bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology and prognostic relevance of morphofunctional classification of secondary mitral regurgitation
Authors: Provencio A , Diz J , Pozo Osinalde E , Mahia Casado P , Marcos Alberca P , Gomez De Diego J J , Islas F , Perez De Isla L , Perez Villacastin J 
Published: November 2023

Abstract

Background
Mitral regurgitation has traditionally been divided into organic and functional (FMR) due to its different etiology and prognosis. However, FMR is not a homogeneous entity, and may be secondary to annular dilation, ventricular dilation and dysfunction, or posterior leaflet restriction.

Purpose
Our aim is to assess the epidemiology of these FMR subtypes and their prognostic impact.

Methods
Patients with FMR from our center who underwent three-dimensional transesophageal echocardiography (3D-TEE) between 2016 and 2020 were retrospectively evaluated. Patients with at least moderate FMR, effective regurgitant orifice (ERO) by 3D-TEE &gt;0.2 cm2 were selected. They were classified according to the predominant mechanism: type 1 or ventricular dysfunction, type 2 or posterior leaflet restriction, and type 3 or annular dilation. 3D-TEE and the closest transthoracic study variables, as well as baseline demographic and clinical characteristics and evolution events, were obtained and statistical analysis was performed according to FMR types.

Results
112 patients were included (66.1% male, mean age 72.3 years). 54.5% had previous hospitalization for heart failure and 53.6% had a history of ischemic heart disease. The most frequently identified FMR mechanism was type 1 (61.6%), followed by type 3 (23.2%) and type 2 (15.2%). There were significant differences in epidemiological factors and echocardiographic parameters (Table) between groups.
During follow-up, 43.8% died, received a heart transplant or LVAD and 44.6% had any hospitalization for heart failure. There were no significant differences between FMR types in relation to total mortality (p=0.28), mortality due to heart failure (p=0.13), total hospitalizations (p=0.73), or hospitalization for heart failure (p=0.12). Valvular intervention was performed in 54 patients (48.2%), 33 of them percutaneously with a clip, with no differences in FMR subtypes.

Conclusions
FMR is a heterogeneous entity and different morphotypes with different epidemiology and etiology can be identified. Despite the different mechanism, all subgroups presented a similar unfavorable prognosis and similar intervention rates.
Chronic kidney disease and survival of patients with tricuspid regurgitation
Authors: Loutati R , Copeland V , Ben-Zekry S , Fefer P , Mazor E , Klempfner R , Barbash I M , Guetta V , Segev A , Kuperstein R , Maor E 
Published: November 2023

Abstract

Introduction
Chronic kidney disease (CKD) patients are under-represented in clinical trials examining transcatheter interventions for tricuspid regurgitation (TR). The purpose of the current analysis was to investigate how CKD modifies the association of severe TR with overall survival.

Methods
Consecutive echocardiographic reports linked to clinical data from the largest medical center in Israel (2007-2022) were reviewed. Patients were dichotomized into four mutually exclusive TR groups (none/trivial, mild, moderate and severe), following by stratification according to CKD stage classification. The primary outcome was all-cause mortality. Kaplan Meier, Multivariate Cox regression and interaction analysis models were applied.

Results
Final study population included 78,147 patients with a median age of 67 (IQR: 55-78 years), 2,989 (4%) of whom had severe TR. There were 19,910 (25%) patients with estimated glomerular filtration rate [eGFR] &lt; 60 mL/min/1.73 m2, 14,359 (18%) with eGFR between 30-60 and 5,551 (7%) with eGFR &lt;30. During a median follow-up period of 4 years (IQR: 1-7 years), 28,112 patients (36%) died. Kaplan-Meier survival analysis demonstrated an increased risk of death with both increasing severity of TR and/or CKD grade (log-rank p&lt;.001 for both). Multivariate Cox analysis with adjustment for age, sex, left heart disease and pulmonary pressures demonstrated that compared to the none/trivial group, patients with severe TR were 38% more likely to die during follow up (95% CI 1.30-1.47, p&lt;.001). The association of tricuspid regurgitation with poor survival was CKD-dependent, such that in the eGFR&gt;60 group severe TR was associated with 19% increased risk of death, whereas among patients with eGFR&lt;60 the risk was significantly higher and reached 34% in the same multivariate model (p for interaction &lt;.001). Interestingly, the modification effect of CKD was mediated by RV function, such that the interaction analysis was no longer significant when RV function was incorporated into the multivariate model. Sub analysis limited to patients with isolated TR yielded consisted results.

Conclusions
While the association of severe TR with poor survival is consistent across all CKD groups, it is more pronounced among patients with advanced CKD. This association may be modulated through right ventricular function. When examining data and outcome of tricuspid clinical trials , special emphasis should be given to CKD status.Consort like figureHR modification by CKD
Soluble ST2 in acute pulmonary embolism
Authors: Uyanik M , Cinar A , Gedikli Ö , Tuna T , Coksevim M , Avci B 
Published: November 2023

Abstract

Purpose
ST2 is a member of the IL-1 superfamily. It consists of two components, ST2L, which is the membrane form, and sST2, which is soluble in blood. Soluble ST2 (sST2) is a cardiovascular injury–related biomarker. sST2 is also secreted in response to myocyte and fibroblast mechanical tension and has prognostic value for heart failure. Moreover, biopsy studies have shown that the alveoli are the main source of serum sST2. The extent to which sST2 is elevated in Acute Pulmonary embolism and whether sST2 can discriminate between high-risk and low-risk patients are unknown.

Methods
Patients whose diagnosis was confirmed by Pulmonary CT Angiography were included in the study. Except for pulmonary embolism, other diseases causing sST2 elevation were excluded. Echocardiographic pulmonary artery pressure, CBC, creatinine, CRP, sST2, and d-dimer tests were performed on the patients and the control group at the time of admission.

Results
After pre-assessment, 66 patients were included and 62 in the control group, met the study criteria. sST2 levels were positively correlated with the Pulmonary Embolism Severity Index (PESI). sST2 level was associated with increased mortality and prolonged hospitalization (P&lt;0.05). Moreover, sST2 is a sensitive biomarker as D-dimer and a better prognostic predictor than D-dimer.

Conclusions
Among patients with diagnosed acute pulmonary embolism sST2 showed the superior overall prognostic performance to D-dimer. sST2 might be a useful marker in predicting high-risk patients for Acute PE in the emergency department.
Survival and predictors of outcome in moderate mixed aortic valve disease
Authors: Patel K , Thornton G , Vandermolen S , Mckenna M , Awad W , Baumbach A , Mathur A , Treibel T , Lloyd G , Mullen M , Bhattacharyya S 
Published: November 2023

Abstract

Background
Coexisting moderate aortic stenosis and regurgitation (MAVD) is common. The haemodynamic effect of MAVD is poorly understood with sparse data to guide risk stratification.

Purpose
This study aims to compare all-cause mortality in moderate MAVD with matched controls and identify markers associated with prognosis.

Methods
Patients with both moderate aortic stenosis (aortic valve area [AVA] 1.0-1.5cm2) and regurgitation (vena contracta [VC] 0.3-0.6cm) were identified from a multicentre registry. All-cause mortality was compared to an age and sex matched UK population. The association between echocardiographic and clinical metrics with all-cause mortality was evaluated.

Results
207 patients were included, age 78 [66-84] years and moderate MAVD (AVA 1.2 [1.1- 1.4]cm2 and VC 0.4 [0.4-0.5]cm). Over a median follow up of 3.2 years, 75/207 (36.2%) patients died. Patients with moderate MAVD had a significantly higher mortality compared to age and sex matched controls (36% versus 14.3%), p&lt;0.001. Peak aortic jet velocity (Vmax) was the only haemodynamic metric independently associated with mortality [hazard ratio (HR): 0.61, 95% confidence interval (CI): 0.39-0.93; p=0.02] in a multivariate model along with age, creatinine and previous cerebrovascular accident. Compared to patients with Vmax &gt;3m/sec, those with Vmax ≤3.0m/s had lower LVEF and stroke volume and a higher mortality (HR: 1.76, 95% CI: 1.10-2.80; p=0.017).

Conclusions
Moderate MAVD is associated with reduced survival compared to age and sex matched controls. Patients with discordant low Vmax ≤3 m/sec, have disproportionately worse outcome and may represent a high risk ‘low flow’ phenotype.Figure 1
Effects of SGLT2 inhibition on cardiac remodeling and heart failure development in rats with aortic stenosis
Authors: Urbano Pagan L , Gomes M J , Damatto F C , Oliveira J P G , Gatto M , Souza L M , Santos A C C , Borim P A , Rodrigues E A , Mota G A F , Campos D H S , Murata G M , Polegato B F , Okoshi M P , Okoshi K 
Published: November 2023

Abstract

Introduction
Aortic stenosis prevalence has been increasing as population ages. Currently, no medical therapies influence the natural history of aortic stenosis. Sodium glucose co-transporter 2 inhibitors (SGLT2i) have reduced heart failure hospitalization and cardiovascular mortality in heart failure patients with both reduced and preserved ejection fraction. The aim of this study was to evaluate the effects of SGLT2 inhibitor empagliflozin (EMPA) on cardiac remodeling and heart failure development in aortic stenosis rats.

Methods
Eighteen weeks after supra-aortic banding surgery, male Wistar rats were divided in four groups: Sham (n=15); sham + EMPA (Sham-EMPA, n=16); aortic stenosis (AS, n=27); and aortic stenosis + EMPA (AS-EMPA, n=27). Empagliflozin (10 mg/kg/day) was added to rat chow for 8 weeks. Echocardiogram was performed to evaluate cardiac structure and function. Myocardial collagen content was quantified by histology; activity of antioxidant enzymes and enzymes involved in energy metabolism was assessed by spectrophotometry. Protein expression was quantified by Western blot, and matrix metalloproteinase (MMP) activity by zymography. Statistical analysis: ANOVA and Bonferroni or Kruskal-Wallis and Dunn (p&lt;0.05).

Results
AS-EMPA group had a lower frequency of anatomopathological heart failure features, a lower left ventricular (LV) dilatation (LV diastolic diameter: Sham 8.39±0.57; Sham-EMPA 8.25±0.38; AS 9.80±0.53; AS-EMPA 9.08±0.87 mm; LV systolic diameter: Sham 4.24±0.68; Sham-EMPA 4.19±0.57; AS 5.72±0.74; AS-EMPA 5.09±1.08 mm) and LV mass (Sham 0.85±0.11; Sham-EMPA 0.82±0.07; AS 2.19±0.27; AS-EMPA 1.76±0.34 g), and better diastolic function (isovolumetric relaxation time: Sham 28.6±2.28; Sham-EMPA 29.8±3.04; AS 18.9±2.59; AS-EMPA 22.9±5.02 ms) than AS. Systolic function was impaired in both AS and AS-EMPA compared to their respective controls and did not differ between AS-EMPA and AS. AS and AS-EMPA had larger myocyte diameter, higher interleukin-6 protein expression and lower catalase activity than Sham and Sham-EMPA, respectively. AS and AS-EMPA groups had lower enzyme activity from energy metabolism than their respective controls. AS presented higher lipid hydroperoxide concentration, collagen III and p65 NF-kB protein expression, and lower glutathione peroxidase activity than Sham. AS-EMPA had higher collagen I expression and inactive MMP-2 than Sham-EMPA. AS-EMPA presented higher glutathione peroxidase and intermediary active MMP-2, and lower interstitial collagen fraction (Sham 2.68±0.59; Sham-EMPA 3.16±0.33; AS 5.68±0.97; AS-EMPA 3.55±0.70 %) than AS.

Conclusion
Empagliflozin improves cardiac remodeling, diastolic function and myocardial oxidative stress, and reduces heart failure feature frequency and interstitial collagen fraction in aortic stenosis rats.
Efficacy of aortic valve replacement on Heyde syndrome-related acquired von Willebrand syndrome and gastrointestinal bleeding: a systematic review and meta-analysis
Authors: Rooijakkers M J P , Goltstein L C M J , Hoeks M , Li W W L , Van Wely M H , Rodwell L , Van Royen N , Drenth J P H , Van Geenen E M 
Published: November 2023

Abstract

Background
Heyde syndrome is the co-occurrence of aortic stenosis, acquired von Willebrand syndrome, and gastrointestinal bleeding. Aortic valve replacement has been shown to resolve all three associated disorders.

Purpose
To assess the efficacy of aortic valve replacement (both surgical aortic valve replacement and transcatheter aortic valve implantation) on acquired von Willebrand syndrome recovery and gastrointestinal bleeding cessation.

Methods
A systematic review and meta-analysis using MEDLINE, Embase, and the Cochrane Library was performed to identify articles on Heyde syndrome and aortic valve replacement. Primary outcomes were the proportion of patients with recovery of acquired von Willebrand syndrome within 24 hours (T1), 24 to 72 hours (T2), 3 to 21 days (T3), and 4 weeks to 2 years (T4) after aortic valve replacement, and the proportion of patients with cessation of gastrointestinal bleeding. Pooled proportions and risk ratios (RR) were calculated using random-effects models.

Results
We identified 33 studies (32 observational studies and one randomized controlled trial) on acquired von Willebrand syndrome (n = 1,054), and 11 observational studies on gastrointestinal bleeding (n = 300). One study reported on both associated disorders (n = 6). The pooled proportion of Heyde patients with acquired von Willebrand syndrome recovery was 86% (95% CI, 79-91%) at T1, 90% (74-96%) at T2, 92% (84-96%) at T3, and 87% (67-96%) at T4. The pooled proportion of Heyde patients with cessation of gastrointestinal bleeding was 73% (62-81%). Residual aortic valve disease was associated with lower recovery rates of both acquired von Willebrand syndrome (RR 0.20; 0.05-0.72; p = 0.014) and gastrointestinal bleeding (RR 0.57; 0.40-0.81; p = 0.002).

Conclusion
Aortic valve replacement is associated with a rapid recovery of the bleeding diathesis in Heyde syndrome and cessation of gastrointestinal bleeding. Residual aortic valve disease negatively impacts clinical benefits of aortic valve replacement.Graphical Abstract
Prognostic impact of geriatric frailty profile after transcatheter aortic valve replacement (TAVR): a registry study of a tertiary referral hospital
Authors: Geers J , Van Den Bussche K , Vandeloo B , Van Loo I , Michiels V , Plein D , Beckers S , Muylle T , Lieten S , Cosyns B , Compte N , Argacha J F 
Published: November 2023

Abstract

Background
Assessment of frailty in patients screened for transcatheter aortic valve replacement (TAVR) can improve outcome prediction after TAVR. However, previous studies evaluating frailty indicators in this population provided heterogenic results because of the wide variety of tests and cut-off values used to assess frailty1,2. Recently, the comprehensive geriatric assessment frailty index (CGA-FI) was introduced to ensure a standardized evaluation of patient frailty3.

Purpose
The aim of our study was to evaluate the potential value of frailty assessment by the CGA-FI for outcome prediction in TAVR patients. The prognostic effect of the geriatric profile including nutrition, cognition, mobility and depression was also examined.

Methods
A total of 102 patients treated by TAVR between 2015 and 2020 were included retrospectively. Demographic, medical history, hemodynamic, geriatric, procedural, hospital stay, and 2 years follow-up data were collected. The primary study endpoint was defined as 2-year all-cause mortality. The secondary endpoint was defined as lack of dyspnea improvement at 2-year follow-up.

Results
Mean patient age was 84.2 ± 4.3 years and 14% of patients were classified as frail according to CGA-FI &gt; 0.2. The 2-year mortality rate after TAVR was 29.4% and lack of dyspnea improvement during follow-up was observed in 13.7% of patients. A CGA-FI &gt; 0.2 did not predict all-cause mortality after TAVR (hazard ratio (HR): 1.302, 95% confidence interval (CI): 0.494-3.427, p=0.593 (Figure 1)). However, patients with a geriatric depression scale ≥ 5 had higher all-cause mortality risk after TAVR than patients with a geriatric depression scale &lt; 5 (HR: 3.047, 95% CI: 1.330-6.977, p=0.008 (Figure 1)). Similarly, malnutrition status was associated with higher all-cause mortality and shorter survival time after TAVR (HR: 2.340, 95% CI: 1.008-5.432, p=0.048 (Figure 1)). In contrast, no association of CGA-FI and geriatric profile with 2-year lack of dyspnea improvement was observed.

Conclusions
A CGA-FI &gt; 0.2 was not associated with 2 years patient mortality after TAVR. However, a geriatric depression scale ≥ 5 and malnutrition may be of prognostic value by predicting all-cause mortality after TAVR.
Impact of pre-procedural bioprosthetic leaflet calcification on hemodynamic and hlinical outcomes after aortic valve-in-valve procedure
Authors: Carter-Storch R , Poulin A , Dumont E , De Larochelliere R , Kalavrouziotis D , Rodes-Cabau J , Mohammadi S , Paradis J M , Salaun E , Clavel M A 
Published: November 2023

Abstract

Background
Transcatheter aortic valve replacement (TAVR) is a recognized option to treat patients with aortic bioprosthetic failure, but preprocedural factors associated with poor hemodynamic and clinical outcomes after valve-in-valve (ViV) TAVR remain unclear. In TAVR performed in native aortic valve, higher degrees of aortic valve calcification (AVC) have been associated with poorer outcome, but the association of bioprosthetic AVC and outcomes after ViV TAVR remains unknown. We hypothesize that a high amount of pre-procedural bioprosthetic AVC may result in a higher risk of patient-prosthesis mismatch (PPM) or post-procedural intervalvular regurgitation, and increased mid-term mortality.

Purpose
To assess the association of pre-procedural surgical bioprosthetic AVC and short- and mid-term hemodynamic and clinical outcomes after aortic ViV procedure.

Methods
All consecutive patients who underwent aortic ViV procedure for surgical aortic bioprosthetic failure at our institution between 2009-2022 with available pre-procedural CT were included, patients with TAVR-in-TAVR were excluded. We measured AVC with non-contrast CT, and this amount was divided by LVOT area (measured on echocardiography) to obtain AVC density (AVCD). Pre and post-procedural transthoracic echocardiograms were analyzed for aortic valve hemodynamics. Multivariate Cox-regression was performed to assess the determinants of mid-term all-cause mortality.

Results
A total of 186 patients were included. An AVCD score above the median was associated with younger age, diabetes, lower indexed aortic valve area and higher preprocedural mean gradient (figure 1). Preprocedural AVCD was not significantly different in patients with: 1) postprocedural severe PPM (n=81, 45%) vs no-moderate PPM (n=100, 55%) (207 [68-335] vs 209 [54-352] Agatston units (AU)/cm2, p=0.80); 2) ≥moderate intervalvular regurgitation (n=10, 5%) vs no-mild regurgitation (n=174, 90%) (198 [57-350] vs 251 [210-352] AU/cm2, p=0.22). Higher AVCD was not associated with 30-day mortality, stroke, or implantation of a new pacemaker (all p&gt;0.05). During 38 [21-65] months of follow-up, multivariate factors associated with all-cause mortality were older age, diabetes, and chronic obstructive pulmonary disease, while AVCD was associated with a lower mortality (HR 0.77 (0.63-0.94) per 100 AU/cm2 increase, p=0.01).

Conclusion
High pre-procedural bioprosthetic ACVD is not associated with a poorer hemodynamic and clinical after Aortic ViV procedure for surgical bioprosthetic failure.Baseline tableSurvival curve
Left ventricular twist in patients with severe aortic stenosis: meaning and evolution after surgery
Authors: Bello A , Abecasis J , Maltes S , Santos R , Lima R , Reis C , Oliveira L , Guerreiro S , Freitas P , Ferreira A , Neves J P , Mendes M 
Published: November 2023

Abstract

Background
Structural and functional left ventricular (LV) remodeling is the result of myocardial adaptation to chronic pressure overload in patients with severe aortic stenosis (AS). Changes in LV rotational dynamics are supposed to occur due to increased afterload in order to maintain LV ejection fraction (EF) in this setting. However, data regarding rotational dynamics with AS severity and their evolution after aortic valve replacement (AVR) are scarce.

Goal
To describe LV twist in patients with severe AS according to LV remodeling and assess its evolution after surgical AVR.

Methodology
Single center prospective cohort study of patients with classical isolated severe AS referred to surgical AVR. Complete transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) were performed before surgery for both valvular and LV remodeling assessment. TTE was performed at the 3rd to 6th post-operative month. LV twist was defined as the peak difference in systolic rotations of LV apex and base as viewed from the apex and calculated at bidimensional strain in short axis views. LV remodeling was categorized by CMR according to Figure 1. Correlation analysis was performed for indexes of AS severity and LV function.

Results
A total of 80 patients with classical high flow, high gradient, preserved LV EF (46% male; mean age 71 ± 8 years old; mean aortic valve [AV] gradient 61±17.6mmHg, mean AV area 0.73±0.18cm2 , mean LVEF: 58 ± 9%) were included. LV twist before surgery was 24.5 +/- 9.7% and this was modestly correlated with both LV flow (r = 0.315, p= 0.001) and AV gradients (r = 0.315, p = 0.013). Rotational indexes were no different across distinct types of LV remodeling. After AVR there was a significant decrease in LV twist (24.5 +/- 9.7% vs. 16.5 +/- 8.3%, p&lt;0.001), despite significant improvement in global longitudinal strain (-14.7 ± 3.9% vs -16.1 ± 3.1%, p &lt; 0.001) and maintenance of preserved LVEF (58 ± 9% vs 60 +/- 8%, p = 0.07).

Conclusion
As LV twist has an inverse relation to GLS after AVR, this may represent a compensatory mechanism for LVEF preservation in patients with severe AS. Rotational mechanics seems to be independent from structural LV remodeling in this setting.