bluuebunny/crossref_metadata_2025_split huggingface dataset:
Redo transcatheter edge-to-edge mitral valve repair: a single centre experience
Authors: Makmal N , Butnaru A , Silbermintz N , Faierstein K , Raphael R , Moeller C , Canetti M , Maor E , Kuperstein R , Hai I , Oren D , Guetta V , Fefer P 
Published: November 2023

Abstract

Introduction: Mitral valve transcatheter edge-to-edge repair (TEER) has been established as a therapy for patients with severe symptomatic mitral regurgitation (MR) who are at high surgical risk. Failure to implant a TEER device and the occurrence of residual or recurrent MR ≥3+ are well documented but data regarding outcomes of redo-TEER following initial failure are sparse.

Purpose
To evaluate the safety and efficacy of redo-TEER following initial failed intervention.

Methods
We included 16 patients who underwent redo-TEER for symptomatic MR ≥3+ from July 2016 to December 2022. Acute results were assessed by echocardiography prior to discharge and safety was evaluated clinically, according to the occurrence of procedure-related adverse events. Mid- and long-term outcomes were evaluated at three months and one year respectively. Data were obtained retrospectively by chart review. Mortality data were drawn from the national death registry.

Results
Reasons for redo-TEER include device failure without detachment in nine (56%) patients, device failure due to single leaflet detachment in four (25%) patients and initial implantation failure in three (19%) patients. Median time from index procedure was 167 days (range: 19 – 1457 days). Technical (implantation of a TEER device) and procedural (MR ≤2+ at discharged) success were achieved in 94% and 87.5% of patients undergoing repeat intervention respectively. MR grade was reduced to 1+ in 71% of patients who had successful TEER. No intra-procedural mortality or life-threatening complications were noted. Mean post-TEER hospitalization length was 1.8 ± 1.3 days. No deaths were noted during the first year following redo-TEER. Echocardiography at three months and one year demonstrated MR ≤2+ for all patients in whom TEER was successful. At three months and one-year follow-up, respectively 67% and 50% of patients who underwent successful intervention were in New York Heart Association (NYHA) class I or II and only one had been hospitalized for heart failure.

Conclusion
Repeat mitral TEER following initial procedural failure is safe and has high acute and mid-term success rates. More research is needed to better characterise patients likely to benefit from repeated intervention.
Transcatheter-edge-to-edge-repair of functional mitral regurgitation in advanced HFrEF: the impact of intrinsic left ventricular performance on the degree of MR reduction and clinical outcome
Authors: Schmeisser A , Rauwolf T , Groscheck T , Tiedge M , Tanev I , Meissler S , Hansen M , Luani B , Bekfani T , Steendijk P , Braun-Dullaeus R U E D I G 
Published: November 2023

Abstract

Background
Transcatheter-edge-to-edge-repair (TEER) of functional mitral regurgitation (FMR) reduces rehospitalisation and all-cause mortality in patients with HFrEF/HFmrEF. Not conclusively clarified is the interaction of pre-interventional intrinsic left ventricular (LV) function with TEER success and clinical outcome.
By using the gold standard of LV contractility analysis, the invasive pressure-volume loop technique, we examined the interaction of pre-and post-interventional intrinsic LV performance with the degree of MR reduction and all-cause mortality after TEER in patients with advanced HFrEF.

Methods
In a prospective study of 71 patients with advanced HFrEF (median EF 26%, 22-31%) and severe FMR, we quantified different intrinsic parameters of LV performance by PV-loop analysis (single beat analysis) pre-and post-interventionally.

Results
In 83% of the patients a MR reduction to grad &lt; 2 could be achieved (hospital discharge). In the ROC analysis, the best cut-off to separate medium-term survival from all-cause mortality (median FU 2.9 years) was a post-interventional regurgitation fraction (RF) &lt; 20% (AUC 0.72, p&lt;0.001, sensitivity 83%, specificity 60%) and a R-volume (RV) &lt; 18ml (AUC 0,7, p=0.002, sensitivity 67%, specificity 72%). The PV-loop-derived intrinsic LV contractility (LV-endsystolic elastance, Ees), LV afterload (arterial elastance, Ea), LV-Ao-coupling (Ees/Ea), LV-mechanical efficacy (ME), PV-loop area (PVA), stroke work, Tau; end-diastolic elastance (Eed), LVEF, LVEDV, and LVESV, pre- and post-TEER, were not predictive for the extent of MR reduction acutely, after 6 months FU, and for all-cause mortality. In multivariate cox-regression analysis, only a post-interventional RF&lt;20% (HR 0.36, p=0.017) or RV&lt;18ml (HR 0.32, p=0.005) and the pre-interventional LV-contractile reserve (LV-CR: post-extra-systolic augmentation of LV-Ees) remained independent predictors of all-cause mortality. In a second model, we included the degree of LV-remodeling (LV-R: LVESV reduction from hospital discharge to 6 months) in the model. In addition to pre-interventional LV-CR, and RF&lt;20%, the LV-R remains independent predictive for all-cause mortality.

Conclusion
In our peri-mitral-TEER LV-PV-loop study, only the extent of MR reduction and the pre-interventional LV-CR, but not the intrinsic LV performance at rest, determine the medium-term survival of patients with advanced HFrEF and FMR. TEER-mediated MR reduction itself seems not be determined by the LV performance.
Impact of transcatheter edge-to-edge repair (TEER) of mitral valve on the clinical outcomes in the management of atrial functional mitral regurgitation
Authors: Moras E , Gandhi K , Narasimhan B , Correa A , Mahmood K , Argulian E , Dominguez A 
Published: November 2023

Abstract

Background
Atrial functional mitral regurgitation (aFMR) has become a novel topic of interest. Data on the safety and efficacy of transcatheter edge-to-edge repair (TEER) of mitral valve among patients with aFMR and ventricular functional mitral regurgitation (vFMR) is scarce and limited to single center studies.

Purpose
We conducted a systematic review and meta-analysis to assess the safety and efficacy of TEER in the management of aFMR vs vFMR and its impact on clinical outcomes.

Methods
PubMed/MEDLINE, Cochrane Library and EMBASE databases were queried to identify studies comparing the efficacy of TEER between aFMR and vFMR. The primary outcome of interest was mortality at 1 year and composite of all-cause mortality and heart failure (HF) hospitalizations. Secondary outcomes included mitral regurgitation (MR) reduction, presence of residual MR, improvement in NYHA functional class, postoperatively and at 1-year. Risk ratios (RR’s) and their corresponding 95% confidence intervals (CIs) were calculated using random-effects model.

Results
We included a total of 3,314 patients from 6 observational studies which met the inclusion criteria (mean age 63.8 ± 3.8 years, 43% male). There were 443 aFMR patients and 2871 vFMR patients with an average follow-up of 12 months. Mortality at 1-year and the composite outcome of all-cause mortality and heart failure hospitalizations were comparable between aFMR and vFMR groups (RR 1.06; 95% CI 0.64 - 1.75; p = 0.81 and RR 0.92; 95% CI 0.75 - 1.14; p = 0.47, respectively). There were no significant differences between aFMR and vFMR groups in terms of MR reduction postoperatively (RR 0.99; 95% CI 0.96 - 1.02; p = 0.53) or at 1-year (RR 1.15; 95% CI 0.96 - 1.38; p = 0.14). Moreover, the presence of residual MR grade ≥ 3+ postoperatively (RR 1.31; 95% CI 0.83 - 2.08; p = 0.25) and at 1-year (RR 0.96; 95% CI 0.44 - 2.11; p = 0.92) was similar between aFMR and vFMR cohorts. Overall, although there was a clinical improvement in symptoms in terms of NYHA functional class at 1 year (grade ≤ 2), there was no statistical significance between the two groups (RR 1.02; 95% CI 0.93 - 1.11; p = 0.74).

Conclusion
This meta-analysis suggests that transcatheter edge-to-edge repair is likely to be an efficacious and safe option in patients with aFMR and vFMR. Future randomized control trials are needed to fully assess the clinical impact of this procedure in the two MR etiologies.Figure 1Figure 2
Urgent Transcatheter Edge-to-Edge Repair (TEER) of severe mitral regurgitation in patients with cardiogenic shock: A systematic review and meta-analysis of 5,428 patients
Authors: Soulaidopoulos S , Dimitriadis K , Sagris M , Beneki E , Tsiachris D , Pananikolaou A , Tsioufis P , Aznaouridis K , Tousoulis D , Aggeli K , Tsiamis E , Tsioufis K 
Published: November 2023

Abstract

Background
Patients presenting with severe mitral valve regurgitation (MR) and cardiogenic shock (CS) demonstrate a poor prognosis and high mortality rate. Transcatheter edge-to-edge repair (TEER) of the mitral valve regurgitation with MitraClip may alter patient management while alleviating hemodynamic instability.

Aim
To perform a systematic review of the published literature and meta-analysis on the use of MitraClip in patients with severe MR and CS.

Methods
We performed a systematic review and meta-analysis according to the PRISMA guidelines. We systematically explored published literature in MEDLINE (Pubmed) before January 8, 2023, for studies assessing urgent TEER with MitraClip in patients presenting with severe MR and CS. CS was defined as 1) CS according to ICD-10; 2) inotrope use; or 3) mechanical circulatory support before TEER. The primary outcome was device success and all-cause mortality rates while the secondary outcome was the incidence of myocardial infarction (MI), stroke, and hospitalization for heart failure (HF), during in-hospital/30-days and long-term periods. We calculated I² to test heterogeneity. We used random-effects modeling for the meta-analyses to assess the primary and secondary outcomes.

Results
In total 25 studies, including 5,428 patients met the predefined eligibility criteria and were included in this meta-analysis. During the in-hospital/30-day period, device success was achieved in 86% (95% CI: 80%-91%, I2 =49%) with MR ≤2+ to be described in 87% (95% CI: 79%-93%, I2 =75.8%) of the cases, while the overall all-cause mortality was 14% (95% CI: 10%-19%, I2 =84%). The incidence of MI and stroke hovered at 4% (95% CI: 1%-13%, I2 =92%) and 2% (95% CI: 1%-2%, I2 =0%), respectively. During a mean follow-up of 10.6 ± 6.4 months, the all-cause mortality was increased to 31% (95% CI: 24%-39%, I2 =92%), while hospitalization for HF is needed in 18% (95% CI: 9%-29%, I2 =80%) of the patients. In the subgroup analysis of patients in CS due to acute MI who underwent urgent TEER, 11 studies and 352 patients were included. Device success was achieved in 92% (95% CI: 75%-100%, I2 =77.8%) and the in-hospital/30-day mortality was 13% (95% CI: 5%-21%, I2 =60%). In a mean follow-up of 10.2 ± 8.3 months, long-term all-cause mortality fluctuated at the same rate of around 11% (95% CI: 2%-23%, I2 =70%).

Conclusion
The use of MitraClip in patients with MR and concurrent CS is associated with improved in-hospital/30-day and long-term survival. Our findings indicate that using MitraClip in the acute phase is a safe approach that can significantly reduce all-cause mortality, MI, stroke, and re-hospitalization for HF in this patient population.
Perioperative aspirin and coronary artery bypass graft surgery: a meta-analysis of randomised controlled trials
Authors: Zaka A , Gupta A , Lombardo A , Kovoor J , Bacchi S , Smith J , Bennetts J , Maddern G 
Published: November 2023

Abstract

Background
Although consensus guidelines demonstrate clear benefit for the continuation of aspirin in patients awaiting coronary artery bypass grafting (CABG) following an acute coronary syndrome where risk of re-infarction outweighs bleeding risk, the evidence remains unclear in the case of elective CABG. We performed the largest to date systematic review and meta-analysis to compare outcomes between CABG patients who stopped and continued aspirin perioperatively.

Methods
A thorough search of PubMed, MEDLINE and CENTRAL databases was conducted to 25th July 2022 for randomized control trials that evaluated patients undergoing CABG. Summary odds ratios were calculated using a random effects model for dichotomous and continuous variables. Subgroup and sensitivity analyses were conducted in order to explore sources of heterogeneity.

Results
16 eligible studies were included with a total of 6188 patients who underwent CABG. Patients who continued Aspirin perioperatively demonstrated an increased risk of all cause mortality [OR 1.37 (0.81-2.33)] and reduced risk of perioperative myocardial infarction [OR 0.81 (0.55-1.18)], however neither were statistically significant. No significant difference was observed between low-dose and higher doses of Aspirin. There was minimal heterogeneity amongst included studies (i2 = 0%, p=0.97 and i2=33%, p=0.13 respectively). Continuing aspirin produced a modest increase in postoperative blood loss [mean difference 66.12mL (-1.45-133.69)], as was a dose greater than 100mg [216.87(-152.99-586.72), p=0.60], however this was not statistically significant.

Conclusion
Continuing Aspirin before CABG is not associated with a significantly increased risk of all-cause mortality, of perioperative myocardial infarction, and of postoperative bleeding. Future trials with more robust methodology should be aimed at further evaluating this patient cohort to guide perioperative Aspirin use.
Incidence and risk factors for permanent pacemaker implantation in patients undergoing tricuspid valve surgery
Authors: Kassab J , Harb S C , Desai M Y , Chedid El Helou M , El Dahdah J , Nakhla S , Elgharably H , Kapadia S R , Cremer P C , Mentias A 
Published: November 2023

Abstract

Background
Bradyarrhythmias requiring permanent pacemaker (PPM) implantation are commonly described after cardiac surgeries. Numerous studies evaluated the demographic and clinical risk factors for PPM placement following aortic and mitral valve surgeries. However, a paucity of data exists when it comes to tricuspid valve surgery (TVS).

Purpose
Our study aimed to evaluate the incidence of PPM placement after TVS and investigate the demographic, clinical, and procedural risk factors associated with the need for a PPM.

Methods
We included 13 294 patients from the Medicare database who underwent isolated TV repair (N=1319 (10%)), isolated TV replacement (N=2123 (16%)), or concomitant TV repair or replacement with different combinations of surgical aortic valve replacement (SAVR), mitral valve repair or replacement (MVR), and coronary artery bypass graft (CABG). Patients who underwent TV surgery for endocarditis were excluded. The primary exposure of interest for the study was new pacemaker placement after TV surgery and before discharge, or within 30 days from discharge date. Each patient from the pacemaker group was matched to up to 3 controls from the no pacemaker group.

Results
Among the included patients, 2518 (18.9%) required a PPM placement after TVS. In the logistic regression including patients’ variables, subjects who needed PPM implantation were more likely to be women (64.4% vs. 57.6%, P&lt;0.001) and had a higher prevalence of prior sternotomy (P=0.01), chronic kidney disease (P=0.03), heart failure (P=0.04) and tumor (P=0.02). Patients who underwent isolated TV replacement and TV replacement with concomitant surgeries had a significantly higher risk of PPM implantation when compared to isolated TV repair and TV repair with concomitant surgeries (P&lt;0.0001) (Table).

Conclusion
Post-procedural PPM implantation is a very frequent complication of TVS, especially in TV replacement with or without concomitant left-sided heart surgeries. Numerous demographic and clinical factors are associated with an increased risk of PPM placement. Adequate risk stratification and counseling of patients before surgery decision is essential.Demographic & Surgical Risk Factors
Sex specific associations between serum uric acid levels and risk of hypertension for different reference values of high blood pressure
Authors: Salim A , Kawasoe S , Kubozono T , Ojima S , Kawabata T , Ikeda Y , Miyahara H , Tokushige K , Ohishi M 
Published: November 2023

Abstract

Background
Uric acid (UA) has been linked to the development of hypertension. However the sex specific associations between UA levels and different diagnostic blood pressure (BP) references is unknown.

Purpose
We aimed to ascertain the association between serum UA quartiles, hyperuricemia, and 5-year hypertension incidence and weather lower BP diagnostic references may alter these associations in men and women without cardiometabolic diseases.

Methods
This 5-year study used the check-up data from a hospital. We excluded participants with hypertension (defined as BP ≥140/90 mmHg in cohort 1 and BP ≥130/80 mmHg in cohort 2), diabetes, dyslipidemia, obesity, estimated glomerular filtration rate (eGFR) &lt;60 ml/min/1.73m², metabolic syndrome, history of gout, and UA lowering medication. We categorized UA into quartiles as follows: men: 1st quartile UA≤4.8 mg/dL, 2nd quartile 4.9-5.6 mg/dL, 3rd quartile 5.7-6.4 mg/dL, and 4th quartile UA≥6.5 mg/dL; women: 1st quartile UA≤3.4 mg/dL, 2nd quartile 3.5-4.0 mg/dL, 3rd quartile 4.1-4.7 mg/dL, and 4th quartile UA≥4.8 mg/dL. Hyperuricemia was defined as UA&gt;7 mg/dL in men and UA&gt;6 mg/dL in women. To analyze the effects of UA on development of hypertension, we adjusted for age, body mass index, systolic BP, diastolic BP, tobacco smoking, alcohol consumption, exercise habit, serum triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fasting plasma glucose, and eGFR by sex in both cohorts. The outcome was 5-year hypertension incidence defined as BP ≥140/90 mmHg in cohort 1 and BP ≥130/80 mmHg in cohort 2.

Results
In total, 21,514 participants (age, 52.9±10.9 years; men, 39.8%), were enrolled in cohort 1, and 15,316 participants (age, 51.3±10.9 years; men, 36.5%), in cohort 2. The incidence of hypertension in cohort 1 and cohort 2 over a 5-year period was 16.3% and 29.7% in men and 10.9% and 21.4% in women, respectively. Using multivariable logistic regression, we found that when comparing the fourth to first UA quartile, there was an increased risk of hypertension in men in cohort 1, OR 1.36 (95% CI, 1.13-1.63, P&lt;0.01) and cohort 2, OR 1.31 (95% CI, 1.09-1.57, P&lt;0.01) but not in women, cohort 1, OR 1.14 (95% CI, 0.95-1.36, P=0.16) and cohort 2, OR 1.14 (95% CI, 0.98-1.34, P=0.10) respectively. In contrast, for hyperuricemia, we observed increased hypertension risk only in men in cohort 1, OR 1.23 (95% CI, 1.07-1.42, P=0.02) and women were associated with increased risk of hypertension in cohort 2, OR 1.57 (95% CI, 1.14-2.16, P&lt;0.01) but not in men OR 1.15 (95% CI 0.95-1.40, P=0.15).

Conclusion
Uric acid effect on development of hypertension is affected by sex and incidence differs with the BP reference used. We emphasize on early UA screening to enhance hypertension prevention among cardiometabolic free population.Hypertension 5-Year Incidence Proportion
Association of cumulative systolic blood pressure load and stroke in patients without diabetes
Authors: Zhao Y , Zhang Y I , Li M O R A N 
Published: November 2023

Abstract

Objectives
The purpose of this study was to assess the association between cumulative systolic blood pressure (SBP) load and risk of stroke in patients without previous stroke and diabetes.

Methods
The present study was a post hoc analysis of patients enrolled in the SPRINT study. Cumulative SBP load was defined as the area under curve for SBP values &gt;120 or 130 or 140mmHg respectively (named SBP load120, SBP load130 and SBP load 140 respectively) divided by the area under curve for all measured SBP values over a 48-month exposure period. Hazard ratios for the association between cumulative SBP load with stroke were estimated using Cox models.

Results
Only SBP load130, but not mean SBP, SBP standard deviation (SBP SD), time at therapeutic range (TTR); had a well-correlation with the incidence of stroke according to the restricted cubic spline curve (RCS). Grouping participants with tertiles of cumulative SBP load130 distinguished the incidence of stroke by K-M curve. Different Cox models indicated SBP load130 was an independent risk factor for stroke. For the prediction of stroke, only cumulative SBP load130，but not SBP load120 and SBP load140, outperformed mean SBP, TTR, SBP SD in terms of C-statistics and net reclassification indexes.

Conclusions
Cumulative SBP load may provide better prediction of stroke compared with traditional BP measures among patients without previous stroke and diabetes. 130mmHg could be the best cutoff value for predicting incidence of stroke by SBP load.abstract figure
A medical impact of war: the hypertension crises dynamic in an adjacent population
Authors: Tase A , Stefan C , Stanciulescu L , Calina F C , Tantu M 
Published: November 2023

Abstract

Background
The current military conflagration in Ukraine impacted also boundaring countries by fear military conflict extension in the region, often augmented by mass-media, as well as by real horror stories told by refugees.
Goal. The aim of our research was evolutive assessment of the hypertension (HTN) crises in our emergency units during last twenty months.

Method
In this observational study, we analysed 45.293 patient (pts) files during five distinct intervals: 24.06.2021-23.10.2021, as four months of peace (P), 24.10.2021-23.02.2022, as four months of pre-war army manœvres (PW), 24.02.2022-23.06.2022, as the first four months of war – Russian invasion (RI), 24.06.2022-23.10.2022, as next four months of war – Ukrainean counteroffensive (UC), and 24.10.2022 – 23.02.2023, as other four months of war – Russian destructive attacks (RD), statistically matched 1:1:1:1:1. The acquisition of arterial pressure values was performed by professional digital tensiometers.

Results
From a quite steady number of 150 +/- 14 pts daily, the distribution of HTN pts was: 29,17 (P); 38,21 (PW); 67,49 (RI); 43,58 (UC); 56,14 (RD). Concerning the HTN crises, the data are as follows: 12,43 (P); 14,97 (PW); 27,65 (RI); 16,28 (UC); 24,93 (RD). Demographically, the male predominance oscillated as follows: 68,32% (P); 65,89% (PW); 59,58% (RI); 62,37% (UC); 56,94% (RD). The medium age for HTN crises pts balanced as follows: 65,32 yrs (P); 64,97 yrs (PW); 62,18 yrs (RI); 63,74 yrs (UC); 62,85 (RD).

Conclusion
According to our outcomes, the stress and high anxiety caused by fear of war in the neighbourhood significantly influenced the incidence of HTN crises along the five abovementioned periods. The most dramatic data were registered during RI period. Taking into consideration that this war is irrepeatable, this research is unique.