bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic implications of papillary muscle delayed hyperenhancement in dilated cardiomyopathy patients
Authors: Beijnink C , Raafs A G , Vos J L , Rodwell L , Heymans S R B , Nijveldt R 
Published: November 2023

Abstract

Background
Similar to left ventricle (LV) myocardial delayed hyperenhancement (HE), papillary muscle delayed hyperenhancement (papHE) at cardiac magnetic resonance (CMR) may indicate fibrotic or infiltrative processes. The prevalence in patients with non-ischemic dilated cardiomyopathy (DCM) and its impact on outcome are unknown.

Objectives
We aimed to determine the prevalence of papHE in an outpatient DCM cohort with longitudinal follow-up.

Methods
From the Maastricht Cardiomyopathy Registry, we included 528 consecutive patients who underwent Late Gadolinium Enhancement (LGE) Cardiac Magnetic Resonance imaging (CMR), and both papHE and papillary tip delayed hyperenhancement (tipHE) were assessed. The primary outcomes were all-cause mortality, sudden cardiac death, life-threatening arrhythmia, and hospitalization for heart failure (HFH). Unadjusted Kaplan Meier curves were constructed and compared using log-rank tests. PapHE was related to outcomes, using univariable and multivariable Cox regression analysis, correcting for clinical covariables (age, sex, and LV ejection fraction). In a second model, we corrected for myocardial HE, on top of the covariables included in the first model. Mitral valve regurgitation was assessed during follow-up echocardiography in 409 patients (77%).

Results
Three hundred and twenty five patients (62%) had tipHE and 131 patients (25%) had papHE. The median follow-up duration was 5.6 (IQR 3.5-9.0) years. PapHE was associated with all-cause mortality (HR=1.76, 95% CI 1.04-2.97), sudden cardiac death (HR=2.23, 95% CI 1.10-4.54) and HFH (HR=2.42, 95% CI 1.16-5.06), but not with life-threatening arrhythmias, after correction for clinical covariables. The presence of isolated tipHE was not associated with adverse outcomes. The correlation of myocardial HE was stronger than that of papHE, specifically with sudden cardiac death (HR=2.40, 95% CI 1.10-5.23 for myocardial HE) and life-threatening arrhythmias (HR=2.97, 95% CI 1.04-8.46 for myocardial HE). Additional correction for myocardial HE rendered the correlation between papHE and the studied outcomes insignificant. Finally, papHE did not correlate to mitral regurgitation.

Conclusions
PapHE is present in 25% of DCM patients. The presence of papHE correlated with sudden cardiac death and HFH, still myocardial HE remains a stronger predictor. Our results support the incorporation of myocardial HE in implantable cardioverter-defibrillator guideline recommendations. Future studies should investigate if the addition of PapHE helps to improve such guidelines further.
Prevalence of pulmonary hypertension in aortic regurgitation and its influence on outcomes
Authors: Ratwatte S , Playford D , Stewart S , Strange G , Celermajer D 
Published: November 2023

Abstract

Background
Pulmonary hypertension (PHT) is known to complicate left heart diseases (LHD) including left sided valvular pathologies such as aortic regurgitation (AR). However, there is a paucity of data on the prognostic importance of PHT in AR patients.

Purpose
We aimed to describe the prevalence and prognostic importance of PHT in adults with "isolated" ≥ moderate AR.

Methods
In this retrospective study, we analysed the National Echocardiography Database of Australia (data from 2000-2019). Adults with an estimated right ventricular systolic pressure (eRVSP), left ventricular ejection fraction (LVEF) &gt;50%, with moderate or greater AR and without severe aortic stenosis or prior aortic valve replacement, were included (n= 8392). These subjects were then categorised according to their eRVSP. The relationship between PHT severity and mortality outcomes were evaluated (median follow-up of 3.1 years, interquartile range 1.5-5.7 years).

Results
Subjects were aged 74±14 years and 58.4% (4901) were female. Overall, 1417 (16.9%) had no PHT (eRVSP&lt;30.00mmHg); and 3253 (38.8%), 2249 (26.9%), 893 (10.6%) and 580 (6.9%) had borderline (30.00-39.99mmHg), mild (40.00-49.99mmHg), moderate (50.00-59.99mmHg) or severe PHT (&gt;60.00mmHg), respectively. Mean eRVSP was slightly higher in females than males (41±13 vs 39±12mmHg, p&lt;0.0001) and increased with age in both sexes. A typical phenotype of "left heart disease" was evident with E:e’ and the proportion of patients with RV functional impairments increasing progressively, from no PHT to severe PHT (p&lt;0.0001, for all). After adjustment for age and sex, the risk of long-term mortality increased as eRVSP increased (adjusted hazard ratio (aHR) 1.20, 95% confidence interval 1.06-1.36 in borderline PHT, to aHR3.32, 95%CI 2.85-3.86 in severe PHT) (Figure 1). These trends were maintained on a sensitivity analysis excluding patients with ≥moderate mitral regurgitation (n=6753), though only became significant from mild PHT onwards (aHR 1.13, 95% CI 0.98-1.30 in borderline PHT, to aHR3.51, 95%CI 2.94-4.18 in severe PHT). Using decile distribution of eRVSP a mortality threshold seen from mild PHT onwards (eRVSP 41.36-44.15mmHg; aHR1.41, 95%CI1.17-1.68) (Figure 2).

Conclusions
In patients with ≥moderate AR, PHT is associated with a progressive risk of mortality, even in those with mild PHT.Adjusted Risk for All-Cause MortalityThreshold for Mortality
Sex-specific differences in patients with significant aortic regurgitation
Authors: Gonzalez Gomez A , Monteagudo J M , Garcia Martin A , Hinojar R , Casas E , Antonana-Ugalde S , Martinez-Vives P , Ramos P , Martinez-Moya R , Jimenez Nacher J J , Zamorano J L , Fernandez-Golfin C 
Published: November 2023

Abstract

Background
Significant aortic regurgitation (AR) leads to left ventricular (LV) remodelling and poor outcomes if untreated; however, data on sex-differences in the setting of significant AR is scare.

Purpose
To examine contemporary clinical and echocardiographic differences between men and women with significant chronic AR.

Methods and results
Consecutive patients with significant AR evaluated in a heart valve clinic following a comprehensive clinical and imaging protocol were included. Comparison was performed between genders. A total of 206 patients with significant AR were included (130 grade III, 76 grade IV AR) (mean age 69 years, 49% women). Mean follow-up was 3.7 years. Women showed similar comorbidities, but were older (66.5 vs 71.4, p=0.017), and more symptomatic. Women were smaller in terms of height, weight and surface area, showing significantly smaller volumes and diameters (LVEDD 52 ± 6.2 mm men vs 47.0 ±6.7 mm women, p&lt;0.001). However, when diameters were normalized, no significant differences were seen between men and women. Hospital admissions due to heart failure and number of surgeries were not significantly different between genders.

Conclusion
In patients with significant AR, indication for intervention in guidelines is based on the same values for both men and women. However, women were more symptomatic and showed significantly smaller volumes and diameters. Indexed values should be considered in decision making taking into account differences in gender.
Arrhythmic form of mitral valve prolapse: presentation, risk stratification and management
Authors: Elgharably Y , Frati G , Mahrous M R , Asfour A , Heikal A , Kazamel G 
Published: November 2023

Abstract

Background
Mitral valve prolapse (MVP) is a common finding that has been considered as benign condition for a long time. However, some anatomic forms have been recently recognized to be associated with life-threatening ventricular arrhythmia and sudden cardiac death (SCD), recently known as arrhythmic MVP (AMVP).

Objectives
This study is aiming to clinically characterize and risk stratify patients with malignant phenotype of MVP of high risk for ventricular arrhythmia which may lead to SCD. We aim to explore characteristics and assess potential markers for MVP induced ventricular arrhythmia that might need monitoring and follow up with medical or invasive treatment as implantable cardioverter-defibrillator, catheter ablation or even surgical repair.

Methods
A prospective cohort study of 45 (age 35±8, 29 females), consecutive patients with MVP and/or mitral annular disjunction (MAD) and comprehensive clinical arrhythmia on resting electrocardiography (ECG) or 48-hours Holter monitoring , Doppler echocardiography and contrast based cardiac magnetic resonance (CMR) characterization were identified. Patients were followed-up for a period of maximum one year to identify any further management needed.

Results
Frequent ventricular arrhythmia was evidently seen associated to MVP (69% with at least ventricular ectopy ≥5%), as well as complex ventricular arrhythmia (31% with sustained or non-sustained ventricular tachycardia ) P&lt;0.001. AMVP was strongly associated with premature ventricular contractions (PVCs) having Right bundle branch block (RBBB) morphology on ECG and late gadolinium enhancement (LGE) on CMR (all p&lt;0.05). Furthermore, it was shown to be associated with bileaflet prolapse and higher left ventricular volumes, however not statistically significant. On Follow-up, Out of 36 patients with ventricular arrhythmia, 64% were controlled on medical anti-arrhythmic and some others were referred either for ablation after worsening of symptoms despite of medical treatment (27.8%), implantable cardioverter-defibrillator device for secondary VT prophylaxes (5.6%) or surgery (2.8%) due to progression in mitral regurgitation severity and deterioration of symptoms.

Conclusion
In this small cohort study, characteristic form of MVP was found to be associated with ventricular arrhythmia more common in the form of frequent PVCs and less common in the complex form. Although majority of patients were controlled on medical treatment, few patients required further invasive management despite of medical treatment . Thus, arrhythmia associated with a special form of MVP could be life threatening and needs close monitoring, long follow-up and proper management approach to prevent SCD. Large prospective studies with comprehensive approach and long term follow up is pivotal. CMR T1 mapping and electro anatomical CARTO mapping could help in better detection and proper defining of arrhythmia substrate in future studies.AMVP illustration
M-mode proximal iso-velocity surface area-based dynamics of instantaneous flow rate and its implications for degenerative mitral regurgitation quantification
Authors: Ge Z , Hu C , Zhao S , Tian F , Dong L , Wang Y , Chen H , Kong D , Pan C , Shu X , Ge J 
Published: November 2023

Abstract

Background
Instantaneous flow rate of degenerative mitral regurgitation (DMR) showed dynamic changes. However, inconsistencies exist across literatures about the timing of measurements for flow convergence in proximal iso-velocity surface area (PISA) calculation. While the 2017 ASE guideline suggested measurement of PISA radius and velocity should be performed at simultaneous moments of the regurgitant phase (PISApair), a few studies used max PISA radius (PISAmax) to calculate regurgitant volume and showed poor agreement with cardiac magnetic resonance (CMR) results.

Purpose
This study aimed to compare the above methods with M-mode PISA, thus to investigate the effect of instantaneous flow rate on the agreement of the diagnosis of severe mitral regurgitation (sMR).

Methods
We prospectively enrolled 75 DMR patients with a) at least mild MR, b) single and non- eccentric MR jet. Regurgitant volume (RVol) was calculated using three PISA methods, respectively. In 25 patients who received CMR, RVol was calculated using volumetric method. The correlation and agreement of RVol among three PISA methods and CMR were compared. The agreements of the diagnosis of sMR between PISA methods and ASE multi-parameter algorithm were analyzed using Cohen’s kappa analyses.

Results
The curve of instantaneous flow rate of DMR displayed unimodal pattern with at the mid-late systolic phase. The correlation of RVol between PISA methods and CMR were moderate for PISAmax (r = 0.77) and strong for PISApair and M-mode PISA ( r = 0.80 and 0.87, respectively). PISAmax derived RVol was larger than that of CMR (69.1 ± 37.1 mL versus. 49.0 ± 29.0 mL, P = 0.002). Compared to the ASE algorithm, only PISAmax significantly overestimated the percentages of sMR (74.7% versus 54.7%, P =0.010), but both PISAmax and PISApair showed moderate consistency (Kappa coefficient (k): 0.496 and 0.525, respectively). A strong agreement was found between M-mode PISA and the ASE algorithm with regard to the diagnosis of sMR (k = 0.867, P &lt;0.05).

Conclusion
Based on the unimodal pattern of instantaneous flow rate in DMR patients, PISAmax significantly overestimated RVol and may expose a significant proportion of DMR patients to MR surgery.
Hemodynamic implications of transcatheter tricuspid valve repair in HFpEF Patients - HERACLES-HFpEF
Authors: Kresoja K P , Rommel K P , Rosch S , Kister T , Schoeber A , Roeder M V , Schlotter F , Besler C , Unterhuber M , Gutberlet M , Thiele H , Lurz P 
Published: November 2023

Abstract

Background
Patients with severe tricuspid regurgitation (TR) and heart failure with preserved ejection fraction (HFpEF) have been suggested to respond favourably to transcatheter edge-to-edge tricuspid valve repair (TEER), but the mechanisms remain poorly understood.

Purpose
The aim of this study was to investigate the pathophysiological implications of TV-TEER in patient with HFpEF and severe TR.

Methods
This was a prospective interventional single arm trial that included 20 HFpEF patients with invasive evidence of increased filling pressures (i.e. left-ventricular enddiastolic pressure [LVEDP] &gt;15 mmHg and preserved ejection fraction i.e. LVEF ≥50%) at a single centre. All patients received transthoracic echocardiography and cardiac magnetic resonance imaging (MRI) immediately before and 1-month after TV-TEER. During the TV-TEER procedure LV pressure-volume loops were recorded by using a conductance catheter (Figure 1A). The primary outcome was the periprocedural change in the ratio of LVEDP to left-ventricular end-diastolic volume (LVEDV) as surrogate for preload independent diastolic function. The secondary outcomes included single-beat estimated end-diastolic pressure volume-relationships (EDPVRs), and LV distending pressure (calculated as LVEDP-mean right atrial pressure) as well as changes at 1-month in LVEDV and right ventricular EDV (RVEDV) as surrogates for ventricular interdependence.

Results
Between 02/2021 to 12/2022 20 patients (median age 78, IQR 72 to 83 years, 65% ♀) were included in the prospective HERACLES-HFpEF trial. All patients successfully underwent TV-TEER with a median TR grade reduction of 2 (IQR 2 to 1) on a five-grade scaling. Despite a periprocedural increase in LVEDV (p&lt;0.001), LVEDP remained stable after successful TV-TEER (p=0.12). This led to a significant reduction of the primary endpoint LVEDP/LVEDV (p=0.001, Figure 1B).
Load independent diastolic function improved with a rightward shift of the EDPVR (Figure 1C). LV distending pressure increased implying stronger LV distension in the restricted pericardial space. At one-month follow-up MRI (available for 17 patients) LVEDV increased (∆ median +5 ml, p=0.017), while RVEDV decreased (∆ median -17 ml, p=0.031). Interestingly, there was a significant inverse correlation between the change of LVEDV and RVEDV, again implying more favourable LV to RV interaction (Figure 1C).

Conclusion
TV-TEER in HFpEF patients leads to an immediate periprocedural increase in LV volume at maintained filling pressures. The improved diastolic function is possibly attributable to a more favourable LV to RV interaction where RV volumes are reduced to allow for the LV to better distend in the limited pericardial space. TV-TEER might pose a potential therapy for a subgroup of HFpEF patients with severe TR, meriting validation in prospective endpoint driven clinical trials.Figure 1
Functional volume distribution in tricuspid regurgitation associated right heart failure
Authors: Rommel K P , Besler C , Unterhuber M , Kresoja K P , Noack T , Kister T , Brener M , Fudim M , Abdel-Wahab M , Leon M , Thiele H , Burkhoff D , Lurz P 
Published: November 2023

Abstract

Background
Tricuspid regurgitation (TR) associated right heart failure is a significant challenge, and while tricuspid edge-to-edge repair (TEER) has been suggested to improve outcomes, patients remain at substantial residual risk. Thus, adjunctive therapies to treat associated right heart failure are warranted. Sympathetically mediated venoconstriction with subsequent changes in functional volume distribution with increases in stressed blood volume (SBV) ( the volume compartment which generates intravascular pressure) has been shown to importantly mediate hemodynamic derangements in heart failure and might pose an attractive adjunctive treatment target (e.g. by means of splanchnic denervation).

Objectives
This study aimed to elucidate the determinants of unfavorable functional volume distribution in patients with TR-associated right heart failure and investigate the prognostic role of SBV after TEER.

Methods and Results
A total of 279 patients underwent right heart catheterization (RHC) prior to TEER. SBV was estimated (eSBV) from hemodynamic variables fit to an extensively validated and comprehensive cardiovascular model. eSBV was associated with obesity, renal and hepatic dysfunction, and cardiac remodeling (p &lt; 0.05 for all). Hemodynamically, eSBV correlated with pulmonary artery (PA) and cardiac filling pressures, as well as right ventricular-PA coupling (p &lt; 0.05 for all). After TEER, patients with eSBV above the median demonstrated less reduction in right atrial pressures, peripheral edema, and ascites compared to lower eSBV patients (p &lt; 0.05 for all). Higher eSBV was a powerful predictor of the occurrence of death and heart failure hospitalization during a median follow-up of 618 days (p &lt; 0.05 for all) independent of all clinical, imaging, and invasive hemodynamic parameters.

Conclusion
In severe TR, eSBV is associated with obesity, renal and liver dysfunction, more severe heart failure, attenuated reduction of venous congestion after TEER, as well as adverse clinical outcomes. Estimation of SBV should be incorporated in future trials in the field to identify patients in need of adjunctive therapies and test its role as a potential treatment target.
Assessment of multicausality in tricuspid regurgitation
Authors: Segovia Reyes J , Marquez Camas P , Soler Gonzalez M , Arroyo Monino D F , Garcia Rodriguez L , Alegre Garcia G , Rodriguez Cordoba A , Palma Marti L , Angullo Gomez M , Gonzalez Aguado N , Contreras Munoz A , Diaz Exposito A , Gomez Doblas J J , Jimenez Navarro M F , Rodriguez Capitan J 
Published: November 2023

Abstract

Introduction
Tricuspid regurgitation (TR) is a condition with multiple etiologies. The increased clinical knowledge of this pathology in recent years has led to a paradigm shift in its classification, with the latest literature advocating for stratification based on the pathophysiological profile beyond the classical division into primary and secondary or functional causes. In this study, we aimed to evaluate the possible concomitant causes of TR in a large series of patients classified into different groups according to their clinical profile.

Methods
Multicenter and retrospective study that included a series of consecutive patients with significant TR (moderate to severe or greater) diagnosed between 2002 and 2017. The patients were classified by the type of TR based on their main clinical context. For this purpose, we followed the step-by-step classification proposed by Topilsky et al so that the type of TR was defined in the first step that met the established criteria. Subsequently, an individual analysis of each of the obtained groups was performed to detect other possible causal mechanisms of TR.

Results
A total of 778 patients with significant TR were included and classified into 6 groups according to their clinical profile following the proposed classification (see attached image). Functional TR associated with left-sided valvular disease (56.16%) was the most frequent group observed. The attached table shows the different groups and concomitant pathologies. In those with primary etiology (congenital and acquired), only 33.33% and 25%, respectively, had no other etiology defined. Among the functional causes, those with TR associated with left-sided valvular disease did not present other causal mechanisms in 62.92% of cases, and 66.66% of cases in the group with TR associated with ventricular dysfunction did so. The functional groups associated with pulmonary hypertension and atrial cause did not present other notable concomitant causes as they were at the end of the classification.

Conclusions
In a large series of patients with significant TR, up to 31.87% of the sample showed other possible concomitant causes of TR apart from their main clinical profile, and this percentage was even higher in patients with primary causes. Given that the clinical course of this entity has been shown to differ according to the type of TR, this suggests that in approximately one-third of our patients with significant TR, a more descriptive and exhaustive etiological classification may be necessary to understand their prognosis and establish the best therapeutic strategy.Flow-chart and classification.Concomitant pathologies.
Clinical risk factors and prediction model for infective endocarditis in patients with gram-positive bacteremia
Authors: Panthong S , Takkavatakarn K , Sitticharoenchai P 
Published: November 2023

Abstract

Introduction
Gram-positive bacteremia (GPB) is a common condition in clinical practice that potentially leads to infective endocarditis (IE), a high morbidity and mortality disease. Clinicians still encounter challenges in determining the likelihood of developing IE in GPB patients. Comprehensive and invasive cardiac investigations in every patient with GPB for IE could be unnecessary and potentially harmful while missing proper investigations might result in the delay or misdiagnosis of this fatal condition.

Objective
We aimed to determine the significant clinical risk factors and develop the prediction model for IE in patients with GPB.

Methods
Data were obtained from medical records of hospitalized adult patients with GPB in our hospital from January 2016 to December 2020. IE was defined by the ‘definite’ group according to modified Duke criteria. The cohort was divided into training (80%) and test (20%) sets. We identified the association between clinical risk factors and the development of IE by logistic regression analyses. Significantly associated clinical risk factors in multivariate analysis were used in the prediction model. The area under the receiver operating characteristic curve (AUROC) was utilized to evaluate model performances.

Results
A total of 794 patients with GPB were included in the study. IE was diagnosed in 89 patients (11.2%). Among 21 selected clinical risk factors from univariate analysis, 10 variables, including the unknown origin of bacteremia, mechanical and bioprosthetic heart valve, duration of symptoms more than 7 days, presence of Roth spot, neurological symptoms, murmur, heart failure, number of positive hemoculture more than 2 specimens, and Staphylococcus aureus septicemia, were significantly associated with IE in multivariate analysis (Figure 1) and were utilized in the prediction model. The AUROC of prediction models were 0.943 and 0.865 in training and test sets, respectively.

Conclusions
Our prediction model based on clinical risk factors can precisely predict IE in patients with GPB. Using this model allows clinicians to address patients at risk and guide decision-making in which cases need an urgent and comprehensive workup for IE or a wait-and-see strategy.Figure 1