bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of prosthetic heart valve-associated subclinical intravascular hemolysis on endothelium and cardiovascular system: a retrospective cohort study
Authors: Yamanturk Y , Ozdol C , Esenboga K , Uludag D M G 
Published: January 2025

Abstract

Background
Mechanical prosthetic heart valve implantation is a surgical treatment method used in the treatment of severe and symptomatic valvular disease. Regular follow-up of prosthetic valve functions, clinical and laboratory parameters is of great importance in patients who have undergone valve implantation. Chronic subclinical intravascular hemolysis is frequently seen in this patient group, but its management and long-term adverse effects are uncertain. In this study, it was aimed to determine the effects of subclinical hemolysis on the endothelium by comparing the frequency of clinical events such as pulmonary hypertension and atherosclerotic vascular events in patients with mechanical valves.

Methods
In this single-center, retrospective cohort, patients with functional mechanical prosthetic valves were evaluated. A total of 346 patients who underwent aortic and/or mitral valve replacement were included in the study according to the inclusion and exclusion criteria. The severity of mechanical intravascular hemolysis (MIH) in patients was evaluated based on serum lactate dehydrogenase (LDH) levels measured during follow-up after valve implantation. The study population was divided into two groups according to the median follow-up LDH value (fLDH) of 264.5 U/L: non-hemolysis/mild hemolysis (Group 1) and moderate hemolysis (Group 2). Study patients were evaluated for pulmonary hypertension (PHT) and major adverse cardiovascular events (MACE) during the retrospective follow-up period.

Results
The mean age of the study patients was 57.5±12.5 years, and the study population consisted of 65% male patients. The mean follow-up period of the patients was 9.4 years (±3.3). MACE (composite of non-fatal cerebrovascular event, myocardial infarction, new-onset arrhythmia, cardiovascular death, and elective coronary revascularization) were observed in 5.2% (n=18) of the study population. New-onset PHT was detected in 122 patients (35.3%) during follow-up period. When compared in terms of MACE, 1 event (0,6%) occurred in group 1, while 17 events (9,8%) occurred in group 2 (p&lt;0.001). In the multivariate analysis performed with logistic regression method to determine statistical significance of the parameters that stand out in terms of MACE prediction, fLDH value ≥ 265 and having DM were found to be statistically significant variables (fLDH; OR = 37.18, 95% CI: 3.24-426.35, p=0.004, DM; OR = 27.14, 95% CI: 1.22-601.72, p=0.037).

Conclusion
The results of the study show that subclinical intravascular hemolysis in prosthetic heart valve patients may be associated with the development of MACE and PHT. Evaluation of the severity of hemolysis, which can be evaluated by LDH level in routine clinical practice, can be a prognostic factor in this patient group and may contribute to the appropriate management and treatment of patients.
Baseline characteristics
Critical outcomes of study
Impact of preprocedural LA strain on outcome in severe MS
Authors: Yoon S , Kim D Y , Cho I S , Son J W , Choi K U , Kim I C , Seo J W , Shim C Y , Ha J W , Kim H S , Hong G R 
Published: January 2025

Abstract

Background
In patients with mitral stenosis (MS), left atrial (LA) remodeling is crucial for predicting outcomes in severe cases. In this study, we aimed to investigate whether LA longitudinal strain, a parameter of LA remodeling, is associated with adverse outcomes following mitral valve (MV) intervention in patients with severe MS.

Methods
We included patients with severe MS who underwent percutaneous mitral valvuloplasty (PMV) or MV replacement (MVR) from the long-term registry of Multicenter mitrAl STEnosis with Rheumatic etiology (MASTER) except for previous valvular surgery / intervention or coronary artery bypass surgery, at least moderate other valvular dysfunction, abnormal heart rate (&lt;50 or &gt;100 beats per minute). LA longitudinal strain for each patient was measured on pre-interventional echocardiography, and decreased LA strain was defined as the lower cut-off value on receriver operating characteristics analysis. The primary outcome was defined as all-cause mortality.

Results
Among 505 patients over a mean follow-up of 6.8 ± 4.9 years after MV intervention, 27 (5.3%) patients had experienced primary outcomes. Patients with decreased LA strain were older (61.1 ± 11.6 vs. 58.2 ±12.1 years, p=0.007), had more atrial fibrillation (97.6 vs. 79.5%, p&lt;0.001), underwent more MVR (89.4 vs. 82.8%, p=0.038), had higher mean diastolic pressure gradient (MDPG) and right ventricular systolic pressure, had lower left ventricular ejection fraction, and larger LA. Patients with decreased LA strain (&lt; 12.2%) revealed a poorer outcome than those with preserved LA strain (log-rank p&lt;0.001) (Figure 1).

Conclusions
Decreased LA strain on pre-interventional echocardiography was associated with an increased risk of all-cause death after MV intervention. Further prospective studies would be warranted to establish the risk stratification of MV intervention in patients with severe MS.
Figure 1. Kaplan-Meier analysis for primary outcomes according to the cut-off value of LA longitudinal strain in patients with severe MS.
Bioprosthetic valve function in carcinoid heart disease
Authors: Douglas S , Yuan M , Gue Y , Hodson J , Rooney S , Ashoub A , Muir A , Shah T , Dobson R , Steeds R P 
Published: January 2025

Abstract

Background
Carcinoid heart disease (CHD) is a complication of neuroendocrine tumours (NETs) with significant cardiovascular morbidity and mortality. It causes fibrotic damage to predominantly the right-sided valves with subsequent tricuspid valve (TV) and/or pulmonary valve (PV) regurgitation leading to right ventricular (RV) dilatation and dysfunction. The definitive treatment is valve replacement commonly using bioprosthetic valves. Case studies have suggested that bioprosthetic valve degeneration may occur due to ongoing carcinoid plaque deposition, but serial data is lacking.

Purpose
To assess the trajectory of prosthetic valve function on serial transthoracic echocardiography (TTE) in patients with CHD and determine the effect on long-term outcomes.

Methods
A retrospective multicentre observational cohort study including 81 patients who had valve replacement for CHD between 2005-2022. TTE data assessing prosthetic valve function (peak velocity, mean gradient, para/transvalvular regurgitation) and any associations with outcome were identified.

Results
Eighty-one patients (64±8 years, 56% male) were followed up for a median of 24 months (IQR: 8-48), during which there were 52 deaths, an estimated median survival of 32 months and 1-, 3- and 5-year survival rates of 69%, 48% and 38%, respectively.
The post-operative TTE was carried out at a median of 10 days (IQR: 7-47) after surgery. Of the 71 patients with available post-operative TTEs, 48 had &gt;1 TTE.
No significant trends were seen in TV parameters over time. PV peak velocity and mean gradient increased significantly over time (p=&lt;0.001).
Increasing TV peak velocities were significantly associated with shorter survival (p=0.008) and those with increases of &gt;5% per year had 5-year survival of 0% compared to 70% in those with decreasing by &lt;5% per year.
Increasing PV mean gradients were associated with longer survival (p=0.014), with 5-year survival 35%, 55%, and 91% for patients with increases of &lt;0, 0-2 and ≥2 mmHg per year, respectively. This may reflect RV remodelling and improved RV function.
There were 5 cases of prosthetic valve dysfunction, with only 1 needing re-intervention with transcatheter valve-in-valve procedure.
A cause of death was available for 39 patients, 46% were due to NET causes and 31% due to cardiac causes.

Conclusions
Our data suggests that bioprosthetic valve degeneration in CHD is uncommon. TV function did not change over time and PV velocities although increased with time did not lead to significant valve dysfunction.
The main cause of death was due to advancing NET disease. This raises the question as to whether transcatheter replacement may be a viable alternative in patients with CHD, who are facing a median survival of less than 3 years.
Assessing handheld echocardiography: can it reliably detect HVD and LVSD compared to comprehensive echo?
Authors: Laskar N , Melamed T , Singh H , Joshi A , Bhattacharyya S , Lloyd G 
Published: January 2025

Abstract

Introduction
Hand held echocardiography (HHE) and abbreviated protocols (AP) offer the opportunity to widen accessibility in the community. There remain doubts about the sensitivity of these techniques to detect clinically relevant pathology when compared with standard transthoracic echocardiography (TTE). We therefore compared TTE in patients identified with significant left sided valve disease (VHD) or Left ventricular systolic dysfunction (LVSD) for agreement between the two tests.

Methods
Patients attending a community detection program underwent HHE using an AP on the GE Vscan Extend platform. The AP included parasternal long axis view, four chamber view and three chamber view, with and without colour. Those adjudicated to have anything more than trivial disease underwent full TTE. All adjudications were made by an accredited sonographer. The two tests were examined for agreement .

Results
Of the 518 patients evaluated in the community program, 73 TTE’s were available for comparison with handheld AP studies, which were identified as having potentially significant HVD or LVSD. Among these there were 67 identified with HVD , 39 aortic (26 regurgitation, 13 stenosis or calcified )and 41 mitral (39 regurgitation, 2 stenosis).
Comparing both studies, aortic regurgitation (AR) had the highest kappa values (0.88), and showed high specificity (95%) and sensitivity (93%). The kappa value for MR was 0.37 with high sensitivity (95%) and low specificity (41%). This is primarily due to mild MR seen during initial HHE, which appeared to be trivial or absent at the time of TTE. Conversely, calcified mitral and aortic valves showed the lowest kappa values (0.48 and 0.54) and the lowest sensitivity and specificity (50% and 99%) and 86% and 89%. For HVD, TTE identified 39 studies for MR, 2 for MS or a calcified MV, 30 for AR and 13 for AS or calcified aortic valve (for MR, 6 were moderate/severe, for AR, 4 were moderate/severe and for AS, 2 were moderate/severe.
For those with suspected LVSD on HHE, 4 studies did not show LVSD on TTE. Additionally, 1 case of LVSD was newly identified on comprehensive echocardiography. The kappa for LVSD was 0.74 with a sensitivity of 90% and a specificity of 95%.
2 studies of AR on HHE were not detected on TTE, 20 cases of MR, 7 cases of AS/Calcified AV and 1 for MS/Calcified MV.

Conclusion
These results suggest that abbreviated echo using HHE shows variable reliability. The detection of impaired LV and aortic regurgitation are reliable with other lesions less so. Improved technology and machine learning based detection and analysis are likely to improve the technique.
Mitra-Clip results based on a single centre experience
Authors: Golinska-Grzybala K , Szosarczyk B , Stapor M , Trebacz J , Gackowski A 
Published: January 2025

Abstract

Background/Introduction
The uncertainty, whether TEER may improve clinical outcome was explored in two randomized trial targeting patients with symptomatic heart failure (HF), reduced left ventricular ejection fraction (LVEF) and moderate or severe mitral regurgitation (MR) – the MITRA-FR and COAPT trials. So far the COAPT trial is the only randomised trial that showed lower mortality in TEER group.

Purpose
The objective of this study is to compare the results of single Mitra-Clip centre with COAPT trial, with the focus on baseline population characteristic and 2-years overall and HF related mortality rates.

Methods
This study was designed as a retrospective cohort study that included 108 consecutively enrolled, sympomatic patients with moderate-to-severe and severe SMR and HF who underwent mitral valve repair with the MitraClip device (Abott) in John Paul II Hospital in Krakow, between 2014 and 2021. The exclusion criteria were cardiogenic shock, end-stage right or left heart failure or severe aortic valve disease.

Results
Among all patients 86 (79.6%) had fulfilled all Copat criteria. Initially one or two clips were implanted, and in over 90% of patients only mild and moderate (I or II degree) residual MR was observed in echocardiography at discharge and during follow up. In most most patients we also observed significant improvement in clinical status – before the procedure 86% patients were in NYHA class III and IV, and afterwards only 32% at discharge and 34% during follow-up. Death from any cause in the study population between 2016 and 2021 occurred in 16 % (n=31) and heart failure related death was observed in 10 % (n=16) patients.

Conclusions
Despite some differences between our study and COAPT trial, especially concerning patient selection, left ventricle structure and severity of MR, the overall 2 years mortality in our study was 16% vs. 29% in COAPT trial. This confirms that also some non-COAPT patients as well may contribute from TEER procedure, and beside the patients selection the procedural success significantly contributes to mortality benefit.
The SGLT-2 inhibitor empagliflozin improves myocardial strain,ejection fraction, reduces pro-inflammatory cytokines and H-FABP/troponin in models of anthracyline-induced cardiotoxicity
Authors: Quagliariello V , Paccone A , Palma G , Luciano A , Bruzzese F , Giacobbe I , Izzo F , Barbato M , Arianna R , Giordano V , Di Mauro A , Ferrara G , Berretta M , Maurea N I C O L A 
Published: January 2025

Abstract

Background
Empagliflozin (EMPA), a selective inhibitor of the sodium glucose co-transporter 2, reduced the risk of hospitalization for heart failure and cardiovascular death in type 2 diabetic patients in the EMPA-REG OUTCOME trial. Recent trials evidenced several cardio-renal benefits of EMPA in non-diabetic patients through the involvement of biochemical pathways that are still to be deeply analysed. We aimed to evaluate the effects of EMPA on myocardial strain of non-diabetic mice treated with doxorubicin (DOXO) through the analysis of NLRP3 inflammasome and MyD88-related pathways resulting in anti-apoptotic and anti-fibrotic effects.

Methods
C57Bl/6 mice were untreated (Sham, n = 6) or treated for 10 days with doxorubicin (DOXO, n = 6), EMPA (EMPA, n = 6) or doxorubicin combined to EMPA (DOXO-EMPA, n = 6). DOXO was injected intraperitoneally. Ferroptosis and xanthine oxidase were studied before and after treatments. Cardiac function studies, including EF, FS and radial/longitudinal strain were analysed through transthoracic echocardiography (Vevo 2100). Cardiac fibrosis and apoptosis were histologically studied through Picrosirius red and TUNEL assay, respectively and quantified through pro-collagen-1α1, MMP-9 and Caspase-3 expression. Tissue NLRP3, MyD88 and cytokines were also quantified before and after treatments through ELISA methods.

Results
In preclinical study, EMPA increased EF and FS compared to DOXO groups (p &lt; 0.05), prevented the reduction of radial and longitudinal strain after 10 days of treatment with doxorubicin (RS) 30.3% in EMPA-DOXO vs 15.7% in DOXO mice; LS - 17% in EMPA-DOXO vs - 11.7% in DOXO mice (p &lt; 0.001 for both). Significant reductions in ferroptosis, xanthine oxidase expression, cardiac fibrosis and apoptosis in EMPA associated to DOXO were also seen. A reduced expression of pro-inflammatory cytokines, NLRP3, MyD88 and NF-kB in heart, liver and kidneys was also seen in DOXO-EMPA group compared to DOXO (p &lt; 0.001). Troponin-T, B-type natriuretic peptide (BNP), N-Terminal Pro-BNP (NT-pro-BNP) and H-FABP were strongly reduced by EMPA during anthracycline therapy (p&lt;0.005 for all).

Conclusion
EMPA reduced ferroptosis, fibrosis, apoptosis and inflammation in doxorubicin-treated mice through the involvement of NLRP3 and MyD88-related pathways, resulting in significant improvements in cardiac functions. These findings provides the proof of concept for translational studies designed to reduce adverse cardiovascular outcomes in non-diabetic cancer patients treated with doxorubicin.
Mavacamten reduces left ventricular mechanical dispersion in hypertrophic obstructive cardiomyopathy
Authors: Ozbay B , Venkatesan N , Wong T C , Sade L E 
Published: January 2025

Abstract

Background
Mavacamten, a cardiac myosin inhibitor, reduces actin–myosin cross-bridge formation, has been shown to improve exercise capacity and symptoms in patients with hypertrophic obstructive cardiomyopathy (HOCM). However, its effects on left ventricular (LV) arrhythmogenic substrate remains unknown.

Aim
This study aimed to investigate the effects of mavacamten on LV remodeling and mechanical dispersion (MD).

Method
We consecutively reviewed 32 patients’ echocardiograms before and 2-12 months after mavacamten treatment. Speckle tracking echocardiography was performed, and the MD was calculated as the standard deviation of the time to peak strain of 17 segments. Patients were monitored for life threatening arrythmias (sustained ventricular tachycardia and sudden cardiac arrest).

Results
In 32 patients (mean age 60.5 ± 13.5 years, 11 female) LV outflow tract gradient reduced from 71 (44-125) mmHg to 10 (7-24) mmHg (p&lt;0.001) after mavacamten treatment. We observed significant decrease in LV ejection fraction (66±4% vs 59±5%, p&lt;0.001), LV deformation (global longitudinal strain (GLS); -14.3±3.2% vs -12.5±2.9%, p=0.038) and increase in end-systolic volume index (20±4 ml/m2 vs 26±6 ml/m2, p&lt;0.001). Despite impaired LV contractile function, MD improved significantly (87.1±26.6 ms vs 62.8±14.5 ms, p&lt;0.001). None of the patients experienced life-threatening arrhythmias during the follow-up period (median 8, range 2-21 months), despite the fact that 9% had a history of life-threatening arrhythmias before mavacamten treatment.

Conclusion
Mavacamten appears to improve MD despite decreasing LV contractile function. Further studies are warranted to investigate whether mavacamten is associated with reduced risk of life-threatening arrhythmias in patients with HOCM.
Validity of the left ventricular sphericity index in apical and basal aneurysms
Authors: Tomic S , Veljkovic S , Perunicic A , Djokic O , Radoicic D , Nikolic A , Bojic M 
Published: January 2025

Abstract

Introduction
Left ventricular aneurysm (LVA) correlates with changes in ventricular geometry related to the size and shape of the left ventricle (LV). On echocardiography it presents as global changes in the ventricle with reduced systolic function (ejection fraction - EF). Abnormal remodeling geometry of the ventricle leads to a more spherical shape and the manifestation of the spherity index (SI) as a parameter of abnormal geometric change (SI is the ratio of the short (S) to the long (L) axis of the heart measured from the apical four-chamber view). In healthy individuals and in ischemic dilated cardiomyopathy SI remains constant due to proportional enlargement of S and L.
The aim of this study was to evaluate the value of SI in the presence of apical left ventricular aneurysm (A-LVA) and basal aneurysm (B-LVA) using echocardiography, to determine the parameters that can influence SI, and their significance in daily clinical practice.

Material and Methods
The clinical study included 54 patients with post-infarction LVA (36 men, 18 women). The localization of the LVA was determined by echocardiography. A-LVA was formed near the apex of the LV, while B-LVA was in the basal segments of the LV walls. SI was determined in systole and diastole in the entire population and stratified among patients with A-LVA and B-LVA. LV EF was determined by Simpson's method.

Results
Study included 41 patients with A-LVA and 13 with B-LVA. The average SI value in diastole was 0.55 and in systole 0.47. Patients with A-LVA had an average SI value in diastole of 0.51 and in systole 0.44. Significantly higher SI values were found in the presence of B-LVA, with diastolic SI at 0.65 and systolic SI at 0.57 compared to A-LVA. The reason is that the long axis (L) values of the heart in both diastole and systole are lower in B-LVA compared to A-LVA.
LV EF in patients with A-LVA was 23.95%, and in B-LVA, it was 30.85%, with no significant difference. The difference in absolute values is due to apical aneurysms being larger compared to basal aneurysms, thus more significantly reducing the percentage of functional myocardium.

Conclusion
The results indicate that it is important to differentiate A-LVA and B-LVA by determining SI using echocardiography. SI is higher in B-LVA due to the reduction of the long axis (L). Surgical reconstruction of the left ventricle always addresses the reduction in length (L) compared to the reduction in width (S). Therefore, in surgical reshaping of the LV for B-LVA, it is crucial to maximally preserve the long axis (L) to maintain a more physiological shape.
Early cardiac mechanics abnormalities in patients with mitochondrial diseases
Authors: Lillo R , Meucci M C , Malara S , Primiano G , Servidei S , Lombardo A , Grandinetti M , Massetti M , Lanza G A , Limongelli G , Burzotta F , Graziani F 
Published: January 2025

Abstract

Background
Evidence about early cardiac mechanics abnormalities in patients with mitochondrial diseases (MDs) before overt cardiomyopathy is limited.

Purpose
To investigate whether conventional and advanced echocardiography can unveil signs of early cardiac involvement in MDs.

Methods
In this prospective study, we performed a comparative analysis of conventional and speckle tracking echocardiographic parameters between patients with genetically identified MDs and no overt cardiomyopathy vs controls matched for age, sex and cardiovascular risk factors. The Newcastle mitochondrial disease adult scale (NMDAS) was calculated, using a threshold of &gt;21 as indicator of high disease severity.

Results
We enrolled 24 MDs patients (50% males, mean age 47.2±14.3 years), the most prevalent mutation was the MT-TL1 m.3243A.G (37.5%). In MDs patients all dimensional echocardiographic parameters were similar to controls. Conversely, albeit normal, Tissue Doppler septal systolic (p=0.002) and early diastolic velocities (p=0.016) were significantly lower and E/e’ ratio was higher (p=0.032) in MDs. Moreover, LV-GLS was significantly reduced in MDs as compared to their counterparties (20.2±1.6 vs 22.6±1.5, p&lt;0.001). Similarly, LA reservoir and conduit strain were significantly lower in MDs (31.7±7.0 vs 35.9±6.6, p=0.038; 19.7±5.6 vs 23.1±6.0, p=0.049 respectively), while LA contractile strain was similar between the two groups. Lower values of LV-GLS were observed in patients with NMDAS&gt;21 vs patients with NMDAS≤21 (19.0±1.2 vs 21.0±1.3, p=0.001).

Conclusions
In patients with MDs and no overt cardiomyopathy Tissue Doppler and speckle tracking analysis unveil worse LV systolic and diastolic function indices as compared to controls. Reduced LV-GLS values were found especially in those with worse disease burden.