bluuebunny/crossref_metadata_2025_split huggingface dataset:
Meta-analysis of the performances of contemporary risk models in cardiac surgery for infective endocarditis
Authors: Wang T K M , Agrawal A , Arockiam A D , El Dahdah J , Honnekeri B , Shekhar S , Unai S , Griffin B 
Published: November 2023

Abstract

Background
Risk scores play important roles in the decision-making for cardiac surgery, but remain under-studied in the setting of infective endocarditis (IE) when there is often a high risk of adverse outcomes. Several IE-specific risk scores have been developed recently, but there is a paucity of external validation studies. We aimed to pool the performance of current risk models applied to IE surgery.

Methods
Ovid Medline, Ovid Embase and Cochrane Library were comprehensively searched following PRISMA guidelines for eligible studies. Standard meta-analysis techniques using random effects models were used to pool the discriminative and calibration performance of risk scores for predicting operative mortality after IE surgery.

Results
Amongst 620 studies and 50 full-text articles screened, 17 studies reporting 12 risk scores and totaling 6337 patients were included. Amongst traditional risk scores, EuroSCORE I, EuroSCORE II, and STS IE score had pooled areas under curve (95%CI) of 0.727 (0.700.754), 0.753 (0.731-0.775), and 0.695 (0.645-0.746) (Table1). However, EuroSCORE II significantly over-estimated operative mortality while EuroSCORE I had good calibration with pooled Peto’s odds ratio (95%CI) of 2.47 (1.22-5.01) and 1.00 (0.74-1.36) respectively. Amongst IE-specific scores, areas under curve (95%CI) was highest for the ANCLA score 0.838 (0.803-0.873) and lowest for the COSTA score 0.641 (0.573-0.710).

Conclusion
Most contemporary risk score had moderate discriminative ability for operative mortality after IE surgery, with the IE-specific ANCLA score performing the best. However, there is room for improving the performance of current risk models, along with need for further external validation studies and calibration assessment, especially for IE-specific scores.
Prevalence, profile, causes and prognostic factors of surgical rejection in patients with left-sided infective endocarditis
Authors: Lopez Diaz J , De Miguel M , Pulido P , Cabezon G , Lozano A , Vilacosta I , Olmos C , Saez C , Gomez I , San Roman J A 
Published: November 2023

Abstract

Background
Despite the benefits of cardiac surgery in infective endocarditis, a high proportion of patients with surgical indication are not operated, which worsens their prognosis profoundly. Several attempts have been done to study this group of patients, but many aspects remain unclear so far.

Purpose
To analyze the prevalence, to describe in detail their characteristics, to determine the reasons for the denial and the prognostic factors of these patients in the widest series to date of patients with surgical indication but not operated.

Patients and methods
We included in an ongoing multipurpose database, all patients with definite left-sided infective endocarditis admitted in three Spanish tertiary hospitals from 2005 to 2022. We describe the clinical, epidemiological, microbiological, echocardiographic characteristics of patients with surgical indication according to the European guidelines who did not undergo surgery and compared with those patients operated on. We also analyzed the reasons of the denial and finally, through a univariate and multivariate analysis, determine the independent factors of in-hospital mortality of these patients.

Results
Of a total of 1105 patients with left-sided infective endocarditis of our series, 893 had surgical indication (81%) and 219 did not undergo surgery (19.8%). The main reason for surgical rejection was very high risk determined by an endocarditis team (56%), followed by stroke (25%), death before surgery (15%) and patient rejection (0.7%). The most frequent surgical indication of patients who were not operated was uncontrolled infection (50.4%). Patients not operated were older (73 vs 63; p&lt;0.001), more frequently female (38.8% vs 29.5%; p=0.01), diabetic (34.7% vs 24.4%, p=0.003) and chronic renal failure (27.4% vs 11.3%; p&lt;0.001). At admission they had more stroke (21.5% vs 12.1%; p=0.001) and septic shock (13.2% vs 6.9%; p=0.03). Staphylococcus aureus (34.7% vs 16.5%; p&lt;0.001) and echocardiographic vegetations (92.7% vs 85.3%; p=0.005) were more frequent whereas Streptococcus viridans (8.2% vs 17.7%; p=0.001) and severe valvular regurgitation (64.8% vs 74.6%; p=0.005) were less frequent. In hospital mortality of patients not operated was 63.9%, significantly higher than operated patients (23%; p&lt;0.001). The only independent risk factor of in-hospital mortality in patients with surgical indication who did not undergo surgery was persistent infection (HR 3.689; CI 95% 1.75-7.78).

Conclusions
A very high proportion of patients with definite left-sided infective endocarditis had surgical indication according to the European guidelines, but a quarter of them were not operated. Very high surgical risk was the main reason for the denial. They were older, had more comorbidities and a more aggressive microbiological profile. Mortality of these patients was three times higher than operated patients.
Association of dysglycaemia with persistent infarct core iron in patients with acute ST-segment elevation myocardial infarction
Authors: Oberhollenzer F , Lechner I , Reindl M , Tiller C , Holzknecht M , Fink P , Mayr A , Bauer A , Reinstadler S , Metzler B 
Published: November 2023

Abstract

Background
Dysglycaemia increases the risk of myocardial infarction and subsequent recurrent cardiovascular events. However, the role of dysglycaemia in ischemia/reperfusion injury with development of irreversible myocardial tissue alterations remains poorly understood.

Objectives
To investigate the association of dysglycaemia with persistence of infarct core iron and their longitudinal changes over time in patients undergoing primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI).

Methods
We analyzed 348 STEMI patients treated with primary PCI between 2016 and 2021 that were included in a prospective observational study. Peripheral venous blood samples for glucose and glycated hemoglobin (HbA1c) measurements were drawn on admission and 4 months after STEMI. Cardiac magnetic resonance (CMR) imaging including T2* mapping for infarct core iron assessment was performed at both time points. Associations of dysglycaemia with persistent infarct core iron and iron resolution at 4 months were calculated using multivariable regression analysis.

Results
Persistent infarct core iron was present in 89 (26%) patients (HBA1c &lt;5.7%: 16%, 5.7-6.4: 37%, ≥6.5: 34%) and was independently associated with HbA1c levels (OR: 1.64 [95% CI: 1.11-2.42]; p=0.01), but not glucose levels on admission. The independent association was present even after exclusion of patients with diabetes (pre- and newly diagnosed, n=42). Infarct core iron resolution was observed in 34 (14%) patients and was independently associated with HbA1c levels at 4 months (OR: 0.51 [95% CI: 0.28-0.93]; p=0.03).

Conclusions
In STEMI patients treated with primary PCI, dysglycaemia is independently associated with persistent infarct core iron and impaired iron resolution at 4 months. Persistent infarct core iron might represent a mechanistic driver for adverse outcome and a potential therapeutic target in patients with altered glycemic status suffering acute STEMI.
Prognostic value of left ventricular hypertrophy in patients with myocardial fibrosis by ECV mapping on cardiac MRI
Authors: Alam L , Riasat M , Reyes H , Lopez P , Kim G H , Elias J , Argulian E , Agarwal V 
Published: November 2023

Abstract

Background
Cardiovascular magnetic resonance (CMR) can noninvasively identify myocardial fibrosis using extracellular volume (ECV) mapping. In patients with elevated ECV, and without hypertrophic cardiomyopathy (HCM) or cardiac amyloidosis, the prognostic significant of mild-to-moderate left ventricular hypertrophy (LVH) has not been well established.

Purpose
To determine if the presence of mild to moderate LVH has an impact on major adverse cardiovascular outcomes (MACE) in patients with elevated ECV without HCM or cardiac amyloidosis.

Methods
This was a retrospective cohort study assessing a group of patients referred for CMR between July 2019 and January 2023 to Mount Sinai Morningside. Patients with ECV&gt;30% and left ventricular wall thickness &lt;1.6 cm (to exclude patients with the possible diagnosis of HCM or cardiac amyloidosis) were considered for inclusion. Those with an established diagnosis of HCM or cardiac amyloidosis were also excluded. The LVH group comprised of patients with mild-to-moderate LVH, defined as a maximum wall thickness of 1.2-1.5 cm. The control group included patients without LVH (wall thickness &lt;1.2 cm). Patients were further stratified by ECV, using the median value for our sample, as "high ECV" (≥35%) or "low ECV" (&lt;35%). The outcome of interest was time-to-first MACE (all-cause death, or incident acute coronary syndrome, acute heart failure, or arrhythmia). Time-to-first MACE within 1 year was compared among groups using unadjusted Kaplan-Meier curves. Additional Cox regression analyses were performed to adjust for significant univariate analysis, including hypertension, hyperlipidemia, diabetes mellitus, use of beta-blocker, use of diuretic, and category of glomerular filtration rate. The results are presented as hazard ratios and 95% confidence intervals. All analyses were performed in SAS Enterprise using α&lt;0.05.

Results
Out of the cohort, we identified 186 patients that met our selection criteria. The mean age was 61.1 ± 15.5 years, and 58.1% of patients were female. The median follow-up was 175 days in the control group and 115 days in the LVH group. There were 61 MACE (32.8%) in our sample. After adjusting for covariates, mild-to-moderate LVH was associated with 2.2 times the risk of MACE (95%CI 1.3 to 3.8; p=0.0047) at 1 year, compared to patients without LVH. A higher ECV (≥35%) was not significantly associated with worse outcomes within each study arm (p=0.3450). Kaplan Meier survival curves for patients with and without LVH are shown in Figure 1 (p=0.0002).

Conclusions
In patients with evidence of elevated ECV without underlying cardiac amyloidosis or hypertrophic cardiomyopathy, mild-to-moderate LVH is associated with 2.2 times the risk of MACE compared to normal left ventricular wall thickness.Figure 1
A novel strategy for key gene identification in hypertrophic cardiomyopathy based on cuproptosis and multiple WGCNA analyses
Authors: Xiao Y , Pan R J , An Z H , Liu Q M , Zhou S H 
Published: November 2023

Abstract

Background
Hypertrophic cardiomyopathy (HCM) is a potentially fatal disease, and early diagnosis is crucial for effective treatment. Microarray analysis and the discovery of cuproptosis, a new form of cell death, offer new possibilities for identifying potential biomarkers for early diagnosis.

Purpose
This study aimed to identify cuproptosis-related genes associated with HCM and potential biomarkers for early diagnosis using machine learning.

Methods
Expression data of cuproptosis-related genes were extracted from the GSE36961 dataset, and differential expression analysis was conducted. Immune infiltration analyses were also performed. Samples were categorized into two clusters, and cluster weighted gene coexpression network analysis (WGCNA) was performed based on HCM and cluster clinical data. The results were combined to develop the best machine learning model, which was verified through calibration and external validation (GSE1145 and GSE32453).

Results
Cuproptosis-related genes (NLRP3, ATP7B, ATP7A, SLC31A1, LIAS, LIPT1, DLD, DLAT, PDHB, and DBT) were differentially expressed between HCM and control samples. Five key genes (TSPAN12, ANP32C, C4ORF18, COL21A1, and HMGB2) were identified, which showed great efficiency in the diagnosis of HCM in external validation, with an AUC of 0.948. These genes may play critical roles in megakaryocyte differentiation, RAGE receptor binding, and protein digestion and absorption.

Conclusions
Cuproptosis-related genes may play significant roles in HCM, and TSPAN12, ANP32C, C4ORF18, COL21A1, and HMGB2 may be potential biomarkers for the early diagnosis of HCM. This study provides new insights for further research on HCM diagnosis and treatment.Flow chart of research designEvaluation and verification results
Perfomance of sudden cardiac death prediction strategies before and after Septal Reduction Strategies in patients with Hypertrophic Cardiomyopathy
Authors: Maurizi N , Fumagalli C , Ho C , Day S , Olivotto I 
Published: November 2023

Abstract

Background
Actual sudden death (SD) risk stratification strategies for Hypertrophic Cardiomyopathy have not been validated for patients after a septal reduction treatment (SRT). Therefore, it is largely unresolved the quantification of the ventricular arrhythmias (VA) burden after an SRT and how risk stratification should be performed in such patients.

Purpose
To evaluate the performance of ESC SD Risk stratification model and AHA ACC Risk Factors for SD in the identification of patients with lethal ventricular arrhythmias after SRT.

Methods
Data from 11 high-volume HCM specialty centers from the international SHaRe Registry were used to describe the natural history of patients with SRT. Patients were followed from SRT until last follow-up or meeting the composite outcome of ventricular arrhythmias (sudden cardiac death (SCD), resuscitated cardiac arrest, or appropriate implantable cardioverter-defibrillator (ICD) therapy). Cox proportional hazards models were used to identify predictors of prognosis and incident development. Calculation of SD score was performed before the SRT and at 1 year from the procedure.

Results
Of the 10385 patients part of the ShaRe Registry, 1835 (18%, 968 (53%) males) underwent a SRT during a median follow-up of 6.8 (IQR 3.4-9.8). A total of 455 (25%) had Alcohol Septal Ablation (ASA) and 1377 (75%) had myectomy. Patients who underwent myectomy were younger (49±18 vs 56±15 years, p&lt;0.01), more frequent with a sarcomeric mutation (396 (29%) vs 111 (24%), p&lt;0.01). Over 6.8 years after the procedure, 77 (4%) died because of HCM (0.6%/year) and 87 (5%) presented a composite VA outcome (0.7%/year). Development of the composite VA event was associated with younger age at procedure (38±20 vs 54±18 years, p&lt;0.01), the development of a LV EF&lt; 50% (29 (33%) vs 351 (20%), p&lt;0.01), a more severely dilated LA (47±7 vs 43±11 years, p&lt;0.01) and greater LV maximal wall thickness (24±6 vs 21±6 years, p&lt;0.01). Significant predictor of the composite VA outcome was the presence of a LA diameter ³ 45 mm (HR, 2.6 [95% CI, 1.7–3.5]). Patients who presented the VA outocome were classified according to ESC SCD Risk pre and post SRT as: 40 (46%) as high risk, 31 (36%) as intermidiate risk, 16 (18%) as low risk pre intervention and 26 (46%) as high risk, 41 (47%) as intermidiate risk, 20 (18%) as low risk post procedure. AHA ACC SCD risk factors pre and post SRT classified patients as: 56 (64%) as class IIA 25 (29%) as Clas IIB, 6 (7%) as Class III and post SRT 42 (48%) as Class IIA, 31(36%) as Class IIB, 14 (16%) as Class III.

Conclusions
Current stratification strategies potentially underestimate the risk of SD pre and post SRT. Specifically, ESC SD risk strategies underperformed in the identification of intermidiate high risk patient, whereas AHA ACC were capable of identifying 84% of patients who had a malignant VA.
Sacubitril/valsartan for treatment of symptomatic non-obstructive hypertrophic cardiomyopathy: a randomised, controlled, phase II clinical trial (SILICOFCM)
Authors: Velicki L , Popovic D , Okwose N C , Preveden A , Tesic M , Tafelmeier M , Charman S J , Macgowan G A , Filipovic N , Ristic A , Olivotto I , Maier L S , Jakovljevic D G 
Published: November 2023

Abstract

Aim
To evaluate the effect of sacubitril/valsartan on exercise capacity, cardiac structure, and function in patients with hypertrophic cardiomyopathy (HCM).

Methods
Phase II, randomised, open-label multicentre study enrolled adult patients with symptomatic non-obstructive HCM (NYHA class I–III) who were randomly assigned (2:1) to receive sacubitril/valsartan (target dose 97/103mg) or usual care for 16 weeks. Primary endpoint was a change in peak oxygen consumption (peak VO2). Secondary endpoints included echocardiography measures of cardiac structure and function, natriuretic peptides and other biomarkers, and Minnesota Living with Heart Failure quality of life (QoL).

Results
Between May 2018 and November 2021, 354 patients were screened for eligibility, 115 patients (mean age 58 years [SD 11], 37% women) met the study inclusion criteria and were randomly assigned to sacubitril/valsartan (N=79) or usual care (N=36). At 16 weeks, there was no significant change in peak VO2 from baseline in sacubitril/valsartan (15.3 [4.3] vs 15.9 [4.3] ml/kg/min, p=0.13), or usual care group (p=0.47). There was a significant reduction in ventilatory efficiency slope (30.1 [7] vs 28.4 [4.9], p=0.03), but not in the control group (p=0.09). No significant changes were found in systolic or diastolic function, cardiac structure, or plasma biomarkers. The QoL score decreased significantly in the sacubitril/valsartan by 6 points (p=0.005) but not in the usual care group (p=0.66).

Conclusion
In patients with hypertrophic cardiomyopathy, 16 weeks of treatment with sacubitril/valsartan was well tolerated and contributed to a significant improvement in ventilatory efficiency and quality of life but not in exercise capacity or cardiac function.
Relation between non-sustained ventricular tachycardia and major arrhythmic events in patients with dilated cardiomyopathy caused by titin truncating variants
Authors: Hirose K , Cannie D , Syrris P , Bakalakos A , Elliott P 
Published: November 2023

Abstract

Background
Truncating titin variants (TTNtv) are the most frequent monogenetic cause of dilated cardiomyopathy (DCM). Current data suggest that nonsustained ventricular arrhythmia is common in patients with TTVtv but its relation to the risk of major arrhythmic events (MAE) is uncertain.

Purpose
To investigated the relationship between NSVT recorded on Holter ECG or implanted device and MAE in patients with DCM.

Methods
We retrospectively studied consecutively evaluated patients with DCM (left ventricle ejection fraction (LVEF) below 50%) on echocardiography and a pathogenic TTNtv. Patients with obstructive coronary artery disease, valvular disease, ventricular tachycardia ablation during follow-up time and follow-up less than one month were excluded. Survival was modelled from the initial Holter or device implantation. NSVT was defined as ≥3 consecutive ventricular beats at a rate &gt;120 beats per minute, lasting for &lt;30 s. MAE was defined as sustained ventricular tachycardia (VT), ventricular fibrillation (VF), sudden cardiac death, implantable cardioverter defibrillator (ICD) treated ventricular arrhythmias (appropriate shock and ATP). The clinical endpoint was MAE (sustained VT, VF, sudden cardiac death, ICD shocks and ATP) and multivariable analysis was performed using Cox proportional hazards models. Event-free survival probabilities were estimated using the Kaplan-Meier method, and comparisons of Kaplan-Meier curves were made using log-rank tests.

Results
The cohort comprised 58 men and 30 women [mean age 49 ± 15 years; mean follow-up 3.5 ± 1.8 years]. Symptoms were NYHA class I in 56 patients, class II in 25 patients, class III in 7 patients and class IV in none. Holter ECGs were performed in 77 patients, 41 of whom had NSVT. Twenty five patients had pacemaker/ICD in situ; 14 had NSVT. Six patients had MAE; 4 with NSVT. Univariate analysis association between MAE and LVEF ≤35% (hazard ratio (HR), 9.03; 95% confidence interval (CI), 1.49-54.71; P=0.017), prolonged (&gt;8 beats) NSVT (HR, 6.71; 95% CI, 1.22-36.98; P=0.029) and fast (&gt;200 bpm) NSVT (HR, 5.09; 95% CI, 1.02-25.47; P=0.048). Kaplan-Meier showed similar differences in freedom from MAE (LVEF ≤35%; P=0.004, long NSVT; P=0.025, fast NSVT; P=0.031).

Conclusion
Fast and prolonged NSVT is associated with a higher risk of MAE in patients with TTNtv.Characteristics at the beginningSurvival probability for freedom
Monitoring patisiran and inotersen treatment with quantitative SPECT/CT in hereditary transthyretin amyloid cardiomyopathy
Authors: Rettl R , Calabretta R , Duca F , Binder C , Kronberger C , Dona C , Beitzke D , Loewe C , Bonderman D , Hengstenberg C , Badr Eslam R , Kastner J , Bergler-Klein J , Hacker M , Kammerlander A A 
Published: November 2023

Abstract

Background
Novel ribonucleic acid interference (RNAi) therapeutics such as patisiran and inotersen have been shown to benefit neurologic disease course and quality of life in patients with hereditary transthyretin amyloidosis (ATTRv).

Purpose
We aimed to determine treatment effects on myocardial amyloid load determined by quantitative single photon emission computed tomography/computed tomography (SPECT/CT) in patients with ATTRv-related cardiomyopathy (ATTRv-CM) and to identify nuclear imaging biomarkers to quantify and monitor response to therapy.

Methods
ATTRv-CM patients underwent [99mTc]-radiolabeled diphosphono-1,2-propanodicarboxylic acid ([99mTc]-DPD) scintigraphy and SPECT/CT imaging before and after 12 months of treatment with patisiran (n=5) or inotersen (n=4).

Results
Patisiran-treated patients had a significant reduction in cardiac uptake as measured by standardized uptake values (SUVpeak: 7.98 g/mL ±0.87 vs. 6.50 g/mL ±1.59, p=0.025, Figure 1A; SUVmax: 8.80 g/mL ±0.94 vs. 6.96 g/mL ±1.59, p=0.009, Figure 1B; SUVmean: 5.64 g/mL ±1.01 vs. 4.42 g/mL ±1.26, p=0.016, Figure 1C). Patients treated with inotersen showed evidence of stabilization in cardiac SUV uptake (SUVpeak: 8.56 g/mL ±2.25 vs. 7.99 g/mL ±1.90, p=0.665; SUVmax: 9.29 g/mL ±2.39 vs. 8.79 g/mL ±2.03, p=0.719; SUVmean: 5.07 g/mL ±1.46 vs. 4.86 g/mL ±0.95, p=0.834) but had significant deterioration in left ventricular (LV) function (LV cardiac index: 3.39 L/min/m2 ±0.04 vs. 2.94 L/min/m2 ±0.01, p=0.028, Figure 1D). Comparison of cardiac SUV uptake and longitudinal cardiac function revealed significant correlations between longitudinal changes in cardiac SUVpeak and LV global longitudinal strain (r=-0.658, p=0.027, Figure 1E) and right ventricular free wall longitudinal strain (r=-0.771, p=0.008, Figure 1F).

Conclusions
In conclusion, using serial quantitative SPECT/CT imaging, we demonstrated that patisiran treatment significantly reduces cardiac SUV uptake in ATTRv-CM patients, indicating regression of cardiac TTR amyloid. Our data suggest that quantitative SPECT/CT imaging may be a valid tool to quantify and monitor response to disease-specific RNAi therapeutic agents in ATTRv-CM patients.Figure 1Graphical Abstract