bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maternal pre-existing and gestational diabetes and the risk of bicuspid aortic valve in the offspring
Authors: Hansson M , Sillesen A S , Dannesbo S , Voegg R O B , Axelsson Raja A , Vejlstrup N , Iversen K , Bundgaard H 
Published: November 2023

Abstract

Background
Approximately 6% of all pregnancies in Denmark are affected by maternal pre-existing or gestational diabetes. Maternal diabetes is a well-known risk factor for congenital heart defects. Among the most common congenital heart defects is bicuspid aortic valve (BAV), which is present in 0.8% of newborns. Familial clustering of BAV is seen in 30-40%, but the heritability is not completely understood and since most cases are sporadic, a multifactorial aetiology has been proposed. The association between maternal diabetes and BAV in the offspring has been sparsely investigated previously.

Purpose
The purpose was to assess the prevalence of BAV in newborns born to mothers with pre-existing or gestational diabetes compared with children born to mothers without diabetes.

Method
Systematic, standardized transthoracic echocardiography was performed within 60 days of birth in over 25,000 newborns included in a population-based, multicentre, cohort study between 2016 and 2018. Maternal diabetes-status was collected from obstetrical records maintained by the obstetrical departments of the participating hospitals, supplemented by records from a nationwide registry covering patients contacts with private and public hospitals since 1976. Maternal diabetes was categorized as type 1, type 2, or gestational diabetes (GDM) using the ICD-10 codes DO240, DO241, and DO244, respectively.
The exposed newborns were compared with newborns not exposed to maternal diabetes.

Results
In total, the cohort consisted of 25,553 new-borns of whom 24,707 (96.7%) were not exposed to diabetes, 648 (2.5%) were exposed to GDM, and 198 were exposed to pre-existing diabetes; 136 (0.5%) to type 1 and 62 (0.2%) to type 2 diabetes. Median gestational age was 281 days (interquartile range (IQR) 273;287), median age at examination was 11 days (IQR 7;15), and 48% were female. None of the newborns exposed to pre-existing diabetes had a BAV. Nine (1.4%) new-borns exposed to GDM, and 179 (0.7%) newborns not exposed to diabetes were found to have a BAV, corresponding to a relative risk of 1.92 (95%CI 0.99-3.73), p= 0.056.

Conclusion
Exposure to maternal diabetes is associated with an increased risk of congenital heart disease. In our large cohort of unselected newborns, the association between diabetes and BAV did not reach statistical significance, but the numerically observed twice higher risk of BAV in children born to women with gestational diabetes is nevertheless intriguing and deserves future attention.
Predictors of clinical outcome in adults with repaired tetralogy of Fallot and the prognostic value of surrogate markers of right ventricular dyssynchrony
Authors: Papa A , Nussbaumer C , Schwitz F , Wustmann K , Greutmann M , Schwerzmann M 
Published: November 2023

Abstract

Introduction
Sequelae or residual lesions after surgical repair of tetralogy of Fallot (rTOF) are inevitable and have an impact on long-term outcome. So far, most of our attention was directed to negative consequences of residual pulmonary regurgitation. Less attention has been paid to the impact of right bundle branch block and intraventricular dyssynchrony on biventricular function, exercise capacity and clinical outcome.

Purpose
Using the Swiss Adult Congenital HEart disease Registry we aimed to investigate the 5-year clinical course of adults with rTOF late after surgical repair. We used echocardiography strain analysis as surrogate to quantify right and left ventricular dyssynchrony and correlated our findings with routine clinical measures from cardiopulmonary exercise testing, neurohumoral blood work and cardiac magnetic resonance imaging with the aim to identify patients at increased risk for an adverse clinical event.

Methods
2D speckle-tracking strain analysis of the right and left ventricle was performed with dedicated software (Tomtec, Germany). RV dyssynchrony index was measured as the standard deviation of time to peak shortening (TTP) in six RV segments. Interventricular shortening delay (IVSD) was defined as the maximal delay of TTP between ventricular segments. We constructed a multivariate model with NT-proBNP, ECG, clinical, imaging and exercise testing variables to predict the composite outcome of all-cause mortality, relevant arrhythmias and hospital admission for decompensated heart failure.

Results
A total of 285 patients were included. During a mean follow-up of 48±21 months, 33 patient (12 %) suffered an adverse event with a mean time to event of 30 ± 21 months after the baseline visit. RV dyssynchrony index and IVSD did not differ statistically between the groups with and without events (49±31ms vs 41±18ms, p-value 0.21, 130±65ms vs. 103±50ms, p-value 0.9). In the multivariate Cox-regression model, NT-proBNP, right atrial area and peak heart rate at exercise testing were independent predictors of outcome. An integrated risk score with the median values of these 3 variables as cut-off was highly accurate in separating patients at low risk (score 0; n=39) and high risk (score 3; n=38) for an adverse event. After 6 years of follow-up, no patient at low risk (score 0) had an adverse event, while in 62% of patients at high risk (score 3) an adverse event occurred (p&lt;0.001).

Conclusion
In our cohort of rTOF patients, echocardiographic surrogates of RV dyssynchrony did not correlate with clinical events. An integrated multimodality approach proved to be effective in predicting outcomes.
Sex differences in aortic stenosis progression and myocardial response
Authors: Teixeira R , Duarte F , Sousa-Nunes F , Almeida M , Neves I , Lobo A , Leite M , Ferreira D , Brandao M , Diaz S , Saraiva F , Barros A , Sampaio F , Fontes-Carvalho R 
Published: November 2023

Abstract

Background
Aortic stenosis (AS) produces an increased afterload and consequently left ventricular (LV) remodeling. While current guidelines recommend the same echo-doppler criteria for diagnosis and grading of AS for men and women, different sex-specific patterns of cardiac remodeling, and eventually damage, have been reported. Whether these different patterns are caused by sex-related AS progression rate or myocardial response is less well known.

Aim
We aim to compare longitudinal changes in aortic valve and cardiac function between women and men with AS to investigate sex-related differences in AS progression and cardiac remodeling.

Methods
Patients with mild-to-severe AS and LV ejection fraction (LVEF) ≥ 50 % at least in 2 transthoracic echocardiograms (TTE) were retrospectively identified. Prosthetic and bicuspid valves were excluded. Serial TTEs provided a multiparametric framework to compare AS severity, progression rate and induced cardiac changes between sexes.

Results
914 patients were included (median follow-up time of 6.8 years) and 52 % (473) were female. Both sexes had similar baseline aortic peak velocities (APV) (2.9±0.9 m/s), mean pressure gradient (MPG) (27±13 mmHg) and LVEF (60±5 %). Women were older (75±9 vs 73±8 years; p&lt;0.001), had smaller body surface area (BSA) (1.70±0.15 vs 1.88±0.16 m2, p&lt;0.001), proportionally lower stroke volume (SV) (82±19 mL vs 91±22 mL, p&lt;0.001), lower indexed LV mass (iLVM) (118±33 g/m2 vs 125±28 g/m2, p&lt;0.001) and higher indexed left atrial (LA) volume (39±13 vs 49±20 mL/m2, p&lt;0.001). The average annual progression rate of APV and MPG was similar for both groups (2 mmHg/year and 0.14 m s-1 year-1). After multivariate adjustment including time-dependent aortic valve replacement, women had a higher incidence of severe LV hypertrophy as measured by iLVM (HR=1.16, CI=1.08-1.91, p&lt;0.01), moderate-to-severe tricuspid valve regurgitation (HR=2.03, CI=1.01-4.07, p&lt;0.05) and pulmonary hypertension (PHT) (HR=1.49, CI=1.02-2.18, p=0.04) at 5 years. Similar incidence rates were seen for LV dilation, LVEF reduction and mitral valve regurgitation. All-cause mortality rates were similar between groups (p=0.30).

Conclusion
This study suggests that under similar static and dynamic loading conditions, women will develop severe LV hypertrophy and PHT earlier than men, possibly reflecting sex-specific response differences intrinsic to the myocardium. This suggests that the definition of AS severity may benefit from a shift from a valve-focused to a myocardial-integrative approach taking gender into account.
Coronary vascular function in females with history of hypertensive disorders of pregnancy an oxygenation-sensitive cardiovascular magnetic resonance imaging study
Authors: Hillier E , Luu J , Plasa G , Palmer C , Moukarzel M , Lindsay K , Friedrich M G , Quesada O 
Published: November 2023

Abstract

Background
Hypertensive disorders of pregnancy (HDP), including gestational hypertension and preeclampsia, have been associated with increased risk for cardiovascular disease decades after HDP pregnancy. HDP is thought to unmask pre-existing cardiovascular risk in the mother; and in addition HDP triggers a cascade of inflammatory and oxidative stress which leads to vascular endothelial dysfunction and abnormalities in cardiac structure and function evident early post-partum that may persist sub-clinically. Oxygenation-sensitive cardiovascular magnetic resonance (OS-CMR) is an emerging approach that can identify dynamic changes of myocardial oxygenation as a marker for coronary vascular function. The objective of this study was to assess coronary vascular function in females with history of HDP using OS-CMR.

Methods
We analyzed data from two short axis OS-CMR slices in 20 females with history of HDP, including gestational hypertension, preeclampsia and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets) and 20 healthy controls with history of normal pregnancy acquired on a 1.5T MRI scanner. Images were analyzed using a prototype tissue oxygenation module. The images were normalized for signal intensity to both ventricular blood pools. We used both traditional statistics and feature selection machine learning algorithms to select for predictive biomarkers in the dataset. Finally, we used a random forest classifier model for disease classification. We report area under the receiver operating curve (AUROC) as a metric for diagnostic accuracy.

Results
Global breathing-induced myocardial oxygenation reserve (B-MORE) of the mid left ventricular slice was significantly reduced in HDP females (-1.6 ± 14.8) when compared to healthy controls (11.3 ± 17.2, p=0.03), when normalized to ventricular blood pools (Figure 1A). Our feature selection algorithm selected the signal intensity during end-systole normalized to the series as the most predictive biomarker. Our model, which integrated data from &gt;3,300 discrete data points per participant, correctly differentiated healthy controls from women with HDP history with a 90% ± 3% AUROC accuracy, indicating high sensitivity and specificity (Figure 1B).

Conclusion
Compared to healthy controls, females with history of HDP have abnormal coronary vascular function, as shown by reduced myocardial oxygenation on OS-CMR. Combining advanced machine learning approaches can further enhance the potential application of OS-CMR to risk stratify females with adverse pregnancy outcomes susceptible to future cardiovascular disease.
Dobutamine stress echocardiography remains indispensable for the diagnosis of low-flow low-gradient severe aortic stenosis
Authors: Adrichem R , Bouwmeester S , Abdelkarim O , Vogel B , Blusztein D I , Veulemans V , Kuneman J H , Geleijnse M , Bax J J , Bertrand P B , Kodali S K , Mehran R , Little S H , Houthuizen P , Van Mieghem N M 
Published: November 2023

Abstract

Background
In patients with low-gradient aortic stenosis (AS) and low transvalvular flow, current guidelines recommend dobutamine stress echocardiography (DSE) to determine valve stenosis severity. Additionally, aortic valve calcification (AVC) scores are also used with this intent. Previous studies have determined cut-off values of ≥2000AU for men and ≥1200AU for women to distinguish between true severe AS and pseudosevere AS.

Purpose
To assess the relationship between AVC and DSE in low-flow low-gradient aortic stenosis.

Methods
We performed a multicenter international registry study including patients that underwent DSE to determine AS severity and multi-slice computed tomography (MSCT) of sufficient quality to determine AVC scores. Severe AS was diagnosed when resting peak aortic valve velocity was ≥4.0 m/s, or stress aortic valve area (AVA) remained &lt;1.0cm2 at peak dobutamine stress levels; moderate AS was diagnosed when resting AVA was ≥1.0cm2 and peak velocity was &lt; 4.0m/s or stress AVA exceeded 1.0cm² at peak stress.
Using the previous cut-off values, MSCT-AVC scores were compared to DSE-derived AS diagnoses to determine sensitivity and specificity of AVC, and the positive and negative predictive values of high and low scores. Subsequently, we performed a receiver-operating characteristics (ROC)-curve analysis for men and women separately.

Results
We included 271 patients from 8 centers, of which 231 patients had sufficiently interpretable DSE and MSCT. Median age was 79 years (Interquartile range (IQR): 71-84), median BMI was 26.4 kg/m2 (IQR: 24.1-30.0) and median BSA was 1.9 m2(IQR: 1.8-2.1). Left ventricular ejection fraction was reduced (&lt;50%) in 209 (90.5%) patients. Bicuspid valve morphology was present in 20 patients (8.7%).
DSE confirmed severe AS in 103 patients, 4 of whom already had resting peak aortic valve velocity ≥4.0m/s. Moderate AS was diagnosed in 128 patients, of which 76 had a resting AVA ≥ 1.0cm2. Characteristics of these patients are summarized the table.
Of the patients with severe AS, 49 (47.6%) had a high AVC score (≥2000 for men or ≥1200 for women) and of patients with moderate AS, 75 (58.6%) had an AVC score below those cut-off values. This corresponds to a sensitivity of 47.6%, a specificity of 58.4% and positive and negative predictive values of 53.5% and 51.6%, respectively. The ROC-curves are shown in the figure; the area under the curve was 0.55 for men and 0.52 for women, signifying poor discriminative performance.

Conclusion
In this multicenter international registry we found that aortic valve calcification scores correlated poorly with AS severity and therefore DSE remains the preferred technique to assess borderline AS severity.Table.Patient characteristicsFigure.ROC curve
Myocardial work and left heart deformation parameters across mitral regurgitation severity
Authors: Pastore M C , Mandoli G E , Vannuccini F , Lisi M , Iuliano M A , Santoro A , Niglio F P , Lorenz V , Montesi G E , Cavigli L , Focardi M , D'ascenzi F , Valente S , Cameli M 
Published: November 2023

Abstract

Background
Myocardial work (MW) is estimated by pressure-strain loops using an implemented speckle tracking software. It has emerged as an index of LV contractile properties overcoming the load-dependency limit of left ventricular (LV) global longitudinal strain (GLS). This is particularly useful in clinical setting characterized by frequent hemodynamic variations, such as heart failure and valvular heart disease. However, the variation of MW parameters across different stages of primary mitral regurgitation (MR) and its impact on symptoms has never been investigated.

Objective
The aim of this observational study was to assess the variations of MW and deformation parameters of left heart chambers in mild, moderate and severe MR.

Methods
Consecutive patients with mild, moderate and severe MR were prospectively enrolled. Exclusion criteria were: chronic atrial fibrillation, valvular heart prosthesis, previous cardiac surgery.
Patients underwent clinical evaluation, blood sample tests, ECG and echocardiography. Speckle tracking analysis, completed by MW after inclusion of blood pressure values at the time of echocardiographic exam (Fig.1), ,was performed offline. Patients were then divided into groups first according to MR severity. Differences among the groups were analyzed by student T-test (or non-parametric tests for non-normally distributed variables) and predictors of symptoms (as NYHA class ≥ 2) were explored by logistic regression analysis and receiver operating characteristic (ROC) curves.

Results
Overall, 180 patients were enrolled (60 mild, 60 moderate, 60 severe MR). LV GLS and global PALS reduced according to MR severity. Global constructive work (GCW) and global wasted work (GWW) significantly improved in patients with moderate and severe MR, while global work efficiency (GWE) showed a trend towards reduction in patients with higher grades of MR. Global work index did not change significantly in the three groups (Fig.1). Among strain parameters, global PALS emerged as the best predictor of NYHA class (p&lt;0.001; area under curve, AUC=0.75, Fig.2) These results are explained by the pathophysiology of MR, characterized by a mechanism of attempted LV compensation to volume overload with increased contractility parallel to the disease progress, although with low efficacy on increasing LV stroke volume and increased wasted work; while LA and diastolic function have an early reduction which is associated with the occurrence of symptoms.

Conclusions
myocardial deformation parameters of the left heart chambers vary accordingly to the pathophysiologic mechanisms of MR through increasing severity stages and are associate with the burden of symptoms.Fig.1Fig.2
18F-FDG PET/CT as a diagnostic tool for cardiac implantable electronic device infections
Authors: Costa G , Batista G , Guimaraes J , Monteiro E , Fernandes D , Santos T , Simoes M , Silva A L , Marinho A V , Costa G , Goncalves L , Ferreira M J 
Published: November 2023

Abstract

Background
The diagnosis of infective endocarditis (IE) in patients with cardiac implantable electronic devices (CIED) remains a clinical challenge. The modified Duke criteria have suboptimal diagnostic accuracy in this population, highlighting the need for alternative diagnostic tools.

Purpose
This retrospective study aimed to evaluate the diagnostic value of 18F-FDG PET/CT in suspected CIED infection.

Methods
From May 2016 to January 2022, 87 patients referred for 18F-FDG PET/CT for suspected IE were included in the study. The final diagnosis of IE was established by consulting the endocarditis team's diagnosis at the time of hospital discharge or death, based on clinical, microbiological, and imaging information as well as clinical response. Sensitivity, specificity, and positive and negative predictive values of 18F-FDG PET/CT in the evaluation of CIED infection were estimated.

Results
Of the 87 patients, 10 had suspected CIED infection, with a median age of 75 years. Pacemaker was the most common device found (65%). Fever was present in 80% of patients, and laboratory results showed a mean C-reactive protein of 15.9 mg/dL and mean leucocyte count of 10.5 G/L. According to the Duke Criteria, 60% were classified as "possible diagnosis," 20% with "definitive diagnosis," and 20% as "rejected diagnosis." Of the suspected CIED infection patients, compatible findings in 18F-FDG PET/CT were observed in 7 patients. The calculated sensitivity of 18F-FDG PET/CT was 78%, and specificity was 100%.

Conclusion
Our study suggests that 18F-FDG PET/CT is a valuable imaging tool for patients with suspected CIED infections, providing high sensitivity and specificity. The use of this technique could aid in the diagnosis of infective endocarditis and guide treatment decisions, particularly in cases where the modified Duke criteria have limited diagnostic accuracy.
Clinical and neurocognitive outcomes in patients with supra-arch vascular disease following transcatheter aortic valve replacement
Authors: Ko T , Tsai C H T , Kao H L K , Lin M S L 
Published: November 2023

Abstract

Background
Symptomatic carotid, vertebral and subclavian artery stenosis are associated with the risk of stroke, but the impact of these supra-arch vascular diseases (SAVD) on clinical and neurocognitive outcomes following transcatheter aortic valve replacement (TAVR) is unclear.

Methods
Preoperative carotid/vertebral duplex ultrasonography and computed tomography were performed to identify the presence of SAVD. Prospective neurological assessments (Barthel Index), global cognitive tests (Mini-Mental State Examination, MMSE) and executive performances (Color Trail Test A and B and verbal fluency), were applied at baseline, 3 months and 1 year post-TAVR.

Results
Overall, a total of 210 patients were evaluated, and 59 patients (28.1%) had SAVD (carotid stenosis: 37, vertebral stenosis: 23, subclavian stenosis: 6). The patients with SAVD were older (84.0±5.7 vs 79.4±8.2, P=0.0001) and had higher incidence of prior stroke or transient ischemic accident (15.3% vs 5.9%, P=0.031). There was no association between the presence of SAVD and stroke (adjusted hazard ratio (aHR): 1.26; 95% confidence interval (95% CI): 0.217-7.341) or mortality (aHR, 1.38; 95% CI:0.834-2.813). After propensity score matching in patients complete neurocognitive assessment after TAVR, the baseline neurocognitive performance were similar between the patients with (N=44) and without SAVD (N=74). Persistent improvement up to 1 year in Barthel Index, MMSE, Color Trail Test A and B could be observed only in the patients without SAVD, but not in patients with SAVD.

Conclusions
The presence of SAVD was not associated with an increased risk of post-TAVR stroke or mortality. However, the persistent improvement in neurocognitive assessments after TAVR could only be seen in patients without SAVD.
Predictors of permanent pacemaker implantation after transcatheter aortic valve implantation - Results from the SOLVE-TAVI trial
Authors: Feistritzer H , Stachel G , Kurz T , Eitel I , Marquetand C H , Abdel-Wahab M , Desch S , Thiele H 
Published: November 2023

Abstract

Background
Permanent pacemaker implantation (PPI) is frequently required following transcatheter aortic valve implantation (TAVI). However, the predisposing parameters increasing the likelihood of severe conduction abnormalities are still not fully understood.

Purpose
To analyze predictors of PPI 30 days after TAVI.

Methods
The SOLVE-TAVI trial randomized 447 patients to TAVI using either the balloon-expandable Edwards Sapien 3 valve or the self-expanding Medtronic Evolut R valve. Pacemaker rates at 30 days were relatively high, but comparable between both transcatheter heart valve (THV) types (19% vs. 23%). Computed tomography (CT) scans were analyzed semi-automatically to determine aortic annulus size and subannular calcification. The percentage of THV oversizing was calculated using the formula (nominal THV circumference/annular circumference – 1) x 100).

Results
From all patients treated with either the Sapien 3 or Evolut R valve, 47 patients were excluded because of prior pacemaker implantation. Rates of new PPI at 30 days were similar in patients with and without pre-existing left bundle branch block (7/36 patients vs. 53/342 patients, p=0.48) and right bundle branch block (11/51 patients vs. 48/327 patients, p=0.22), without significant differences according to valve type. Patients with new PPI showed a significantly higher degree of THV oversizing compared to patients without PPI (median 15%, interquartile range [IQR] 9-20% vs. median 12%, IQR 7-17%; p=0.03). Moderate/severe compared to no/mild subannular calcification did not result in higher PPI rates (17/121 patients vs. 40/245 patients; p=65).

Conclusion
THV oversizing but not pre-existing left and right bundle branch block and subannular calcification is associated with PPI after TAVI.