bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient characteristics and long-term outcomes in patients undergoing transcatheter aortic valve implantation in a failed surgical prosthesis versus in a native valve
Authors: Begun X , Butt J H , Kristensen S L , Weeke P E , Backer O D , Strange J E , Schou M , Kober L , Fosboel E L 
Published: November 2023

Abstract

Background
Valve-in-valve transcatheter aortic valve implantation (TAVI) is an increasingly used treatment for failed surgical aortic prosthesis, but data from clinical practice are limited.

Purpose
We examined patient characteristics and outcomes of patients undergoing TAVI in a surgical valve compared with patients undergoing TAVI in a native valve.

Methods
Patients undergoing TAVI from January 1, 2008, to December 31, 2020, were identified using Danish nationwide registries.

Results
In total, 6070 patients undergoing TAVI were identified; 247 (4%) patients had a history of SAVR (The valve-in-valve cohort). Patients with valve-in-valve-TAVI were younger but had a greater burden of cardiovascular comorbidities compared with patients with native-valve-TAVI. The cumulative 30-day risk of death was 2.4% (95% CI: 1.0% to 5.0%) in patients with valve-in-valve-TAVI and 2.7% (95% CI: 2.3% to 3.1%) in patients with native-valve-TAVI (Figure 1A). Correspondingly, the cumulative 5-year risk of death was 42.5% (95% CI: 34.2% to 50.6%) and 44.8% (95% CI: 43.2% to 46.4%), respectively. Within 30 days post-procedure, 11 (0.2%) patients with valve-in-valve-TAVI and 748 (13.8%) patients with native-valve-TAVI, had a pacemaker implantation. In multivariable Cox proportional hazard analysis, patients with valve-in-valve TAVI did not have a significantly different risk of rehospitalization from any cause compared to patients with native valve TAVI at 30 days (HR 0.80 [95% CI 0.58-1.10]) and at 5 years (HR 0.85 [95% CI 0.73-1.00]) (Figure 1B). Furthermore, in adjusted analysis, valve-in-valve-TAVI was not associated with significantly different risk of death at 30 days (Hazard ratio (HR)= 0.98, 95% CI 0.43-2.22) and 5 years (HR=0.81, 95% CI 0.64-1.03) compared with native-valve-TAVI.

Conclusions
TAVI in a failed surgical aortic prosthesis as compared to TAVI in a native valve, was not associated with significantly different short- and long-term mortality. Although these findings to some extent reflect thorough patient selection, valve-in-valve-TAVI appears to be a safe procedure.
The impact of resting heart rate on adverse outcomes and haemodynamic progression of aortic stenosis
Authors: Courtney W , Budgeon C , Giudicatti L , Strange G , Playford D , Ihdayhid A , Schultz C , Hillis G S 
Published: November 2023

Abstract

Introduction
A high resting heart rate (RHR) is an established risk factor for cardiovascular disease, adverse cardiac events, accelerated calcification in coronary artery disease and carotid stenosis, and increased aortic valve calcification in patients with and without a confirmed diagnosis of aortic stenosis (AS). Aortic valve calcification is the most common precursor to AS and is associated with significantly faster disease progression.
There are few studies exploring the effects of RHR on the progression of AS, the development of severe stenosis, and the risk of complications and death.

Purpose
We hypothesised that an elevated RHR would be associated with poorer outcomes and more rapid haemodynamic disease progression in patients with AS and tested this in a large cohort of patients without severe disease.

Methods
Using the National Echocardiography Database of Australia (NEDA) we undertook a retrospective observational study on patients without severe AS, a bicuspid aortic valve or prior aortic valve replacement. The association between baseline RHR and time to the composite primary endpoint of severe AS, aortic valve replacement or cardiovascular death was tested using Cox proportional hazards regression. In addition, the relationship between baseline RHR and the components of this composite was investigated.
Subsequently, the relationship between annualised AS progression rate, defined as change in standard indices of AS severity (maximal jet velocity [Vmax], mean pressure gradient [MPG], and aortic valve area [AVA]), and RHR were analysed using general linear models.

Results
The initial study cohort comprised 55 585 individuals: 54% male, mean age 63 years and median baseline RHR 70 bpm. The composite primary endpoint, reached by 7 434 patients, was independently associated with RHR (hazard ratio [per 10bpm increase], 1.04; 95% CI, 1.02-1.05; p &lt; 0.001). RHR was also independently associated with time to developing severe AS (hazard ratio [per 10bpm increase], 1.06; 95% CI, 1.01-1.12; p = 0.017) and cardiovascular death (hazard ratio [per 10bpm increase], 1.04; 95% CI, 1.02-1.06; p &lt; 0.001). The event rate was significantly higher in patients with a RHR of at least 70 bpm (the median RHR) compared to those with an RHR less than 70 bpm.
In addition, RHR was independently associated with rate of change of each individual measurement index of AS severity including Vmax (β = 0.65 cm/s/year [per 10 bpm increase]; p &lt; 0.001), MPG (β = 0.05 mmHg/ year [per 10 bpm increase]; p&lt;0.001), and AVA (β = -0.01 cm2/year [per 10 bpm increase]; p &lt; 0.001).

Conclusions
RHR is independently associated with adverse clinical outcomes and haemodynamic progression of AS in patients without severe disease. Future randomised controlled trials should investigate the effect of lowering RHR on clinical endpoints and progression of AS.
LGE in CMR and outcomes in cardiac sarcoidosis
Authors: Dhaliwal S , Al-Sadawi M , Aslam F , Kim P , Gier C , Henriques M , Singh A , Almasry I , Rashba E , Fan R 
Published: November 2023

Abstract

Background
Late-gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is a predictor of adverse events in patients with cardiac sarcoidosis (CS). This meta-analysis evaluated the correlation between LGE and mortality, ventricular arrhythmias (VA), sudden cardiac death (SCD), and heart failure (HF) outcomes.

Methods
A literature search was conducted for studies reporting the association between LGE in CS and the study endpoints. The endpoints are: mortality, VA and SCD, and HF hospitalization. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. The minimum follow-up duration was one year.

Results
A total of 17 studies and 1,915 CS patients (595 with LGE vs 1,320 without LGE) were included; mean follow-up was 3.3 years (ranging between 17 to 84 months). LGE was associated with increased all-cause mortality (OR 6.05, 95% CI 3.16-11.58; P&lt;0.01), cardiovascular mortality (OR 5.83, 95% CI 2.89-11.77; P&lt;0.01) and VA and SCD (OR 16.48, 95% CI 8.29-32.73; P&lt;0.01). The presence of LGE in the right ventricle is associated with higher risk of VT (OR 6.11, 95% CI 1.14-32.68; P 0.035). LGE was associated with an increased risk of HF hospitalization (OR 17.47, 95% CI 5.54-55.03; P&lt;0.01).

Conclusion
LGE in CS patients is associated with increased mortality, VA and SCD, and HF hospitalization during long-term follow up. The presence of LGE in the right ventricle is associated with higher risk of VT.
Clinical outcomes after transcatheter aortic valve implantation in patients older than 90 years of age
Authors: Ehara N E , Taniguchi T T , Kim K K , Toyota T T , Okada T O , Kinoshita M K , Kobori A K , Sasaki Y S , Murai R M , Furukawa Y F 
Published: November 2023

Abstract

Background
The prevalence of severe aortic valve stenosis is increasing due to the prolonged life expectancy. Transcatheter aortic valve implantation (TAVI) is a minimally invasive treatment for severe aortic stenosis that is particularly attractive for elderly patients. However, there are limited data evaluating clinical outcomes in patients older than 90 years of age undergoing TAVI.

Purpose
The aim of this study was to compare in-hospital clinical outcomes between nonagenarians undergoing TAVI versus patients younger than 90 years of age and to evaluate 2-year clinical outcomes of all-cause death, stroke, and hospitalization for heart failure among nonagenarians.

Methods and results
A total of 57 nonagenarians (12%) and 418 patients younger than 90 years of age (mean 82.5 years of age) undergoing TAVI from February 2014 to February 2023 in our institution were included. Among nonagenarians, 83.7% had hypertension, 8.9% had diabetes mellitus, 17.9% had atrial fibrillation, and 10.5% had malignant diseases. Self-expanding valves were more often implanted in nonagenarians (43.9% vs. 29.0%, p=0.02) and nonagenarians were likely to undergo transfemoral TAVI (89.5% vs. 84.0%, p=0.28) Mean hospitalization days after TAVI was almost similar between nonagenarians and patients younger than 90 years of age (12.5 days vs. 12.8 days, p=0.90). Rates of in-hospital disabling stroke (3.6% vs. 1.8%, p = 0.38) and need for permanent pacemaker implantation (8.8% vs. 5.7%, p = 0.37) tended to be higher in nonagenarians. The rate of major vascular complication was almost similar between two groups (3.5% vs. 4.8%, p=0.66). The 2-year survival rates of all-cause death, stroke and hospitalization for heart failure, composites of all-cause death and stroke and composites of all-cause death, stroke and hospitalization for heart failure among nonagenarians were 86.3%, 87.5%, 88.9%, 80.6% and 74.0%, respectively. During an average 1.6-year follow-up period, nine deaths occurred among nonagenarians. Of those, seven patients died from non-cardiovascular causes.

Conclusion
In this single center analysis, clinical outcomes in nonagenarians undergoing TAVI were acceptable compared with patients younger than 90 years of age.
The prevalence and prognostic impact of aortic valve diseases in heart failure with mildly reduced ejection fraction
Authors: Schupp T , Abel N A , Reinhardt M R , Schmitt A S , Pumpe K P , Weidner K W , Akin I A , Behnes M B 
Published: November 2023

Abstract

Objective
This study aims to investigate the prevalence and prognostic value of aortic valve diseases in patients hospitalized with heart failure with mildly reduced ejection fraction (HFmrEF).

Background
Limited data regarding the prognostic impact of aortic valve diseases in patients with HFmrEF is available.

Methods
A large retrospective study was used including all consecutive hospitalized patients with HFmrEF (i.e., left ventricular ejection fraction (LVEF) 41 – 49%) from 2016 to 2022 according to current European guidelines. The prognostic impact of moderate to severe aortic valve stenosis (AS) and aortic valve insufficiency (AI) was compared to patients without (i.e., non-AS and non-AI, respectively). The primary endpoint was the first heart-failure related re-hospitalization at 3 years. Secondary endpoints comprised amongst others in-hospital mortality. Kaplan-Meier, uni- and multivariable Cox regression analyses were applied for statistics.

Results
800 consecutive patients with HFmrEF were included. The prevalence of AS was 10% (moderate 6% and severe 4%) and AI 8% (moderate 7% and severe 1%). The risk of first heart-failure related hospitalization was not significantly affected by the presence of AS (14% vs. 8%; log rank p=0.092; HR= 1.727; 95% CI 0.908 - 3.284; p=0.096), however, HFmrEF patients with moderate to severe AI were associated with an increased risk of heart-failure related re-hospitalization compared to patients without (18% vs. 8%; log rank p=0.010; HR= 2.270; 95% CI 1.193 - 4.317; p=0.012). Even after multivariable adjustment, the risk of heart failure related re-hospitalization was still significantly higher in patients with moderate to severe AI (HR= 2.022; 95% CI 1.030 - 3.969; p=0.041). Finally, patients with moderate or severe AS and patients with moderate or severe AI revealed no significant difference of in-hospital mortality (4% vs. 3%; p=0.807 and 3% vs. 3%; p=0.946).

Conclusions
In patients hospitalized with HFmrEF between 2016 and 2022, patients with moderate to severe AI – but not AS – had a higher risk of heart failure related re-hospitalization at 3 years.
Association of late-gadolinium enhancement on cardiac magnetic resonance with cardiovascular outcomes and mortality in patients with aortic stenosis
Authors: Tao M , Moussa S , Sheng S , Dhaliwal S , Tam E , Goldschmidt M , Mann N 
Published: November 2023

Abstract

Background
Late-gadolinium enhancement (LGE) on cardiac magnetic resonance has been associated with increased risk of adverse events in various clinical settings. This association in patients with aortic stenosis is not well established.

Purpose
This meta-analysis assessed the association between LGE on CMR with all-cause moratlity, cardiovascular (CV) mortality, and major adverse cardiovascular events (MACE) in patients with aortic stenosis.

Methods
A literature search was conducted for studies reporting the association between LGE in aortic stenosis and the primary endpoint of all-cause mortality. Secondary endpoints included CV mortality and MACE. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. The minimum duration of follow-up was 12 months.

Results
A total of 11 studies and 2527 patients (1279 with LGE vs 1248 without LGE) were included; mean follow up was 30 months (ranging between 12 to 52 months). LGE is associated with increased risk of all-cause mortality on long-term follow-up (odds ratio 2.87, 95% confidence interval 2.03-4.04; P&lt;0.01). Heterogeneity was low-moderate: Chi2= 12.28, df8, I2 =35%. Subgroup analysis of only patients who underwent aortic valve replacement demonstrated that LGE is associated with increased risk of all-cause mortality on long-term follow-up (OR 2.49, 95% CI 1.94-3.20; P&lt;0.01).
For secondary endpoints, LGE was not associated with a statistically significant increase in risk of CV mortality or MACE, however there is a trend toward increased risk (OR 2.43, 95% CI 0.95-6.23; P = 0.06; OR 2.33, 95% CI 0.86-6.28; P=0.09).

Conclusions
Our results suggest that LGE is associated with increased risk of all-cause mortality in patients with aortic stenosis regardless of whether aortic valve replacement is performed. LGE was not associated with a statistically significant increased risk of CV mortality or MACE, however additional high quality prospective studies are needed to further evaluate these endpoints.
The serum haemoglobin to creatinine ratio predicts 1-year adverse outcomes in patients undergoing transcatheter aortic valve implantation
Authors: Ikuta A , Oka T , Matushita S , Kadota K , Komiya T , Fuku Y 
Published: November 2023

Abstract

Background
The baseline serum haemoglobin and renal function are both important predictors of adverse outcomes in patients with severe aortic valve stenosis (AS) after transcatheter aortic valve implantation (TAVI), there are no reports that has examined the correlation between those combined data and adverse outcomes, however.

Purpose
In this study, we examined whether the combined index of anaemia and renal failure is predictive of 1-year prognosis in patients undergoing TAVI.

Methods and Results
This study is a retrospective, single-centre, and observational study. Between January 2015 and June 2021, 469 consecutive patients with severe AS underwent TAVI in our hospital. After excluding dialysis patients, 458 patients were analysed in this study. Patients were categorized into three groups (tertiles) according to their value of haemoglobin to creatinine (Hgb/Cr) raio. The Hgb/Cr ratio was calculated from the serum haemoglobin and creatinine on the day before TAVI. The primary and secondary clinical outcomes measure was defines as all-cause mortality and heart failure hospitalization at 1-year after TAVI.

Results
The mean age was 85.5 ± 4.8 years, and the mean the Society of Thoracic Surgeons score (STS) was 7.0 ± 4.7, the mean serum creatinine, eGFR and haemoglobin were 0.97 ± 0.47 mg/dL, 49.1 ± 21.3 mL/min/1.73 m2 and 13.8 ± 5.9 g/dL, respectively. The procedural success rate and length of admission day after TAVI were equivalent for tertile 1, tertile 2, and tertile 3 groups. In-hospital mortality was higher in tertile 1, tertile 2, and tertile 3 groups, in that order (8.7% vs. 2.6% vs. 0%; p&lt;0.01). Cumulative incidences all-cause mortality and heart failure hospitalization rate were significantly better in tertile 1, tertile 2, and tertile 3 groups, in that order, respectively (16.9% vs. 7.2% vs. 2.0%; p&lt;0.01, 10.7% vs. 3.4% vs. 0.7%; p&lt;0.01, respectively). The index of the area under curve of Hgb/Cr ratio for all-cause mortality and heart failure hospitalization at 1-year after TAVI were 0.73 and 0.73, respectively. The cut-off values were 10.1 for all-cause mortality (odds ratio: 4.78; 95% confidence interval; 2.43-9.74; p&lt;0.01) and 10.4 for heart failure hospitalization (odds ratio: 5.3; 95% confidence interval; 2.21-14.1; p&lt;0.01).

Conclusions
The Hgb/Cr ratio was associated with all-cause mortality and heart failure hospitalization in patients who underwent TAVI. Calculation of Hgb/Cr ratio on the day before TAVI could be useful for predicting adverse outcomes at 1-year in patients undergoing TAVI.
Comorbidity is the driver of adverse outcomes in patients with moderate aortic stenosis
Authors: Sen J , Wahi S , Marwick T 
Published: November 2023

Abstract

Background
Recent studies showed moderate aortic stenosis (AS) was associated with adverse cardiovascular outcomes. Ongoing studies are addressing whether moderate AS may benefit from early transcatheter aortic valvular replacement (TAVR). However, a high comorbidity burden is common, and may be the main driver of poor outcomes.

Purpose
We aimed to identify clusters of patients with moderate AS based on comorbidity and echocardiographic profiles.

Methods
Unsupervised clustering algorithms (including K means, partition around medoids (PAM), hierarchical clustering, Density-Based Spatial Clustering of Applications with Noise (DBSCAN), and Hierarchical Density-Based SCAN (HDBSCAN)) of comorbidities, demographics and echocardiographic parameters were conducted in patients diagnosed with moderate AS [aortic valvular area (AVA) 1-1.5 cm2 or peak velocity (Vmax) 3-4 m/s or dimensionless severity index (DSI) 0.25-0.5]. Cumulative hazard plots and Cox proportional hazards regression models were used to assess the difference in time to cardiac death, heart failure hospitalization or aortic valvular intervention between the clusters.

Results
Four distinct clusters were identified AS patients (n=2,409) using PAM algorithm. The highest risk of cardiovascular outcomes was found among patients in Cluster 4 (Comorbid cluster), followed by Cluster 3 (Risk factors cluster), and Cluster 2 (Valve morphology cluster) (Table 1, Figure 1). Comparing cardiac death outcomes between patients treated with TAVR vs. no TAVR in each cluster revealed that TAVR was of most benefit in Cluster 2 (HR = 0.05, 95% CI: 0.01-0.34, p=0.002).

Conclusions
Multiple comorbidities are the key driver of worse outcomes in patients with moderate AS, which can affect treatment outcomes from TAVR. Thus, careful attention to the comorbidities is imperative in the management of patients with moderate AS.Table 1.Characteristics of 4 clustersFig 1.Cumulative Hazard Plot
Association of aortic valve size with the degree of aortic valve calcification in patients with severe aortic stenosis
Authors: Mousavi R A , Lamm G , Will M , Hoebart P , Kammerlander A A , Schwarz K , Vock P , Hoppe U , Mascherbauer J 
Published: November 2023

Abstract

Background
The development and progression of aortic valve calcification (AVC) is a major contributor to the severity of aortic stenosis (AS). Currently, the 2021 ESC/EACTS Guidelines recommend the use of the Agatston AVC score to predict the likelihood of severe AS in patients with unclear echocardiographic AS severity. It has been shown that AS in women is associated with less AVC, thus lower AVC thresholds for the diagnosis of severe AS in women are recommended. It has furthermore been demonstrated that women generally have smaller hearts. However, whether small aortic valve (AV) size, independent from sex, is associated with less AVC in patients with severe AS has not been explored.

Purpose
The aim of this study was to assess the association of AV dimension and the degree of AVC in severe AS.

Methods
AVC was assessed on computed tomography using the Agatston score in consecutive patients with severe AS. AV diameter and indexed AV annulus area adjusted for body surface area were measured. To analyze the association with AVC, Spearman rank correlation as well as multivariate linear regression models adjusted for age, sex, left ventricular ejection fraction and cardiovascular risk factors were performed.

Results
In total 446 patients (mean age 81±6 years, 45% female) were included. Median Agatston Score was 2949 AU [2135-3986] in men and 1755 AU [1303-2571] in women. Mean AV diameter was 24±2mm and mean indexed annulus area was 248±43mm2.
We observed a significant correlation between AV Agatston score and AV diameter (r=0.6; p&lt;0.001 Figure 1 Panel A) as well as between AV Agatston score and indexed annulus area (r=0.5; p &lt;0.001; Figure 1 Panel B). On multivariate analysis AV diameter (β=273; p&lt;0.001), indexed annulus area (β=13; p&lt;0.001) and sex (β=396; p&lt;0.001) were independently associated with AVC by the Agatston score. In addition, separate regression analyses in men and women showed a significant association of AV diameter (β(men)=265; β(women)=275; both p&lt;0.001) and indexed annulus area (β(men)=13; β(women)=11; both p&lt;0.001) with the AV Agatston score. Hypertension, dyslipidemia, diabetes mellitus, smoking and chronic kidney disease showed no statistically significant association with the amount of AVC.

Conclusion
Our results indicate that patients with severe AS and larger AV dimensions present with more AVC on Agatston scoring, independent from sex. From surgical data, it is known that smaller aortic bioprostheses cause higher gradients, consequently we hypothesize here, that less calcification is required in small valves to cause significant narrowing. Thus, AVC cut-offs for the diagnosis of AS should be indexed for AV size rather than sex.