bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long term impact of measured and predicted prosthesis patient mismatch following transcatheter aortic valve replacement
Authors: Tomii D , Okuno T , Heg D , Nakase M , Lanz J , Praz F , Stortecky S , Reineke D , Windecker S , Pilgrim T 
Published: November 2023

Abstract

Objectives
To investigate the long-term clinical impact of prosthesis-patient mismatch (PPM) in patients undergoing transcatheter aortic valve implantation(TAVI).

Background
Both measured and predicted effective orifice area indexed to the body surface area (EOAi) have been suggested to define PPM in patients undergoing TAVI. The impact of PPM on clinical outcomes may accumulate with extended follow-up and vary according to the definition used.

Methods
Patients included in a prospective TAVI registry were stratified by the presence of moderate (0.65-0.85 cm2/m2 or 0.55-0.70 cm2/m2 if obese) or severe (≤0.65 cm2/m2 or ≤0.55 cm2/m2 if obese) PPM according to echocardiographically measured EOAi (measured PPM) prior to discharge, predicted EOAi based on published EOA reference values for each valve model and size (predicted PPMTHV), or predicted EOAi based on EOA reference derived from computed tomography measurements of aortic annulus dimension (predicted PPMCT).

Results
In an analysis of 2,463 patients, the incidence of measured PPM (moderate: 27.0%; severe: 8.7%) was higher than the incidence of predicted PPMTHV (moderate: 11.3%; severe: 1.2%) or predicted PPMCT (moderate: 12.0%; severe: 0.1%). During a median time to death of 843 days, mortality rates at 10 years were comparable in patients with versus without measured PPM or predicted PPMCT. In contrast, patients with moderate predicted PPMTHV had a lower risk of 10-year all-cause mortality compared with those without PPM (HR: 0.69; 95% CI: 0.52-0.90).

Conclusions
The use of predicted as compared to measured EOAi results in a lower estimate of PPM severity in TAVI ptients. We observed no increased risk of death in patients with PPM throughout 10-year of follow-up.Incidence of PPM after TAVIImpact of Measured an Predicted PPM
Perioperative risk reassessment of non-cardiac surgery during last 10 years in patients with asymptomatic significant aortic stenosis
Authors: Park S , Bak M J , Lee S H , Park J C , Kim D , Kim J H , Kim E K , Chang S A , Lee S C , Park S W 
Published: November 2023

Abstract

Background
Aortic valve stenosis (AS) is a common geriatric disease and the number of patients with significant AS in need of non-cardiac surgery is expected to increase. Significant AS is considered a major risk factor for non-cardiac surgery.

Method
There were 113078 patients who underwent non-cardiac surgery with intermediate-to high risk in general anesthesia from 2011 to 2019 at our Medical Center. There were 221 patients with asymptomatic significant AS among this population.
First, to investigate the effect of significant AS on adverse events after surgery, Major adverse cardiovascular events (MACE) and Perioperative adverse cardiovascular events (PACE) occurrences were compared in the control group and asymptomatic significant AS group. Second, in order find out the factors affecting the occurrence of MACE and PACE in patients with asymptomatic significant AS, patients with and without MACE and PACE were compared and multivariable analysis was performed in patients with asymptomatic significant AS.

Result
There was no significant difference between the three groups in the ratio of primary and secondary outcomes, MACE (p value 0.971) and PACE (p value 0.185). Outcomes such as cardiac death, arrest, myocardial infarction, and stroke were also not significantly different.
Significant factors with MACE were coronary artery disease (OR* 6.256, 95% CI** [1.258 - 31.115], p value = 0.026) and cardiac damage stage (OR 9.241, 95% CI [1.314 - 64.976], p value = 0.025). Factors significantly associated with PACE were dialysis (OR 13.486, 95% CI [1.742 - 104.371], p value 0.013), arrhythmia (OR 11.219, 95% CI [3.474 - 36.231], p value &lt;0.001), LVEF (OR 0.928, 95% CI [0.882 - 0.977], p value 0.004), and cardiac damage stage (OR 2.199, 95% CI [1.055 - 4.584], p value 0.036). MACE increased at LVEF less than 62.5% and PACE increased at LVEF less than 61.7%.

Conclusion
There was no significant difference in major post-operative cardiovascular events between patients with asymptomatic significant AS and the control group. Advanced cardiac damage stage in significant aortic stenosis is an important factor in perioperative risk of non-cardiac surgery.Perioperative outcome in 30 daysRisk factor analysis for PACE
The impact of calcium and vitamin D supplement intake on survival in patients with concomitant moderate aortic and mitral valve disease
Authors: Gaballa A , Hajj Ali A , El Dahdah J , Popovic Z , Wang T K M , Reed G W , Rodriguez L , Griffin B , Roselli E E , Gillinov A M , Kapadia S , Svensson L G , Desai M 
Published: November 2023

Abstract

Background
Calcium and vitamin D supplement intake has increased among the elderly population, who are prone to deficiency. We sought to assess the association between calcium and vitamin D supplementation and the long-term outcomes in patients diagnosed with concomitant moderate aortic and mitral valve disease.

Methods
We included 3257 patients (aged 71.7 ± 12.9 years; 55.2% male; 83.1% white), who presented to the Cleveland Clinic between 2010 and 2018, diagnosed with concomitant moderate aortic and mitral valves disease. The patients were followed up with a mean period of 21.8 months (range 1-155.8). Patients were stratified based on the supplementation with calcium and vitamin D. Focusing on the aortic component of the concomitant valvular disease, patients were further subdivided into two groups; Aortic Stenosis (AS) with either Mitral Regurgitation (MR) or Stenosis (MS)(group 1), and Aortic Regurgitation (AR) with either MR or MS(group 2). The primary endpoints were death and heart failure hospitalization. The data was analyzed using Kaplan Meier survival analysis on SPSS.

Results
Of the total 3257 patients included in this study, 2273 (70%) were not supplemented, and 984 (30%) were supplemented with calcium and vitamin D. Supplementation with calcium and vitamin D was significantly associated with a higher risk of all-cause mortality (HR=1.114, 95% CI [1.003-1.237]; p=0.043) (Figure 1). However, no significant association with heart failure hospitalization was noted (HR=1.003, 95% CI [0.884-1.139]; p=0.958). On further sub-group analysis of the aortic component, 1045 (32%) patients in group 1 and 2212 (68%) patients in group 2 were assessed. In group 1, 701 (67%) patients were not supplemented, and 344 (33%) were supplemented. Calcium and vitamin D supplementation was associated with a significantly higher risk of all-cause mortality in patients with AS (HR=1.203, 95% CI [1.017-1.425]; p=0.031). Conversely in patients with AR (group 2), 1572 (71%) patients were not supplemented, and 640 (29%) were supplemented, and no significant association was exhibited in this group (HR=1.044, 95% CI [0.913-1.193]; p=0.531) (Figure 2).

Conclusion
In our cohort of patients with concomitant moderate aortic and mitral valve disease, the intake of calcium and vitamin D supplements was associated with higher mortality specifically in patients with aortic stenosis.Figure 1Figure 2
Aortic stenosis rapid progression is associated with premature cardiac damage independently of baseline severity
Authors: Teixeira R , Almeida M , Sousa-Nunes F , Neves I , Leite M , Lobo A , Santos D , Brandao M , Diaz S , Saraiva F , Barros A , Sampaio F , Fontes-Carvalho R 
Published: November 2023

Abstract

Background
Aortic stenosis (AS) is one of the major valvular heart diseases in developed countries. Degenerative fibrocalcific AS is a progressive disease of the valve and, ultimately, the myocardium. AS is a potentially fatal disease characterized not only by a narrowing of the aortic orifice but also by gradual cardiac damage (CD) that may extend beyond the left ventricle (LV). However, the presence and extent of extra-aortic cardiac damage did not reflect the baseline hemodynamic severity of AS in retrospective studies.

Purpose
This study aims to determine the rate of AS progression and its impact on cardiac damage and survival.

Methods
We retrospectively identified 914 patients (age 76 ± 8 years, 52% female, median follow-up time 6.8 years) with AS who had undergone &gt; 1 echocardiogram. Bayesian hierarchical nonlinear models were used to predict aortic peak velocity as a function of time and estimate individual AS acceleration rates. Then, patients were clustered into rapid (RP) and slow progressors (SP) using machine learning algorithms.

Results
APV was best modeled by a logistic function of time. 483 patients were clustered as RP (53 %) and 431 as SP (47 %), with acceleration rate coefficients estimated at 0.14 ± 0.02 years-1 and 0.09 ± 0.02 years-1, respectively (p &lt; 0.01). No association between progression rate and clinical variables was found. Compared with SP, RP had significantly higher 5-year incidences of LV damage, combined left atrium and mitral valve damage and combined tricuspid valve damage and pulmonary hypertension (all p ≤ 0.01). No statistically significant differences were seen for right ventricle damage between RP and SP, as the number of events was low. After multivariate adjustment for age, gender, comorbidities and baseline AS severity, RP remained an independent predictor for all extra-aortic cardiac damages except for the RV dysfunction. Importantly, baseline AS severity was not predictive of AS-related CD. RP was associated with higher mortality (HR 1.28, p = 0.02), persisting after adjustment for demographics, comorbidities, AS severity, and time-dependent aortic valve replacement (AVR) (HR = 1.36, p &lt; 0.01).

Conclusions
RP may impair cardiac adaption to rapidly changing loading conditions, which induces premature cardiac damage that may not be reversible in the late stages of AS, when guideline-triggered interventions are currently delivered.
Long noncoding RNA H19 is elevated in aortic valve stenosis and governs antigenic response and valvular endothelial cell phenotypes through endothelial to mesenchymal transition
Authors: Hosen D R 
Published: November 2023

Abstract

Background
Long noncoding RNAs (lncRNAs) have emerged as important regulators of cardiovascular disease, including aortic valve stenosis (AVS). Endothelial to mesenchymal transition (EndMT) is a transdifferentiation process that is associated with the development of AVS in the elderly population. Although several recent studies have reported that lncRNAs are dysregulated and might play a crucial role in EndMT, no specific role of lncRNA was reported in AVS pathogenesis. Here, we sought to investigate the role of H19 in EndMT during the pathogenesis of AVS.

Methods and results
High-throughput lncRNA sequencing of human aortic valve tissue explanted from patients with AVS due to severe stenosis during surgical aortic valve replacement (SAVR) demonstrated that certain lncRNAs [H19, AGAP2-AS1 (PUNISHER), GAS5, MALAT1] are significantly dysregulated compared to patients without AVS. To validate the RNA-seq data, 60 patients with AVS (n=30) or without AVS (n=30) were prospectively investigated. Among these, H19 (p=0.002), AGAP2-AS1 (p=0.002), and GAS5 (0.02) were significantly upregulated in patients with AVS, compared to non-AVS patients. Aortic valvular endothelial cells (VECs) were isolated from explanted valve tissue from AVS patients or obtained commercially. In vitro EndMT-promoting stimuli (TNFα or TGFß+IL1ß) were used for VEC stimulation for 5 days. RT-qPCR was used to quantify the expression of EndMT markers (EC markers, vWF, and NOS3, and mesenchymal markers, αSMA, SM22, Vimentin, and SNAI2). Loss of H19 led to dysregulation of the EC gene network and protein expression patterns that were analyzed by qRT-PCR, immunoblotting, and immunofluorescence, respectively. Further experiments show that silencing of H19 affects migration and proliferation, and promotes EndMT in EC. Functional assays suggested that H19 is a critical regulator of angiogenic properties. The molecular signature of angiogenesis was investigated using a RT-qPCR-based angiogenesis array to identify the regulation of angiogenesis with 84-angiogenesis-related genes. Mechanistically, the angiogenesis array revealed that H19 regulates Jagged Canonical Notch Ligand 1 (JAG1) (4.43-fold vs. control EC), an important regulator of NOTCH1 signaling, and pro-angiogenic factor in EC. Accordingly, EndMT marker expressions were dysregulated upon H19 depletion. A high-throughput luciferase reporter array demonstrated STAT3 activation upon H19 knockdown. Depletion of H19 increased the phosphorylation of STAT3 at TYR705 and pharmacological inhibition of STAT3 activation abolished the effects of H19 silencing on EndMT marker expression as well as on angiogenesis. Overexpression of H19 in VEC abrogated the H19-mediated promotion of JAG1- and VEGFA gene- and protein expression.
Improved detection of echocardiographically occult left ventricular thrombi following ST-elevation myocardial infarction
Authors: Lechner I , Reindl M , Holzknecht M , Tiller C , Fink P , Oberhollenzer F , Mayr A , Bauer A , Metzler B , Reinstadler S J 
Published: November 2023

Abstract

Background and Aims
Patients with STEMI are at significant risk for developing left ventricular thrombi (LVT). However, this complication often (up to 65%) remains undetected by using transthoracic echocardiography (TTE), referred to as TTE-occult LVT. The aim of this study was to investigate predictors of TTE-occult LVT and to propose a clinical model for improved detection of TTE-occult LVT post ST-elevation myocardial infarction (STEMI).

Methods
In total, 870 STEMI patients underwent TTE and cardiac magnetic resonance (CMR), the reference method for LVT detection, 3 days after infarction. Clinical and echocardiographic predictors were analyzed. Primary endpoint was the presence of TTE-occult LVT identified by CMR-Imaging.

Results
From the overall cohort, 37 patients (4%) showed an LVT by CMR. Of these thrombi, 25 (68%) were not identified by TTE. TTE-occult thrombi did not significantly differ in volume (1.4 vs. 2.74cm3), diameter (19.0 vs. 23.3mm), number of fragments or shape compared with TTE-apparent LVT (all p&gt;0.05). For predicting these TTE-occult LVT, apical wall motion score using the 16-segment model (AWMS16Seg) showed highest validity (AUC:0.91 [95%CI:0.89-0.93];p&lt;0.001), with an association independent of ejection fraction and AWMS17Seg (OR:1.68 [95%CI:1.43-1.97];p&lt;0.001), clinical (body mass index, peak troponin) and angiographic (culprit lesion, post-interventional TIMI flow) associates of TTE-occult LVT (all p&lt;0.05). Dichotomization at AWMS16Seg≥8 (n=260, 30%) allowed for a detection of all TTE-occult LVT (sensitivity:100%), with a corresponding specificity of 77%.

Conclusions
After acute STEMI, AWMS16Segserved as simple and very robust predictor of TTE-occult LVT. An AWMS16Seg-based algorithm to identify patients for additional CMR-imaging offers great potential to optimize detection of TTE-occult LVT following STEMI.Key IllustrationProposed Algorithm
Thirty-year follow-up of patients submitted to percutaneous balloon mitral valvuloplasty for severe rheumatic mitral stenosis
Authors: Jacinto S , Ferreira A P , Almeida Morais L , Bernardes L , Cacela D , Rodrigues I , Galrinho A , Moura Branco L , Timoteo A T , Rio P , Soares C , Fondinho C , Cruz Ferreira R 
Published: November 2023

Abstract

Background
Percutaneous balloon mitral valvuloplasty (PBMV) remains the mainstay of treatment for patients with severe rheumatic mitral stenosis (MS) and a favorable anatomy.

Aim
The present study aimed to assess very long-term outcomes after PBMV.

Methods
A retrospective analysis of PBMV performed at a single tertiary center between August 1991 and September 2022 was conducted. Successful PBMV was defined as a post-procedural functional mitral valve area (MVA) ≥1.5 cm2, mitral regurgitation less than moderate, and absence of in-hospital major cardiac or cerebrovascular events. The primary endpoint was composed of overall mortality and need for mitral reintervention (percutaneous and/or surgical).

Results
A total of 238 PBMV for severe rheumatic MS were conducted in our center during the specified timeframe (88.7% [n=211] female gender; mean age 48 ± 16 years; 48.6% [n=108] had atrial fibrillation [AFib]; 78.8% [n=149] had a Wilkins score ≤8). Acute success was achieved in 88% (n=198) procedures. Acute complications were present in 10.2% (n=23), mainly severe mitral regurgitation (n=10) and acute cerebrovascular events (n=5). During a mean follow-up of 15.3 ± 9.4 years, the incidence of the primary endpoint was 55% (n=131) (overall mortality 32.9% [n=77] and mitral valve reintervention 22.1% [n=54]). On bivariate analysis, higher age (p=0.042), presence of AFib (p=0.002), unsuccess of the procedure (p&lt;0.001), acute complications (p=0.001) and larger left atrial (LA) diameter (p=0.05) were statistically significant for the occurrence of the primary endpoint. On multivariate analysis, larger LA diameter (hazard ratio [HR]: 1.03; 95% CI: 1.00-1.06; p=0.022), unsuccessful procedure (HR: 3.30; 95% CI: 1.56-7.01; p=0.002) and presence of complications (HR: 0.37; 95% CI: 0.17-0.84; p=0.017) were the only independent predictors of the primary endpoint.

Conclusion
In a large registry of patients submitted to PBMV for severe rheumatic MS, more than half met the primary endpoint for overall mortality or need for reintervention, up to 30 years after the procedure. This supports the dismal prognosis of this pathology. Prediction of late favorable results is multifactorial and appears to be determined by smaller LA diameter, absence of complications and acute success of the procedure.Event-free survival after PBMV
A new regional Rheumatic Heart Disease Registry: results of the first 2595 patients
Authors: Kotit S , Yacoub M H 
Published: November 2023

Abstract

Background
Rheumatic Heart Disease (RHD) remains a major cause of morbidity and mortality in low- and middle-income countries. However, specific disease characteristics and progression varies in different regions.

Purpose
We here present preliminary results of a new regional RHD registry.

Methods
A total of 2595 consecutive patients with clinical and echocardiographic RHD were registered from March 2009 and February 2023, and their baseline clinical and echo characteristics, demographics, comorbidities, the pattern and severity of valvular involvement, intervention history and treatment practices were recorded. Follow-up ranged from 1 to 168 months (47±38.8) and was complete in 90.4% of the patients.

Results
The age of the patients ranged from 3-86 years (40.18±13.83). The majority was female (n=1765, 68%). At enrolment only 26 (1%) patients were on secondary penicillin prophylaxis. Symptoms were present in 73.8% (n=1916) of the patients (NYHA III: n=984, 37.9%). 2226 (85.8%) patients had moderate-to-severe multivalvular disease complicated by pulmonary hypertension (n=877, 33.8%), atrial fibrillation (AF) (n=750, 28.9%), cerebrovascular events (n=158, 6%), infective endocarditis (n=17, 0.66%) and thrombosis of valve prosthesis (n=14, 0.54%). Previous cardiac intervention was reported by 492 patients (19%).
Regular 6 monthly follow-up at our centre for periods ranging from 1 to 168 months (47±38.8). During this period a total of 1309 (50.4%) patients underwent cardiac procedures. Balloon Mitral Valvuloplasty was performed in 289 patients (11.1%).
Cerebrovascular events (n=92, 3.5%), LA thrombus (n=22, 0.85%), infective endocarditis (n=13, 0.5%) and thrombosis of valve prosthesis (n=19, 0.73%) occurred during follow-up. Patient mortality was 12.6% (n=328) during the study period (47±38.8 months).
Penicillin prophylaxis rate was 63.3% (n=1742), however, only 15% of these patients followed the penicillin prophylaxis schedule.

Conclusions
In spite of continued cardiac care in this study, young patients with rheumatic heart disease have high morbidity and mortality. Further efforts to determine the exact causes involved and improve prognosis are warranted.
Seven year follow up of subclinical rheumatic disease using WHF criteria
Authors: Bhaya M , Choudhary D , Gupta J , Panwar R B , Panwar V , Gupta B K 
Published: November 2023

Abstract

Background
The prevalence of rheumatic heart disease (RHD) is higher using echocardiographic screening compared with clinical examination. It is proven that clinical screening underestimates the prevalence, but it still remains the cornerstone for the purpose of intervention. Echocardiography can identify subclinical RHD and can be used for subclinical cases and to see progression /regression on follow up. Follow-up data of children with subclinical lesions are very much needed before implementing large scale screening programs in endemic regions. We are submitting the 7 year follow up data for subclinical RHD who were on RF prophylaxis.

Method
A total of 3000 school going children were screened echocardiographically during November 2015 to December 2018 for subclinical rheumatic heart disease using WHF criteria. Subjects with subclinical rheumatic heart disease were given prophylaxis for rheumatic fever in form of injection Benzathine penicillin or oral penicillin or tablet erythromycin depending upon tolerance and acceptance. These cases were followed up at 2-year and 7-year for echocardiographic evaluation and compliance to the prophylaxis.

Results
Out of 3000 cases screened, 114 were found to be having subclinical rheumatic heart disease. 39 subjects turned up for 2-year follow up and 13 subjects turned up for 7-year follow up(Table 1). All 13 were on rheumatic fever prophylaxis. 23% ( 3 out of 13) turned to be with normal echocardiography findings using WHF 2012 criteria.
Limitation: Children who were not taking prophylaxis were not evaluated echocardiographically, therefore comparison could not be done.

Conclusion
Our study shows screening of school going children by echocardiography can detect subclinical rheumatic heart disease and rheumatic fever prophylaxis in such cases can results in reversion of the lesion and prevention of progression of RHD.