgery, p=0.962). Mean aortic gradients were significantly lower with TAVI (9.7 mmHg) compared with surgery (12.9 mmHg, p&lt;0.001) and effective orifice areas were significantly larger with TAVI (2.2 cm²) compared with surgery (1.9 cm², p&lt;0.001). There were no differences in the rates of residual moderate or greater paravalvular regurgitation (TAVI: 1.1% and surgery: 0.4%, p=0.626).

Conclusion(s)
Low risk patients less than 75 years age who underwent TAVI with a supra-annular, self-expanding TAVI had comparable clinical and haemodynamic outcomes with surgery through the 3-year follow-up; additional study through 10 years in these low risk patients is ongoing.
Insulin resistance in patients suffering from severe AS
Authors: Freitag L , Leuders P , Kelm M , Zeus T , Quast C 
Published: November 2023

Abstract

Background
There are several cardiovascular risk factors known to promote the development of AS, one of them being type 2 diabetes (T2D). T2D is increasingly recognized as a heterogenous disease, leading to the latest concept of five diabetes clusters based on clinical parameters. Until now, the impact of the respective clusters, especially insulin resistance in prediabetes, on valvular cells and therefore the development of AS is not clear.

Purpose
We hypothesize that insulin resistance, which is frequently underrated, features a specific pattern of aortic valve calcification characterized by an elevated degree of calcification.

Methods
In order to analyze the impact of diabetes on AS we examined 200 patients with severe AS, scheduled for a transcatheter aortic valve implantation (TAVI). With the exemption of previously diagnosed diabetics, we performed an oral glucose tolerance test (OGTT), identifying patients with prediabetes and T2D. Additionally, blood was drawn from all included patients 2-5 days after TAVI, depicting their metabolic condition and thereby assigning them to a diabetes cluster. These findings were subsequently correlated with data from computertomography in all patients pertaining the severity of the stenosis, including the Agatston score, which illustrates the aortic valve calcium burden.

Results
Following the hypothesis that the extent of insulin resistance impacts the aortic valve calcification, we correlated the HOMA-IR with the Agatston score, resulting in a weak non-significant linear correlation (r=-0.129, p = 0.097, n = 166). Therefore, increased insulin resistance has not been shown to be associated with increased aortic valve calcification. Moreover, no differences in the extent of calcification between diabetic, prediabetic and non-diabetic patients could be demonstrated (F (2, 147) = 0.410, p = 0.665). However, it was clearly striking that the majority of the patients examined had already developed prediabetes or diabetes (Non-Diabetic = 7.1%, Prediabetic = 34.6%, Diabetic = 58.2%, n= 182).

Conclusion
Although we were able to observe an increased rate in prediabetic and diabetic patients in our AS cohort, there was no significantly elevated aortic valve calcification in patients with pronounced insulin resistance. This suggests that insulin resistance might not directly impact valvular calcification but upstream processes in valvular cells predisposing for AS since the majority of AS patients in our cohort is (pre)diabetic.
Patient-reported functional and symptomatic outcomes in patients with mild cognitive disorder undergoing transcatheter aortic valve implantation - A secondary analysis of a randomized controlled trial
Authors: Thevathasan T , Hornig C , Leistner D M , Suendermann S , Unbehaun A , Sherif M , Haghikia A , Stangl K , Falk V , Landmesser U , Dreger H , Stangl V , Brand A 
Published: November 2023

Abstract

Background
The impact of pre-existing mild cognitive disorder (MCD) on patient-reported outcome measures (PROMs) after transcatheter aortic valve implantation (TAVI) remains unclear.

Purpose
To investigate functional and symptomatic outcomes after TAVI in patients with or without MCD at two German tertiary care centers as part of a randomised controlled trial (TAVI-COMIC study).

Methods
Adult patients undergoing elective TAVI were enrolled. MCD was defined by the Montreal Cognitive Assessment (MoCA) &lt;26 points. PROMs were assessed at 90 days after TAVI.

Results
Of 199 patients, 109 (54.8%) showed MCD. Female patients had significantly more often MCD (49.5% vs. 34.4%, p=0.046). Prior to TAVI, 21.6% reported dyspnea (NYHA class III-IV), 35.1% angina (CCS class II-IV), 41.2% dizziness and 12.6% syncope. Both patient groups reported similar improvements in general health status after TAVI: "marginally or significantly better" health status in 73.5% with MCD vs. 68.9% without MCD (p=n.s.). In multivariable logistic regression models, the number of patients reporting a "good, very good or excellent" general health status after TAVI was similar in both patient groups (p=n.s.) (Table). Similarly, post-TAVI symptoms of dyspnea, angina, dizziness or syncope were similar between both groups (each p=n.s.). Procuration and walking ability without difficulties as well as functional independence were 54% [95% Confidence Interval (CI) 0.23-0.92] (p=0.028), 55% [95% CI 0.22-0.89] (p=0.023) and 52% [95% CI 0.24-0.94] (p=0.035) less frequently reported by patients with MCD compared to patients without MCD, respectively. Of note, delirium was more frequently observed in patients with MCD within 3 days after TAVI (8.3% vs. 1.1%, p=0.049).

Conclusions
TAVI appeared to result in similar improvements in general health status and symptomatic PROMs in patients with and without MCD. Though, patients with MCD reported impaired functional PROMs after TAVI. More careful post-procedural care should be taken for patients with MCD to enhance functional independence in this vulnerable patient group.
Prevalence and predictors of pacemaker implantation in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: TAVI-NOR study
Authors: Wasim D , Ali A M , Bleie Ø , Packer E J S , Eriksen E , Rotevatn S , Saeed S 
Published: November 2023

Abstract

Background
The transcatheter aortic valve implantation (TAVI) in patients with aortic stenosis (AS) asserts mechanical forces during valve expansion both on the aortic root and conduction system. TAVI is therefore frequently associated with the development of conduction abnormalities requiring a permanent pacemaker implantation (PMI).

Purpose
To identify predictors of new PMI in unselected patients with severe AS undergoing TAVI.

Methods
Among the 600 patients consecutively enrolled in TAVI-NOR study, 52 had PMI prior to TAVI and were excluded, remaining 548 patients eligible for this analysis. Predictors of PMI were identified in binary logistic regression analyses.

Results
A total of 189 patients (31.5%) required a new PMI post TAVI, evenly distributed between females and males (30.1% vs 32.9%, p=0.456). Higher age, comorbidities such as hypertension, chronic kidney disease, coronary artery disease, diabetes, and left ventricular hypertrophy on ECG or echocardiography, and the severity of AS had no association with the risk of PMI after TAVI (Table 1). In univariate logistic regression analyses, larger aortic root diameter was associated with a higher risk of new PMI (OR 1.66; 95% 1.07-2.58, p=0.024), but was no longer significant in multivariate model, and bioprosthesis size had no association with the need for a PMI following TAVI. Bundle branch block (BBB) (OR 1.52; 95% 1.00-2.31, p= 0.051), and especially right BBB (RBBB) (OR 2.05; 95% 1.14-3.70, p= 0.017) showed increased risk of a new PMI, also in a multivariable-adjusted analysis (OR 2.67; 95% 1.39-5.11, p=0.003). Lotus bioprosthesis with mechanical expansion was associated with an increased risk of PMI (OR 2.92; 95% CI 1.92-4.45, p&lt;0.001), while balloon expandable Sapiens had a lower risk for PMI (OR 0.15; 95% CI 0.06-0.37, p&lt;0.001). In a multivariable-adjusted analysis, the use of Lotus valve (OR 2.23; 95% CI 1.44-3.46, p&lt;0.001) was still associated with a higher risk, and use of Sapien with a lower risk of PMI (OR 0.15; 95% CI 0.06-0.40, p&lt;0.001) independent of non-significant association with atrial fibrillation (p=0.067), lower heart rate (0.077), aortic root (p=0.225) and stroke volume index (p=0.097). Adding age and gender to the same primary multivariable-adjusted model did not change our conclusions: Lotus (OR 2.28; 95% CI 1.46-3.57, p&lt;0.001) and RBBB (OR 2.63; 95% CI 1.37-5.04, p=0.004) and Edward Sapien (OR 0.15; 95% 0.06-0.39, p&lt;0.001) of post-procedural PMI.

Conclusion
Our data from less selected patients with severe AS patients show that pre-intervention RBBB and the use of bioprosthesis with mechanic expansion (Lotus) were associated with a higher risk, and the use of balloon expandable bioprothesis (Sapiens) with a lower risk of PMI after TAVI. We found no gender differences in risk of PMI.
Improving risk stratification of moderate aortic stenosis
Authors: Teixeira R , Neves I , Sousa-Nunes F , Almeida M , Leite M , Lobo A , Sampaio F , Fontes-Carvalho R 
Published: November 2023

Abstract

Background
The clinical course of patients with moderate aortic stenosis (AS) remains ill-defined. While a watchful waiting approach is advocated by international guidelines, several studies suggest that the long-term prognosis of these patients is worse than previously considered and may even be similar to patients with severe AS. Whether these findings reflect a subgroup of moderate AS with a high comorbid burden or rapid progression to severe AS is not known.

Purpose
This study sought to 1) analyze the clinical course of AS throughout all stages of the disease, 2) unveil different trajectories of progression through clustering analysis, 3) explore their impact in all-cause death.

Methods
Patients with mild to severe AS in seriated echocardiograms (TTE) were retrospectively identified after excluding for abnormal flow conditions. Aortic peak velocity (APV) was used to monitor disease progression. A sigmoid function was used to model APV throughout time. Individual acceleration rates coefficients were calculated using random-effects models and patients were then clustered into rapid (RP) and slow progressors (SP).

Results
This study included 914 patients (age 76 ± 8 years, 52% female, median follow-up time 6.8 years). 483 patients were clustered as RP (53%) and 431 as SP (47%) based on their individual acceleration rate coefficients (core parameter of sigmoid model). Since the core parameter is constant throughout time and evaluations, only two consecutive TTEs per patient are needed to calculate the acceleration rate coefficient. The time interval required between these seriated TTEs varies between 9 and 14 months. No clinical variables were consistently associated with each cluster. When comparing mortality hazard rates for SP with RP across the range of APV, we found that rapid progression was persistently associated with excess mortality (HR 1.35, CI [1.07-1.69]; p=0.01; after adjusting for demographics, comorbidities, baseline AS severity, and time-dependent aortic valve replacement [AVR]). Using the upper limit of the mortality rate of a SP with an APV of 4 m/s as a reference, we found that a RP significantly exceeded this threshold with an APV velocity of only 3.2 m/s. We built a predictive model which incorporated the AS progression on top of guideline-derived AVR triggers to assign patients with a predicted probability of death ≥ 50% at 5 years to AVR. Using this model, we estimated that an extra death can be prevented for every 100 patients treated without exposing more patients to unnecessary AVR.

Conclusion
We identified two clusters of AS progressors, based on APV from two consecutive TTEs. RP displayed higher mortality rates across all the range of APV which can explain why same patients with moderate AS have a dismal prognosis. Since RP patients have excess adverse outcomes in early stages of AS (moderate AS), a lower APV threshold may be required to better reflect the prognosis of AS and trigger treatment.