bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characteristics, risk factors and outcomes of patients managed for left-sided infective endocarditis: a prospective study in a high-volume center
Authors: Granger C , Elegamandji B , Mihoubi K , Mertens E , Bouziri N , Guedeney P , Lebreton G , Demondion P , Bleibtreu A , Collet J P , Montalescot G , Hekimian G , Hammoudi N 
Published: November 2023

Abstract

Background
Although medical and surgical management of infective endocarditis (IE) have improved in the recent decades, the associated mortality remains high. Available prospective data are scarce, and further knowledge from prospective cohorts could help improving the prognosis of patients with IE.

Objective
To describe the characteristics and outcomes of left-sided IE and to determine the risk factors associated to in-hospital mortality in a high-volume center.

Methods
From 15 September 2020 to 15 February 2023, all patients with left-sided IE managed in a tertiary center of cardiology were included in this prospective, observational study. The diagnosis of IE was made according to current guidelines and management was collegially discussed by the endocarditis team. Determinants of in-hospital death were assessed using a multivariate logistic regression model including any covariate associated in univariate analysis (p&lt;0.1).

Results
A total of 185 patients were included during the study period. Median age was 68 [56 – 76] years, 141 (76%) patients were males, and 75 (41%) cases involved a prosthetic valve. Aortic valve, mitral valve and involvement of both valves were observed in 111 (60%), 48 (26%) and 26 (14%) patients, respectively. Multimodal cardiac imaging, including cardiac computed tomography (CT) and/or PET-FDG, was used in 64 (35%) of all cases, and 49/75 (65%) patients with valvular prosthesis. Severe valvular regurgitation was identified in 56 (30%) patients, root abscess and/or false aneurysms in 57 (31%) patients. A pathogen agent was identified in 169 (91%) patients, and the most frequent germs were Staphylococcus (30%), Streptococcus (30%) and Enterococcus (17%). A severe initial presentation requiring intensive care unit (ICU) admission was observed in 42 (23%) patients. Cardiac surgery was performed in 102 (55%) cases, and 41 (22%) patients required an emergent surgery. A total of 37 (20%) patients died during the initial in-hospital phase, mostly from cardiac or neurovascular causes. In a multivariate analysis, hypertension (Odd ratio (OR) = 3.3; 95% confidence interval (CI): 1.4 – 10), bi-valvular endocarditis (OR = 3.1; 95%CI: 1.0 – 9.5), unidentified pathogen (OR = 4.3; 95%CI: 1.7 – 15) and chronic alcoholic abuse (OR = 16.4; 95%CI: 3.7 – 87.9) were independently associated with increased in-hospital mortality (Table).

Conclusion
Severe initial presentation requiring an ICU admission and/or urgent cardiac surgery was common among patients with left-sided IE. Chronic alcoholic abuse and unidentified pathogen appear as major determinants of in-hospital mortality.Table
Association of anticoagulation with outcomes in patients with infective endocarditis
Authors: Sheng S , Tao M , Ghosalkar D , Despotidis G , Liu Y , Dhaliwal S , Rahman T 
Published: November 2023

Abstract

Background
Infective endocarditis (IE) is a disease that is associated with high risk of morbidity and mortality. The utility of systemic anticoagulation (AC) in patients with IE has not been well defined. The purpose of this meta-analysis is to evaluated the utility of AC in patients with IE.

Methods
A literature search was conducted for studies reporting on the use of AC in patients with IE and clinical endpoints. The primary endpoint was all neurological complications. Secondary endpoints included all-cause mortality, ischemic cerebral vascular accident (CVA), and hemorrhagic CVA. Databases searched included Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted by time or publication status.

Results
A total of 12 studies with 9,063 participants with IE (1994 on AC, 7069 not on AC) met inclusion criteria. Mean age was 58 years, 65.8% were men, 20.9% had prosthetic valves. There was no statistically significant difference in risk of neurological complications in patients on AC compared to patients not on AC (OR 0.88, 95% CI 0.68-1.12; p=0.30). There was a trend towards increased risk of all-cause mortality in patients treated with AC compared to patients not on AC (OR 1.27, 95% CI 0.99-1.63; p=0.06). Patients on AC had significantly higher risk of hemorrhagic CVA compared to patients not on AC (OR 1.51, 95% CI 1.05-2.19; p=0.03). There was no statistically significant difference in risk of ischemic CVA in patients on AC compared to patients not on AC (OR 1.10, 95% CI 0.89-1.37; p=0.37).

Conclusions
Use of anticoagulation in patients with infective endocarditis is not associated with reduction in risk of neurological complications and may increase risk of all-cause mortality and hemorrhagic CVA. Further high quality studies are required to further characterize the use of anticoagulation in this disease process.
Initiation of warfarin is associated with decreased mortality in patients with infective endocarditis: a population based cohort study
Authors: Lee T , Chan C L , Chou O H I , Lee S , Chan J S K , Liu T , Chang C , Wong W T , Lip G , Cheung B Y M , Wai A K C , Tse G 
Published: November 2023

Abstract

Background
The use of warfarin as an anticoagulant to prevent thromboembolism in setting of infective endocarditis (IE) remains controversial due to increased bleeding risks.

Purpose
To study the risks of stroke, mortality and bleeding in warfarin users compared with non-use.

Methods
Patients aged 18 or older and diagnosed with IE in our city between January 1st 1997 and August 31st 2020 were included. Patients with use of any anticoagulant 30 days before IE diagnosis were excluded. Patients initiated on warfarin within 14 days of IE diagnosis and patients without warfarin use were matched using propensity scores (1:1 ratio). The study outcomes were ischemic stroke, all-cause mortality, intracranial hemorrhage, and gastrointestinal bleeding. Cox proportional hazards regression was used to determine the hazard ratios [95% confidence intervals (CIs)] for the predictors of study outcomes at the end of 90-day follow up.

Results
The matched cohort consisted of 675 warfarin users (57.0% male, age 59±16 years, mean CHA2DS2-VASc score: 1.42±1.72) and 675 warfarin non-users (53.5% male, age 61±19 years, mean CHA2DS2-VASc score: 1.58±1.76). Warfarin use was not associated with ischemic stroke risk (Hazard ratio: 1.04 [95% CI, 0.70-1.53]), but was associated with a 50% decreased risk of all-cause mortality (HR: 0.50 [0.39-0.65]). In terms of bleeding risk, intracranial hemorrhage occurred in 36 (5.3%) warfarin users and in 29 (4.3%) patients warfarin non-users, and gastrointestinal bleeding occurred in 27 (4.0%) warfarin users and in 26 (3.9%) warfarin non-users.

Conclusions
Warfarin use is associated with decreased risks of mortality but similar risks of ischemic stroke compared with non-use of warfarin in patients with IE.Kaplein Meier curves of study outcomes
Myocardial injury causes changes in the transcriptional and regulatory landscape of adaptive immune cells in the heart
Authors: De Winter N , Ji J , Sintou A , Sirvastava P , Sattler S 
Published: November 2023

Abstract

Background
Ischaemic heart disease is a leading cause of heart failure (HF) and despite advanced therapeutic options, morbidity and mortality rates remain high. Acute inflammation after myocardial infarction (MI) has been thoroughly studied in recent years and persistent immune-mediated damage has been suggested as a factor contributing to the development of HF. T and B cells are critical mediators of adaptive immune responses after MI, however a thorough analysis of their transcriptomic phenotypes in the heart at baseline and over time after injury are missing.

Purpose
Here, we aim to understand the transcriptional activity of B and T cells in the post-MI heart, in order to characterize their role in maintaining post-MI autoreactivity.

Methods
We obtained single cell RNA sequencing data of mouse and human hearts from Forte et al (2020), Martini et al (2019) and Litviňuková et al (2020) and performed differential expression analysis, gene regulatory inferences and trajectory-based differential expression analysis.

Results
Myocardial T cells subclustered into CD8+, CD4+, CD20+ and NK lineages with naïve, memory and effector functions (Fig. 1). The B cell population was divided into immature, plasma, memory, collagen-producing and B1 cell subgroups (Fig. 2). At baseline, despite a striking presence of effector populations, both B and T cells are governed by homeostatic and tolerance-promoting transcription factors (Deaf1, Ikzf1 and Nr1h3 for T cells and Spi-B as well as Bcl11 for B cells). Post-MI, the activity of transcription factors concerned with differentiation and proliferation increased. T cells express transcripts for proinflammatory chemokines and cytokines (Ccr7, Ccl5, Ifng and Tnf) as well as granzymes and perforin up until 28 days post-MI (Gzma and Prf1). Surprisingly, B cells upregulate collagen transcript levels 5-7 days post-MI (Col1a, Col5a, and Col4a) and regulon analysis supports that B cells increase the activity of transcription factors necessary for collagen production (Ets-1 and Krox20). Both B and T cells remain persistently activated post MI. 28 days post-MI T cells have increased activity of proinflammatory (Nfkb1) and cytokine producing (Crem and Rel) transcription factors, whereas B cells have increase maturation (Nfkb1), autoantibody production (Stat3 and Rel) and memory (Stat5b) transcription factor activity.

Conclusion
Collectively, our data shows that there are effector immune cell populations present at baseline, which are governed by homeostatic transcription factors. Post-MI, effector transcription factors are upregulated in both T cells and B cells, which promote proliferation, differentiation, cytokine production and in the case of B cells, collagen production. Even after resolution of acute inflammation, both the T and B cell population do not return fully to baseline but remain at a state of persistent activation, as effector transcription factors remain upregulated.
Heart rate and ejection fraction as prognostic markers in recurrent pericarditis
Authors: Yesilyaprak A , Kumar A , Agrawal A , Furqan M , Verma B , Akyuz K , Syed A , Majid M , Wang T , Cremer P , Klein A 
Published: November 2023

Abstract

Background
Heart rate (HR) and left ventricular ejection fraction (LVEF) are both important markers in assessing symptom improvement in patients with recurrent pericarditis (RP). However, their prognostic significance in predicting RP outcomes remains largely unexplored, as no prior studies have investigated this relationship.

Methods
Patients with RP were identified from a pericardial database covering the period between 2012 and 2019. The outcome of interest was clinical remission, which was defined as the resolution of symptoms without any further recurrences after discontinuing all anti-inflammatory therapies.

Results
A total of 365 patients were included in this study, of which the majority were females (56%) and less than 55 years old (68%). The mean number of recurrences at baseline was ≥4 in 158 (43%) of patients. The time to clinical remission was 24 months in the low HR group (HR ≤ 70 bpm), 60 months in the moderate HR group (HR: 71-90 bpm), and could not be determined for the high HR group (HR ≥ 90 bpm) due to few events. Patients with LVEF &lt; 60% took 56 months to achieve clinical remission, compared with patients with LVEF ≥ 60%, who took over 60 months. Multivariable analysis revealed that patients in the high (HR: 0.22, 95% CI: 0.09-0.51, p=&lt;0.001) and moderate (HR: 0.39, 95% CI: 0.21-0.75, p=0.005) HR groups were less likely to achieve clinical remission than those in the low HR group. Similarly, patients with LVEF ≥ 60% were less likely to achieve clinical remission than those with LVEF &lt; 60% (HR: 0.54, 95% CI: 0.36-0.80, p=0.002).

Conclusion
Both HR and LVEF play important roles in prognosticating outcomes in patients with RP. The significance of both markers can be attributed to the heightened shear stress on the pericardium, which can exacerbate inflammation.Multivariable analysis
Late gadolinium enhancement following Covid-19 infection does not predict outcome: a single-centre study
Authors: Vimalesvaran K , Howard J P , Zaman S , Ariff B , Bharath A A , Cole G 
Published: November 2023

Abstract

Background
Some patients are found to have myocardial scarring after infection with coronavirus-2019 disease (COVID-19) as evidenced by the presence of late gadolinium enhancement on cardiac MRI (CMR). In many types of heart disease, the presence of late gadolinium enhancement (even without symptoms) is associated with a poorer prognosis. However, it is not known whether the presence of scar after COVID-19 is associated with outcome.

Purpose
This study explores the association between late gadolinium enhancement (LGE) in recovered patients with COVID-19 and of longer-term clinical outcomes.

Methods
In this single-centre, retrospective, observational cohort study, troponin levels, CMR data, and follow-up outcomes of 169 patients with COVID-19 were collected. The primary outcome was all-cause mortality. The secondary outcome was a composite of myocardial infarction, stroke, and admission for heart failure. The log-rank test was used to compare survival of those with and without late gadolinium enhancement.

Results
A total of 169 patients (mean age 61 ± 16 years, 54% male) were included. Scans were typically performed in patients with a raised troponin or ongoing cardiac symptoms post COVID-19 infection. The median (IQR) time between COVID-19 diagnosis and CMR was 14 (7-23) weeks. Median follow-up was 28 (IQR 23 to 37) months. Troponin was performed in 92% (n=155) of patients. Of those, 78% (n=121) had a positive result.
Late gadolinium enhancement was present in 54 patients (32%). There were no observed differences in comorbidities such as hypertension, known ischaemic heart disease or heart failure, diabetes, obesity, or frailty between in patients with LGE compared to those without LGE. Kaplan-Meier survival analysis showed no significant difference in all cause mortality for patients with COVID-19 with LGE compared to those without LGE (Log-rank P = 0.36). Similarly, the composite secondary endpoint was not significantly different (Log-rank P = 0.48).

Conclusion
In this single centre study, patients found to have myocardial LGE after COVID-19 did not have an increased risk of mortality or cardiovascular events compared to those without. The overall event rates remain low even after 2-3 years of follow-up. The cause of this is unclear but underlines the importance of larger multicentre studies to follow-up COVID-19 survivors.
Natural history and predictors of all-cause mortality and major arrhythmic cardiac events in pediatric RASopathy associated hypertrophic cardiomyopathy
Authors: Boleti O , Field E , Norrish G , Bhole V , Uzun O , Daubeney P E F , Mcleod K , Ilina M , Bharucha T , Delledonne G , Jones C , Mathur S , Reinhardt Z , Prendiville T , Kaski J P 
Published: November 2023

Abstract

The RASopathies are a group of developmental disorders caused by germline variants in components of the RAS-MAPK pathway, commonly associated with hypertrophic cardiomyopathy (HCM). The aim of this study was to describe the natural history and predictors of all-cause mortality and major arrhythmic cardiac events (MACE) in a large, multi-centre cohort of paediatric patients with a RASopathy syndrome and HCM.
One-hundred-and-forty-nine patients were included (111 (74.5%) Noonan Syndrome (NS); 12 (8.05%) Noonan Syndrome with Multiple Lentigines (NSML); 6 (4.03%) Costello Syndrome (CS); 6 (4.03%) Cardiofaciocutaneous Syndrome (CFCS); and 14 (9.4%) with Noonan-like syndrome patients). NSML patients had higher maximal left ventricular wall thickness (MLVWT) (z score 17.02 (10.57-32.78), p=0.004] and higher left ventricular outflow tract (LVOT) gradient values (60mmHg, 36-80, p=0.019), with no other significant echocardiographic differences between RASopathy syndromes. Over a median follow up of 197.5 months (93.58-370), 23 patients (15.43%) died, at a median age of 48.94 months (3.29-175.84). Overall survival was 96.45% (91.69-98.51), 90.42% (84.04-94.33) and 84.12 (75.42-89.94) at 1, 5 and 10 years, respectively, but this was varied according to RASopathy syndrome. RASopathy syndrome, specifically Noonan-like syndrome (Hazard ratio 4.18, p=0.032) and congestive cardiac failure admission (Hazard ratio 7.35, p=0.037) were independent predictors of all-cause mortality and LVOT gradient was an independent predictor for MACE (Hazard ratio 1.02, p=0.025). These findings highlight a distinct category of patients with Noonan-like syndrome with a milder HCM phenotype but significantly worse survival and identify predictors of adverse outcome in patients with RASopathy-related HCM.
Endomyocardial biopsy practice in non-transplant patients: a nationwide descriptive study
Authors: Guiraud-Chaumeil P , Segol E , Leclerc Du Sablon N , Baudet M , Biassette H , Logeart D 
Published: November 2023

Abstract

Background
Endomyocardial biopsy (EMB) is an invasive diagnostic tool, mainly used during the follow-up of heart transplant patients (HTx). Its others indications have been established and discussed in position statement paper from international cardiac societies. However the use of EMB in real life remains controversial and differs widely from a center to another.

Purpose
We carried out a nationwide survey to describe the current use of EMB in non-heart transplant patients.

Methods
We used the National Hospital Discharge Database (PMSI) that contains diagnostic codes of all hospitalizations. Medical data is coded from different sources (e.g. laboratory reports, discharge reports) according defined terminologies and coding rules. We included all hospitalizations during which EMB (code CCAM DAHF001 – Endocardium or Myocardium Biopsy, transcutaneous vascular access) was performed from January 1st 2019 to December 31th 2020. We excluded all patients with a main or secondary or associated diagnosis of heart transplant. Main diagnosis as well as secondary and associated diagnoses were collected in order to define the medical indication of EMB. We aggregated EMB indications into 8 groups.

Results
Among 9735 EMB, 914 (9%) were carried out for non-transplant patients during the 2 years of analysis. Among the 212 hospitals with interventional cardiology units, only 53 (25%) carried out EMB in non-transplant patients and 86% of these procedures were carried out in transplant centers. Three hospitals carried out 37% of all non-transplant EMB while 23 centers carried out no more than 5 EMB over the 2-year survey.
The figure displays main indications of EMB in non-transplant patients. According to the PMSI database, the 3 main indications of EMB were amyloïdosis (29%), non-ischemic Dilated Cardiomyopathy (28%) and myocarditis (22%). The medical indication could not be specified in 155 (16%) patients.

Conclusion
In non-transplant patients, EMB is rarely performed in France, only in a few hospitals and with significant disparity in the annual rate of procedures carried out by each. Most EMB were performed because of amyloidosis or dilated cardiomyopathy and myocarditis. Further data about local constraints as well as clinical impact of EMB for each patient would be useful to understand further the role of EMB in real life.EMB indications in non HTx patients
The electrophysiological substrate of biopsy-proven cardiac amyloidosis
Authors: Casella M , Compagnucci P , Ciliberti G , Barbarossa A , Valeri Y , Cipolletta L , Volpato G , Stronati G , Vagnarelli F , Lofiego C , Perna G P , Natale A , Basso C , Guerra F , Dello Russo A 
Published: November 2023

Abstract

Background
Cardiac amyloidoses (CA) are an increasingly recognized group of infiltrative cardiomyopathies associated with high risk of major adverse cardiac events. Endomyocardial biopsy (EMB) may be required to differentiate the amyloid type (mainly, Immunoglobulin light chain [AL] versus transthyretin-related [ATTR]) in some cases.

Purpose
The aim of this study was to provide the first description of the right ventricular (RV) electroanatomical substrate of CA, and assess its association with EMB findings and clinical outcomes.

Methods
We enrolled ten consecutive patients undergoing EMB for suspected CA (median age, 68[63-77]; male, 50%) in a monocentric, observational, retrospective study. All patients had a clinical diagnosis of CA, but a diagnosis of CA type was hampered by the presence of inconclusive or discordant laboratory-imaging findings (abnormal serum free light chain assay and positive bone scintigraphy, n=5; ambiguous imaging results, n=4; abnormal serum free light chain assay and TTR gene mutation, n=1). Therefore, each patient underwent RV high-density electroanatomical voltage mapping (EVM) and EMB. The primary outcome was death or hospitalization at 1-year follow-up. We recorded electrogram features at EMB sampling sites and in the overall RV, and explored their correlations with histopathological findings and primary outcomes events.

Results
A final EMB-proven diagnosis of AL or ATTR CA was formulated in 6 and 4 patients, respectively. Electrogram amplitudes in the bipolar and unipolar configurations averaged 1.58±0.65 mV, and 5.38±1.41 in the overall RV. We found a significant inverse correlation between unipolar electrogram amplitude and amyloid burden at EMB (p&lt;0.001); the unipolar voltage cutoff that best identified regions with &gt;15% amyloid tissue infiltration according to Youden index was 9.1 mV (sensitivity, 43%; specificity, 100%; accuracy, 77%).
At 1-year follow-up, 6 patients (60%) experienced a primary outcome event. Compared to subjects with uneventful follow-up, patients with a primary outcome event had larger unipolar low-voltage zones (32.3 [6.1] cm2 vs. 20.7 [6.5] cm2, p=0.043) and bipolar dense scar areas (6.1 [2.3] cm2 vs. 1.8 [0.7] cm2, p=0.005), and after pooling mapping points from all patients, unipolar electrogram amplitude was moderately associated with primary outcome events (AUC: 0.65 [95% CI, 0.64-0.65]).

Conclusions
In CA, electrogram amplitudes are around the lower limit of normal, yet disproportionately low compared to the increased wall thickness. We found evidence that unipolar electrogram amplitude may be a quantitative marker of amyloid burden, possibly associated with adverse clinical outcomes.EVM and EMB in ATTR cardiac amyloidosisEVM and EMB in AL cardiac amyloidosis