bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mortality and heart failure in patients with a history of atrial fibrillation undergoing mitral valve surgery
Authors: Due H , Petersen J K P , Havers-Borgersen E H B , Meulengracht D M , Bager L G V B , Koeber L K , Fosboel E F , Oestergaard L O E 
Published: November 2023

Abstract

Background
A history of atrial fibrillation (AF) is frequently seen in patients with mitral regurgitation. However, the impact of AF on heart failure (HF) and mortality following mitral valve repair/replacement for mitral regurgitation remains unclear.

Purpose
To examine the long-term risk of HF admission and mortality in patients undergoing mitral valve repair/replacement with or without AF.

Methods
We included adult patients undergoing mitral valve repair/replace for mitral regurgitation in Denmark (2000-2018). Patients were categorized according to a history of AF. We examined the cumulative incidences of HF admission and all-cause mortality with a maximum of three years of follow-up. Here we used Kaplan-Meier and Cumulative Incidence Function curves accounting for competing risk of death. Likewise, groups were compared using Cox proportional hazards in adjusted analyses.

Results
We included 4480 patients where 1685 (37.6%) patients had a history of AF (median age: 70, 66.1% males) and 2795 (62.4%) patients had no history of AF (median age: 64, 67.6% males). Patients with a history of AF had a higher proportion of chronic HF (42.0% vs 23.5%), ischaemic heart disease (37.4% vs 29.4%), and stroke (7.7% vs. 4.3%) at baseline. Patients with a history of AF before surgery admission were less likely to undergo mitral valve repair (65% vs. 72%).
The cumulative three-year incidence of HF-admission was 23.7% in patients with a history of AF and 14.6% in patients without a history of AF (Figure A). Adjusted analysis found a statistically significant increased rate of HF admissions (HR=1.19 [95% CI 1.02-1.39]). The cumulative three-year incidence of mortality was 13.8% in patients with a history of AF, and 8.2% in patients without a history AF (Figure B). Adjusted analysis yielded no statistically significant difference in the associated rate of mortality (HR=1.16 [95% CI 0.95-1.43]). Factors associated with both increased HF admission and mortality were among others age, myocardial infarction, and known chronic HF.

Conclusion
One in three patients had a history of atrial fibrillation, and these patients were associated with an increased rate of both heart failure admission and mortality, but following adjustments the association was only statistically significant for heart failure admission.Cumulative incidence of HF-admissionCumulative incidence of mortality
Early outcomes of the PASCAL P10 and the MitraClip XT transcatheter mitral leaflet approximation devices - A propensity score matched multicentre comparison
Authors: Von Stein P , Wienemann H , Horn P , Sugiura A , Spieker M , Tanaka T , Lurz P , Ruf T , Grothusen C , Hausleiter J , Nef H , Luedike P , Gercek M , Pfister R , Mauri V 
Published: November 2023

Abstract

Background
The edge-to-spacer PASCAL repair system was recently approved for percutaneous treatment of severe mitral regurgitation (MR). Comparative data with the MitraClip XT device which shows similar size and leaflet grasping features are lacking.

Purpose
Aim of this study was to compare the procedural and short-term safety and efficacy of two transcatheter mitral leaflet approximation devices, the PASCAL P10 and the MitraClip XT.

Methods
Overall, 566 patients underwent transcatheter mitral valve repair (TMVR) with PASCAL P10 (n=309) or MitraClip XT (n=257). The PASCAL P10 cohort included patients treated at 10 tertiary care centres in Germany between February and December 2019, while the MitraClip XT cohort consisted of patients treated at three of these 10 centres between May 2018 and September 2022. Propensity score (PS) matching based on the parameters gender, age, left ventricular ejection fraction, NYHA class, left ventricular end-diastolic diameter, left atrial volume index, vena contracta width, MR aetiology, and mean gradient resulted in 191 well balanced patient pairs. Primary efficacy endpoints were technical success, degree of residual MR at discharge and at 30-days as well as device success at 30-days. Primary safety endpoint was the rate of major adverse events (MAE) at 30-days.

Results
Technical success was 95.8% in the PASCAL group and 95.3% in the MitraClip group (P&gt;0.99). An MR ≤2+ at discharge was numerically more frequent in the PASCAL than in the MitraClip group (PASCAL: 91.5% vs. MitraClip: 85.9%; P=0.101). An MR ≤1+ at discharge was achieved more frequently in the PASCAL group (PASCAL: 68.3% vs. MitraClip: 56.5%; P=0.025). This difference was sustained at 30-days with numerically more patients with residual MR ≤2+ (PASCAL: 89.7% vs. MitraClip: 82.4%; P=0.071) and significantly more patients with MR ≤1+ (PASCAL: 64.7% vs. MitraClip: 51.6%; P=0.021) in the PASCAL group than in the MitraClip group. At 30-days, the mean gradient was similar between the two groups (PASCAL: 3.0 [2.3–4.0] mmHg vs. MitraClip: 3.1 [2.7–4.2] mmHg], P=0.218). Device success at 30 days was achieved with an equal frequency in both groups (PASCAL: 78.8% vs MitraClip: 71.3%; P=0.129). At 30-days, MAE occurred more often in the MitraClip than in the PASCAL group (PASCAL: 3.7% vs. MitraClip: 12.6%; P=0.002).

Conclusions
In this PS-matched study comparing the PASCAL P10 with the MitraClip XT, safety and efficacy were comparable at 30-days.
Dapagliflozin effect on functional mitral regurgitation and myocardial remodeling (DEFORM trial)
Authors: Huang Z S , Fan R , Xie P H , Zhong J L , Zhang S Z , Zhuang X D , Liao X X 
Published: November 2023

Abstract

Background
Functional mitral regurgitation (FMR) has already been demonstrated to lead to various adverse outcomes. However, the therapeutic effect of current guideline-directed medical therapy (GDMT) in FMR still remained limited. The purpose of this study was to assess the efficacy of sodium-glucose cotransporter 2 (SGLT-2) inhibitor dapagliflozin in reducing the extent of mitral regurgitation and myocardial remodeling in FMR patients.

Methods
In this prospective, randomized, parallel controlled trial, we randomly assigned 104 patients with moderate or severe FMR in a 1:1 ratio to receive either dapagliflozin 10mg once daily or not in addition to GDMT for FMR and follow-up for 12 weeks. The primary outcome was the change in effective regurgitant orifice area (EROA) of mitral regurgitation. Secondary outcomes included changes in regurgitant volume (RV), left atrial dimension (LAD), left ventricular end-systolic dimension (LVESd), left ventricular end-diastolic dimension (LVEDd), left ventricular ejection fraction (LVEF) and E/e’ ratio. Furthermore, we additionally compared the occurrence rate of hospitalization for heart failure or cardiac death between groups.

Results
Dapagliflozin was associated with a significant reduction in EROA of FMR (-0.074±0.099 vs -0.030±0.058 cm2for dapagliflozin vs. control, P=0.008). Dapagliflozin was also associated with significant reduction of RV (-9.08±15.27 vs. -2.98±9.28 ml for dapagliflozin vs. control, P=0.017), LAD (-2.45±4.44 vs. -0.36±3.08 mm for dapagliflozin vs. control, P=0.007) and E/e’ ratio (-5.88±7.41 vs -1.98±7.63 for dapagliflozin vs. control, P=0.011), and improvement in LVEF (6.57±10.10 vs. 1.92±9.57 for dapagliflozin vs. control, P=0.017). There were no significant differences in the changes of LVESd (P=0.662) and LVEDd (P=0.677) between groups. Hospitalization for heart failure occurred in 6 patients of dapagliflozin group (11.5%) and 10 patients of control group (19.2%) (log-rank test, P=0.257), and 1 patient in dapagliflozin group (1.9%) and 2 patients in control group (3.8%) had cardiac death during the 12-week follow-up (log-rank test, P=0.552).

Conclusion
Dapagliflozin could further reduce the extent of mitral regurgitation and improve myocardial remodeling in FMR patients based on the current GDMT. Our findings suggest that SGLT-2 inhibitors might be considered for GDMT of patients with moderate or severe FMR.
Left ventricular hypertrophy and ventricular ectopy in mitral valve prolapse
Authors: Cesmat A P , Chaudry A M , Gupta S , Sivaraj K , Weickert T T , Simpson Jr R J , Syed F F 
Published: November 2023

Abstract

Background
Mitral valve prolapse (MVP) is associated with left ventricular hypertrophy (LVH). Individuals with sudden death ascribed to MVP have increased ventricular mass on autopsy. Whether LVH is a risk factor for ventricular arrhythmia in MVP is unknown.

Purpose
We aimed to describe factors associated with LVH in MVP and the association of LVH with ventricular ectopy in MVP.

Methods
We studied all 637 patients aged 18 - 90 years with MVP on echocardiography between 2016-19 at our institution (median age [interquartile range] 64.3 [52.3-73.6] years; 52.6% female; 16.2% African American). Echocardiograms were reviewed for LVH, ventricular size and function, and valvular pathology. Complex or frequent ventricular ectopy (cfVE) was defined as &gt;1% burden of premature ventricular complexes or non-sustained ventricular tachycardia on ambulatory electrocardiogram or ≥2 premature ventricular complexes on a 10-second electrocardiogram. Multivariate logistic regression was used to assess relationships between MVP, LVH, and known associations of cfVE in MVP.
Resul­ts: LVH was present in 144 (22.6%) patients. A history of hypertension (HTN) was present in 78/144 (54.2%) with LVH vs. 204/493 (41.5%) of those without LVH (p=0.008). On multivariate analysis, LVH was independently associated with moderate to severe mitral regurgitation (odds ratio [95% confidence interval] 3.6 [2.4-5.6]) and heart failure (3.2 [2.0-5.1]), but not HTN (1.3 [0.9-2.0], p=0.205). cfVE was present in 55/144 (38.2%) with LVH vs. 127/493 (25.8%) without LVH (p=0.005). Among those without HTN, cfVE was present in 26/66 (39.4%) of those with LVH vs. 68/288 (23.6%) without LVH (p=0.013). On multivariate analysis, independent predictors of cfVE were age (odds ratio [95% confidence interval] 2.9 [1.1-8.1], p=0.035), mitral annular disjunction (3.2 [1.9-5.3], p&lt;0.0001), heart failure (2.4 [1.4-4.0], p=0.001), bileaflet MVP (2.2 [1.4-3.3], p&lt;0.001), and electrocardiogram inferior lead T-wave inversion (2.2 [1.4-3.4], p&lt;0.001), but not LVH (1.2 [0.7-1.9], p=0.486) whether in presence of HTN (1.0 [0.5-1.9], p=0.959) or absence of HTN (1.4 [0.7-2.8], p=0.344).

Conclusion
LVH is a common finding in MVP and is associated with mitral regurgitation and heart failure. LVH in MVP is not associated with increased ventricular ectopy. Ventricular ectopy in MVP is related to mitral morphological factors and heart failure.Multivariate predictors of cfVECharacteristics with and without LVH
Decoding calcific mitral valve disease: a novel deep learning model uncovers the role of calcium burden
Authors: Arif S , Zhang D , Ahmad F , Diagne M , Afilalo J 
Published: November 2023

Abstract

Background
Mitral annular calcification (MAC) is a common degenerative disease that affects older adults and causes calcium deposition in the mitral annulus, increasing the risk of mitral valve (MV) dysfunction, cardiovascular events, conduction abnormalities, and mortality. While the primary imaging modality recommended for the clinical evaluation of MAC is echocardiography, it has been reported to be found incidentally in approximately 8% of routine thoracic computed tomography (CT) scans. CT scan is a sensitive imaging modality for assessing MAC, providing the resolution necessary to understand the anatomical involvement of calcification. Research has shown that the MAC burden is associated with disease activity and progression. Still, the exact correlation between the quantitative calcium burden and the degree of severity of mitral valve disease is unclear.

Purpose
Our study aimed to determine the association between MAC, as assessed on CT, and significant mitral stenosis (MS) or mitral regurgitation (MR), as visualised on echocardiography. In addition, we sought to determine the quantitative MAC cutoffs that would optimally predict significant MS or MR on echocardiography.

Methods
A retrospective cohort study was conducted at our academic centre. Inclusion criteria were: age≥60 years, resting transthoracic echocardiogram performed between 2013-2022, non-gated chest CT performed within one year before echocardiography, and any degree of MAC documented on the echocardiography report. CT scans were requested for clinical indications unrelated to mitral valve disease. Exclusion criteria were: prior mitral valve intervention, endocarditis, and congenital mitral valve disease. Significant calcific mitral valve disease was defined as ≥moderate MR and ≥mild MS on the echocardiography report, ascertained by expert readers based on multiparametric ASE criteria. MAC volume was quantified on the multi-slice CT DICOM images using a 3D U-Net deep neural network previously trained by our group on an independent cohort.

Results
The cohort consisted of 1,560 unique patients with a mean age of 79 years and 61% females. The echocardiographic prevalence of significant MR and MS was 10% and 4%, respectively, for 211 affected patients. The CT-based mean MAC volume was 949 mm³ in patients with significant MR or MS, as opposed to 334 mm³ in those without (P&lt;0.001). MAC volume &gt;1000 mm³ was the optimal cutoff to predict significant MS (specificity 90%, sensitivity 51%, area under ROC curve 0.79) and significant MR (specificity 89%, sensitivity 21%, area under ROC curve 0.60). Adjusting for age, sex, and comorbid conditions did not affect the observed association between MAC volume and mitral valvulopathy.

Conclusion
A novel deep learning model for quantifying MAC volume from non-cardiac clinical CT scans was efficient in screening for calcific mitral valve disease, particularly MS, and identifying patients who may benefit from further evaluation.
An external validation of prognostic scores for patients with severe tricuspid regurgitation
Authors: Ruiz Ortiz M , Fernandez Aviles C , Fernandez Ruiz A , Heredia Campos G , Resua Collazo A , Delgado Ortega M , Mesa Rubio D , Rodriguez Almodovar A , Esteban Martinez F , Maestre Luque L C , Moran Salinas A , Torres Zamudio A , Herrera Flores J , Diaz Andrade M , Pan Alvarez-Ossorio M 
Published: November 2023

Abstract

Background
Three scores have been published in 2022 for assessing prognosis of patients with tricuspid regurgitation (TR): the TRI-SCORE, and those reported by Hochstadt and Wang. All of them have shown to be useful in the prediction of mortality in follow-up. However only one of them has been externally validated, their comparative performance is unknown, and their discriminative ability for broader outcomes has not been investigated.

Purpose
To perform an external validation of available scores for predicting mortality and the combined end-point of mortality and heart failure (HF) admission in follow-up, in an independent cohort of patients with severe TR, and to compare their discriminative ability for this outcomes.

Methods
The validation cohort included retrospectively all consecutive patients ≥18 years with severe TR studied with echocardiography in a tertiary care hospital from 01.01.2008 to 31.12.2017, followed for all cause death and HF admission up to 01.01.2022. Every score was calculated in each patient with variables from the basal visit (Figure 1), and discriminative ability of the scores for predicting events was assessed by means of receiver operating characteristics (ROC) curves.

Results
A total 661 patients (69±13 years, 72% women) with severe TR, followed for up to 14 years (median 5 years, p25-75 2-7 years) were included in the validation cohort, with 384 deaths and 268 patients with 636 HF admissions on follow up. Discriminative ability for predicting death (C-statistic 0.72, 95%CI 0.68-0.76, p&lt;0.0005 for the TRI-SCORE; 0.75, 95%CI 0.71-0.78, p&lt;0.0005 for the Hochstadt score and 0.72, 95%CI 0.68-0.76, p&lt;0.0005 for the Wang score, figure 1A) or the combined end-point (C-statistic 0.74, 95%CI 0.70-0.78, p&lt;0.0005; 0.74, 95%CI 0.70-0.78, p&lt;0.0005 and 0.73, 95%CI 0.69-0.77,p&lt;0.0005, respectively, figure 1B ) on follow up was statistically significant for all of them. Paired comparison among them for predicting the combined end-point were all non-significant. However, the Hochstadt score was superior to the other two scores for predicting mortality in follow-up (p&lt;0.005).

Conclusions
All tested scores showed significant and similar discriminative ability for predicting the combined end-point of mortality or HF admission in this independent validation study of patients with severe TR. However, the Hochstadt score performed significantly better than the other scores for predicting mortality in follow-upScore variablesROC curves
Right ventricular function in moderate-to-severe ventricular tricuspid regurgitation: Is there a pseudo-normalization of conventional echocardiographic parameters?
Authors: Schmeisser A , Rauwolf T , Groscheck T , Tanev I , Meissler S , Hansen M , Luani B , Bekfani T , Steendijk P , Braun-Dullaeus R U E D I G 
Published: November 2023

Abstract

Background
A reliable evaluation of right ventricular (RV) function in the presence of moderate-to-severe tricuspid regurgitation (m/s-TR) is of paramount importance for surgical or interventional risk stratification. Due to the significant systolic regurgitation of blood from the RV to the low-pressure right atrium, conventional echocardiographic parameters could appear normal and thus overestimate RV function (pseudo-normal). The aim of this study was to analyse and compare RV function in trace TR versus m/s-TR by the invasive pressure-volume-loop (PV-loop) technique, the gold standard of RV function analysis, with conventional echocardiographic indices in patients with the ventricular form of mild/no vs. m/s-TR.

Methods
The study was conducted in 134 patients with HFrEF in a post-hoc analysis (110 from the Magdeburg CRT Responder Trial, and 24 from a local CRT-optimization trial).

Results
The logistic regression analysis demonstrated that RV size (RV-end-diastolic volume, RVEDV) and RV function (measured as RV fractional area change, FAC), TAPSE, and lower fractional shortening (FS) of proximal the RV-outflow tract (RVOTprox) was closely associated with PV-loop-derived RV total afterload (pulmonary arterial elastance, Ea) and coupling of RV contractility (end-systolic RV elastance, Ees) to Ea (Ees/Ea) (all, p&lt;0.001). Compared to trace TR (n=98, 73%), m/s-TR (n=36, 27%) was accompanied with significant higher total afterloads (Ea: 0.75 vs.0.41, p&lt;0.001) and lower RV-PA coupling ratios (Ees/Ea, 0.4 vs. 0.79, p&lt;0.001). This was associated with enlarged RVs (RVEDV: 210ml vs. 166ml), lower FAC (31% vs. 50%), TAPSE (13mm vs. 18mm), and RVOTprox (22% vs. 39%) (all p&lt;0.001). For better comparability between trace TR and m/s-TR tertiles (T1-T3) of similar afterloads (Ea) were formed. The m/s-TR patients showed significant lower RV-PA coupling ratios than trace TR at the lower two Ea tertiles T1 (p=0.034) and T2 (p&lt;0.001). At Ea T3 the difference was no longer significant (p=0.055). The hemodynamic data are mirrored by significant lower FACs, FS RVOTprox, and TAPSE at T1 and T2 (all p&lt;0.05), and a nonsignificant difference at T3 in m/s-TR.
In conclusion: In our cohort of HFrEF patients, echocardiographic RV function reflects very closely the hemodynamic coupling efficiency of RV contractility (Ees) to afterload (Ea) and seems independent from the extent of TR. We found no evidence for pseudo-normal or overestimated echocardiographic RV function in m/s-TR.
Tricuspid regurgitation impact on outcomes (TRIO) score: an evaluation tool for patients undergoing tricuspid valve surgery?
Authors: Al-Shakarchi N , Younis A , Juarez Casso F M , Crestanello J A , Nishant S , Anand V , Schaff H V , Greason K L , Nkomo V T , Lara-Breitinger K M , Pislaru S V 
Published: November 2023

Abstract

Background
Isolated tricuspid regurgitation (TR) repair or replacement carries significant operative mortality risk mainly due to delayed referral. We have recently developed the Tricuspid Regurgitation Impact on Outcomes (TRIO) score to assess risk in TR based on 8 simple variables (age, sex, severe TR, creatinine&gt;2 mg/dl, history of heart failure, history of chronic lung disease, AST &gt;40 units/L, heart rate &gt;90). Whether this score can be used in assessment of TR surgical risk and long term outcome is unknown.

Purpose
To examine the impact of TRIO scores on the postoperative outcomes of isolated tricuspid valve surgery.

Methods
Adult patients with severe functional TR who underwent isolated tricuspid valve replacement or repair between 2000-2022 were identified. Postoperative outcomes were compared across low (0-3), intermediate (4-6), and high (7-12) TRIO risk score groups.

Results
177 patients were included. Mean age was 70.7 ± 12.2 years, 69 (39%) were male, 34 (19%) were low TRIO score, 111 (63%) intermediate score and 32 (18%) high score. Tricuspid repair was performed in 43 (24.3%) and valve replacement in 134 (75.7%), reflecting the advanced disease stages of this patient cohort. At short term, higher TRIO scores were associated with more frequent need for urgent surgery, prolonged ventilation (&gt;72h) and postoperative dialysis (p&lt;0.05 for all). Perioperative 30-day mortality increased with the TRIO risk score (low: 0%; intermediate: 4.5%; high: 9.4%) but differences did not reach statistical significance (p=0.187). Low risk patients had a shorter hospital and ICU stay (Figure 1A-B). During a mean follow-up of 5.2 ± 3.2 years, 98 (55.4%) patients died. At long term follow-up, lower TRIO scores were associated with improved survival after tricuspid surgery (Figure 1C).

Conclusions
Patients with higher TRIO scores have more postoperative complications, require longer hospital stay and have higher all-cause mortality at long-term follow-up. Our findings suggest that TRIO score may also be used for risk stratification in patients considered for surgical management of isolated functional TR.