bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effective left ventricular ejection fraction by three-dimensional echocardiography is associated with survival and hospitalizations in ventricular secondary mitral regurgitation
Authors: Delcea C , Tomaselli M , Oliverio G , Gavazzoni M , Heilbron F , Pece C , Clement A M , Buta S A , Radu N , Hadareanu D , Mihaila-Baldea S , Badila E , Dan G A , Badano L , Muraru D 
Published: January 2025

Abstract

Introduction
Left ventricular (LV) systolic function is crucial for determining prognosis of patients with ventricular secondary mitral regurgitation (VsMR). However, both the LV ejection fraction (LVEF) and global longitudinal strain are influenced by the volume overload associated with MR. Effective LVEF (eLVEF) is a novel parameter that accounts for mitral regurgitant volumes and overcomes the load-dependency of LVEF.

Pupose
We sought to explore the association of eLVEF measured by three-dimensional (3D) echocardiography with mortality and heart failure (HF) hospitalizations in patients with VsMR.

Methods
We enrolled 212 VsMR patients (mean age 70±13 years, 26% female) from January 2015 to March 2022. 3D-eLVEF was calculated by dividing forward LV stroke volume (SV), measured by 2D-Doppler echocardiography by the LV end-diastolic volume measured by 3DE. The primary outcomes were all-cause mortality and HF hospitalization.

Results
During a mean follow-up of 22±11 months, 22% VsMR patients died and 28% had HF hospitalizations.
In multivariable Cox regression, 3D-eLVEF was independently inversely associated with all-cause mortality (HR 0.93, 95%CI 0.89-0.97, p&lt;0.001) and HF hospitalization (HR 0.95, 95%CI 0.92 – 0.99, p&lt;0.001), outperforming 3D-LVEF and VsMR severity parameters.
In ROC analysis, cut-off values associated with all-cause mortality were 3D-eLVEF≤24% (77% sensitivity, 61% specificity, AUC 0.74, 95%CI 0.67-0.79, p&lt;0.0001), 3D-LVEF≤40% (87% sensitivity, 44% specificity, AUC 0.69, 95%CI 0.62-0.75, p&lt;0.0001).
Kaplan-Meier analysis demonstrated increasing event rate with 3D-eLVEF≤24% independent of LVEF higher or lower than 40% (log-rank, p&lt;0.001). Patients with 3D-eLVEF≤24% and 3D-LVEF &gt;40% had a worse prognosis than patients with 3D-LVEF≤40% and 3D-eLVEF&gt;24% (log-rank, p&lt;0.001). Those with 3D-eLVEF≤24% had the most HF hospitalizations, irrespective of 3D-LVEF (log-rank, p=0.002)(Figure 1).

Conclusions
In patients with VsMR, 3D-eLVEF was independently associated with all-cause mortality and HF hospitalization. 3D-eLVEF≤24% had a stronger association with both outcomes compared to 3D-LVEF≤40% and refined the risk stratification.
Comparison of diastolic function parameters in transthoracic and transoesophageal echocardiography in patients under mechanical ventilation
Authors: Trauzeddel R , Sieber V , Adamsen A , Greiner A , Berger C , Treskatsch S 
Published: January 2025

Abstract

Background
Hemodynamically focused echocardiography in the perioperative setting allows for the evaluation of cardiovascular function and hemodynamic optimisation in heart failure, especially in heart failure with preserved ejection fraction (HFpEF). However, little is known about the comparability of the Doppler methods for the assessment of left ventricular diastolic function in transoesophageal (TEE) and transthoracic echocardiography (TTE) in intubated patients.

Purpose
The aim of the study was to investigate the comparability of Doppler parameters for the assessment of left ventricular diastolic function in mechanically ventilated patients.

Methods
This study was approved by the institutional ethics committee (Charité – Universitätsmedizin Berlin, EA 4/134/21) and registered at the German Clinical Trials Register (DRKS, DRKS-ID DRKS00027554). A hemodynamically focused TTE and TEE examination was conducted directly one after the other by an experienced examiner under consistent and equal cardiopulmonary conditions in invasively ventilated patients following the induction of general anaesthesia and prior to the commencement of non-cardiac surgery. Diastolic parameters were measured either directly by the examiner or subsequently using the workstation TomTec-Arena version 2.51.04 without Doppler angle corrections. The parameters compared included peak E-wave velocity, peak A-wave velocity, E/A ratio, pulsed-wave tissue Doppler e' average velocity and E/e' average ratio. For quantitative data mean ± standard deviation (SD) are presented. For comparability analyses relative differences (RD) and intraclass correlation coefficients (ICC) as well as Bland-Altman plots assessing the bias and 95% limits of agreement are presented which were calculated using SPSS version 29 and GraphPad PRISM version 9.

Results
17 female and 36 male patients were examined with an age of 66.3 ± 11 years. There was moderate to excellent agreement between the two image modalities (E-wave: RD=3.6±26.5%, ICC=0,816; A-wave: RD=5.3±27.3%, ICC=0.749; E/A: RD=-1.6±32.2%, ICC=0.716; e’ septal: RD=3.9±28.2%, ICC=0.633; e’ lateral: RD=2.6±32.6%, ICC=0.521; e´ average: RD=2.1±22.4%, ICC=0.762; E/e’ septal: RD=-0.8±28.3%, ICC=0.888; E/e’ lateral: RD=0.5±37.4%, ICC=0.817; E/e’ average: RD=0.2±27.2%, ICC=0.920). Bland-Altman plots showing the comparability are displayed in Figure 1.

Conclusion
In the perioperative setting TEE may be used for the evaluation of diastolic function in intubated patients under general anesthesia.
Phenotyping atrial and ventricular secondary tricuspid regurgitation based on aetiologies: insights from the CARE-TR registry
Authors: Lupi L , Antonioli E , Praderio A , Saccani N , Stanskowski K , Cocciani D , Pagliaro B , Tomasoni D , Pagnesi M , Mangieri A , Stolfo D , Sinagra G , Adamo M , Metra M 
Published: January 2025

Abstract

Purpose
To report prevalence and clinical outcomes of different phenotypes of atrial and ventricular secondary tricuspid regurgitation (ASTR; VSTR) enrolled in a prospective observational registry.

Methods and Results
The Consecutive pAtients with seveRE Tricuspid Regurgitation evaluated in Heart Failure (HF) and Valve Clinics (CARE-TR) registry collected data from patients with at least severe tricuspid regurgitation (TR) enrolled at 3 Italian Centres between January 2020 and December 2022. The present analysis includes 648 patients with secondary TR (STR), 143 (22.1%) with ASTR and 505 (77.9%) with VSTR. Patients with ASTR were further stratified in those with atrial fibrillation (AF, 25.1%), HF with preserved ejection fraction (HFpEF, 37.8%), and both (37%). Patients with VSTR were subdivided into those with severe left-sided valvular heart disease (LS-VHD, 28.5%), HF with reduced or mildly reduced ejection fraction (HFrEF/HFmrEF, 29.1%), HFpEF (35.5%), precapillary pulmonary hypertension (PH, 4.0%) and isolated right ventricular (RV) dysfunction (2.9%). After a median follow-up of 498 days (IQR 379-676) 118 (18.2%) patients died and 153 (23.6%) were hospitalized for HF. Two-year survival free from death or HF hospitalization was higher in the patients with ASTR compared with those with VSTR (73.5% vs 54.4%; p&lt;0.001). After adjustment for variables related with HF severity, VSTR remained independently associated with an increased risk of events (adjusted HR 2.00; CI 95% 1.36-2.95; p&lt;0.001). Among ASTR patients, combined AF and HFpEF was associated with a poorer outcome compared with AF or HFpEF alone (60.2% vs 80.5% vs 83.6%, p=0.022). Among patients with VSTR, overall survival free from the composite outcome was 85%, 65%, 54%, 39% and 38% for RVD, HFpEF, HFrEF/HFmrEF, severe LS-VHD, and pre-capillary PH, respectively (p&lt;0.001).

Conclusions
In a real-world population with at least severe STR, 22% had ASTR and showed better outcomes as compared to VSTR. Among patients with ASTR, combination of AF and HFpEF was common and associated with the worst prognosis. Among patients with VSTR, those with pre-capillary PH had the poorest outcomes, followed by those with LS-VHD.
Identification of risk phenogroups among patients with moderate-to-severe tricuspid regurgitation by unsupervised cluster analysis
Authors: Radu D N , Badano L P , Penso M , Tomaselli M , Clement A , Gavazzoni M , Hadareanu D R , Delcea C , Fisicaro S , Parati G , Muraru D 
Published: January 2025

Abstract

Background
Assessing the individual risk of patients with secondary tricuspid regurgitation (STR) is challenging as it requires integrating disease severity and mechanism with different clinical and imaging characteristics. Several scores and cluster analysis have recently been proposed, almost all of them using visual estimation or conventional echocardiography for the evaluation of right ventricle (RV) size and function. However, advanced echocardiography has been scarcely used so far in this context.

Purpose
We sought to identify the different phenogroups of STR using unsupervised cluster analysis and assess their association with clinical outcomes.

Methods
We included 558 consecutive patients (mean age 74±14 years, 54.7% women) with moderate and severe STR who underwent comprehensive two-, three-dimensional, and speckle-tracking echocardiography. The primary endpoint was a composite of heart failure hospitalization and all-cause mortality. Four unsupervised algorithms were used to cluster STR patients based on 16 variables recruited from demographics or echocardiographic domains, routinely obtained for the assessment of STR or having prognostic value.

Results
Over a median follow-up of 16.5 months, 215 patients reached the composite endpoint. A cluster analysis divided the patients into three phenogroups with distinct characteristics: Phenogroup 1 "lowest-risk STR" (rate of event-free survival at two years: 80±3%) with moderate STR, preserved RV size and function, and moderately dilated but normofunctional RA; Phenogroup 2 "intermediate-risk STR (hazard ratio [HR] 2.37, 95% confidence interval [CI] 1.14-4.92, p=0.02) characterized by older age, severe STR, mildly dilated but uncoupled RV; and Phenogroup 3 "highest-risk STR" (HR 3.83, 95% CI 1.94-7.54, p&lt;0.001), characterized by younger age, massive-torrential TR, severely dilated and overtly dysfunctional RV, and dysfunctional RA. After adjusting for multiple variables, the clustering analysis remained independently associated with the composite endpoint (HR 1.40, 95% CI 1.13–1.70, p=0.002, for each increased-risk phenogroup). Additionally, a supervised machine learning model was developed to assist clinicians to assign patients to one of the three phenogroups. The model successfully matched each patient with an accuracy of 0.91, precision 0.91, recall 0.91, and F1 score of 0.91.

Conclusions
The unsupervised cluster analysis has identified three risk phenogroups with distinct characteristics and different risk of experience death or hospitalization for HF which could potentially assist clinicians in developing more personalized treatment and follow-up strategies for STR patients.
Figure 1
Figure 2
Challenging sacred cows: does left ventricle end-systolic and end-diastolic diameter change significantly in long term follow up of patients with severe aortic regurgitation ?
Authors: Schwartzenberg S , Bental T B , Vaturi M V , Shapira Y S 
Published: January 2025

Abstract

Background
American and European valvular heart disease guidelines suggest considering aortic valve surgery in patients with severe aortic regurgitation (AR) and progressive increase in left ventricle (LV) end diastolic diameter (LVEDD) into the severe range or progressive decrease in LV function. Surprisingly, there are almost no studies that actually examined systematically the rate of change over time in these widely used parameters in clinical practice in patients with severe AR.

Purpose
determine the rate of change in LVEDD, left ventricular end systolic diameter (LVESD) and fractional shortening (FS) in patients with significant AR over a long period of time.

Methods
we considered all consecutive patients with at least moderate to severe AR on index transthoracic echo study and at least four subsequent echo studies over a follow-up period longer than 1.5 years in a large tertiary hospital registry between April 1994 and April 2024. Exclusion criteria were concomitant greater than mild to moderate aortic stenosis or mitral valve disease, aortic dissection, previous aortic or mitral surgery, hypertrophic cardiomyopathy or complex congenital heart disease on index study. Aortic valve replacement (AVR) or death terminated follow-up in this study. Partial correlation corrected for repeated measures was determined for LVEDD/LVESD/FS and interval period (in days) between repeat studies.

Results
We included a cohort of 140 patients meeting the inclusion criteria study after excluding 31 patients as per above criteria. Aortic valve was bicuspid in 39 (27.9%) of the patients, and unicuspid in 4 (2.9%) patients. Median follow-up was 4.4 years (interquartile range (IQR) 1.9 to 8.8 years), median interval between consecutive studies was 255 days (IQR 172 to 367 days), 35 (25%) patients died and 61 (43.6%) patients underwent AVR. Partial correlation coefficients and p values for LVEDD, LVESD, and FS were respectively -0.3 (p&lt;0.0001), -0.032 (p=0.24), and -0.18 (p&lt;0.001).

Conclusions
Contrary to conventional wisdom, we didn’t find a significant trend of dilatation in left ventricular end diastolic and end-systolic LV diameter in patients with ≥ moderate to severe AR over a long follow-up, but a weak trend of fractional shortening decrease over time was noted. These findings cast doubt on the utility attributed to change in these parameters as part of the routine clinical follow up of patients with significant AR.
LVEDD and LVESD change over time
Cardiac biomarkers in patients with systemic lupus erythematosus: association with valvular heart disease and utility for routine screening
Authors: Cocolea S , Delcea C , Badea-Lupasteanu I , Buzea C A , Dima A , Soium E , Badila E , Dan G A 
Published: January 2025

Abstract

Background
Valvular heart disease (VHD) is more prevalent in patients with systemic lupus erythematosus (SLE) compared to the general population, determined by direct autoimmune involvement as well as early valvular degeneration, and is associated with higher morbidity and mortality.

Purpose
We aimed to assess the utility of cardiac biomarkers in screening SLE patients for the early detection of VHD.

Methods
This observational prospective cohort study included consecutive adult SLE patients evaluated in our Cardiology Department between August 2021 and May 2024. Clinical data, echocardiography and laboratory parameters including NT-proBNP and high-sensitivity cardiac troponin T (hsTnT) were obtained. Patients with left ventricular ejection fraction ≤50% were excluded. Echocardiographic diastolic dysfunction (DD) was defined according to the 2016 ASE/EACVI guidelines.

Results
Our cohort included 86 SLE patients (mean age 53±12 years, 96% female, 30% with moderate VHD, 41% DD). Median disease duration was 13[IQR 4-21] years.
NTproBNP was associated with DD, mitral regurgitation (MR), aortic regurgitation (AR), and mitral stenosis (MS) (Table 1), but not with ischemic heart disease (IHD) (AUC 0.560, p=0.61), arterial hypertension (HTN) (AUC 0.553, p=0.43), or diabetes mellitus (DM) (AUC 0.637, p=0.29).
hsTnT was associated with DD, MR, AR, MS (Table 1), with IHD (AUC 0.749, p=0.004) and pericardial disease (PD)(AUC 0.736, p=0.002), but not with HTN (AUC 0.612, p=0.12), DM (AUC 0.524, p=0.86).
Association of NTproBNP and hsTnT and VHD was documented for patients with and without DD (Table 1).
In multiple linear regression models adjusted for age and DD, MR (p=0.038), MS (p&lt;0.001), AR (p=0.017) were independent predictors of NTproBNP levels.
In multiple linear regression models adjusted for age, DD, PD, and IHD, MS (p&lt;0.001) and AR (p=0.032) were independent predictors of hsTnT levels.

Conclusions
Increased levels of NTproBNP and hsTnT in SLE patients should prompt echocardiographic evaluation and screening for VHD and DD.
infective endocarditis - what contributes to a bad outcome?
Authors: Milic G , Mladenovic Z M , Ciric N C , Djuric P D J , Jovic Z J , Djuric I D J 
Published: January 2025

Abstract

Introduction
The diagnosis and treatment of infective endocarditis is a major challenge. The clinical course depends on the causative agent, the presence or absence of previous cardiac disease, artificial valves or implantable intracardiac devices, and the mode of presentation.

Purpose
To determine the 30-day mortality rate in patients with infective endocarditis.
Determine the mortality rate of patients after one year from the diagnosis of infective endocarditis.
Statistical analysis is used to assess the correlation between the characteristics of patients determined at admission and 30-day, i.e. mortality one year after diagnosis.
Determine the clinical significance of the results obtained in the diagnosis and treatment of patients with infective endocarditis.

Method
A prospective study analyzed patients with infective endocarditis treated between 2017 and 2023. The study included 59 patients with infective endocarditis with an average age of 62.4 ± 16.0 years, the representation of the male sex was twice as high. A total of 18 patients had artificial valves, of which 18 had an aortic valve, and two had an aortic and mitral prosthetic valve, 10 patients had a previously implanted pacemaker.

Results
In 19 patients, there was a fatal outcome after one month, with a mortality rate of 32%, and after one year, the fatal outcome occurred in 32 patients, with a mortality rate of 59%.
Predisposing factors independently associated with a higher probability of death after the one-month period were heart failure as a complication of infective endocarditis (OR = 0.025, 95% CI OR = 0.01-0.26, p = 0.002) and a higher number of days of hospitalization (OR = 1.160, 95% CI OR = 1.05-1.28, p = 0.003).
Predictors of death one year after diagnosis were the age of the patient, the presence of a congenital bicuspid aortic valve, uncontrolled infection and heart failure as complications of infective endocarditis, as well as a number of days until the ventilator. Independent predictors of one-year mortality were the presence of bicuspid aortic valve (OR = 33,500.95% CI OR = 1.26-887.90, p = 0.036) and a higher number of days to ventilator (OR = 0.536.95% CI OR = 0.32-0.90, p = 0.018).

Conclusion
An increased mortality rate in patients with infective endocarditis was present in those who had previously been highly febrile for a long period of time due to untimely diagnosis and subsequent treatment, in the elderly population, most likely due to a large number of comorbidities, then in patients with congenital heart defects, in those with previously implanted artificial valves or intracardiac electronic devices.
Factors associated with one-month death
Factors associated with one-year death f
TRIVO score: a new tool for predicting outcome in patients with secondary tricuspid regurgitation.
Authors: Tomaselli M , Penso M , Badano L , Clement A , Radu N , Heilbron F , Oliverio G , Baratto C , Caravita S , Springhetti P , Ciambellotti F , Fisicaro S , Pece C , Parati G , Muraru D 
Published: January 2025

Abstract

Background
Predicting outcomes in patients with significant secondary tricuspid regurgitation (STR) is extremely challenging.

Purpose
This study sought to develop and validate the TRIVO-SCORE, utilizing advanced echocardiographic parameters, for predicting hospitalization for heart failure (HF) and mortality in moderate and severe STR patients.

Methods
We retrospectively studied 504 consecutive STR outpatients (mean age 74 ± 13 years, 44% men), randomly divided into derivation (49%) and validation (51%) cohorts. The primary endpoint included all-cause death and/or heart failure HF hospitalization, whereas the secondary endpoint focused on HF hospitalization or all-cause death. Score discrimination was assessed using time-dependent area under the receiver operating characteristic curve (AUROC), and calibration was evaluated via the Hosmer-Lemeshow goodness-of-fit test. In a subset of patients (162/504, 29%) with severe STR and comprehensive clinical, laboratory, and echocardiographic data, we compared TRIVO-SCORE with TRI-SCORE and TRIO-SCORE.

Results
After Multivariable Cox Regression Analysis, four variables were incorporated into the final model: moderate to severe chronic kidney disease (CKD, GFR &lt;30 mL/min), effective Right Ventricular Ejection Fraction (eRVEF &lt;20%), right Ventricular free wall longitudinal strain/pulmonary artery systolic pressure (RVFWLS/PASP) &lt;0.48, and effective regurgitant orifice area (EROA) &gt;0.41cm². The final score ranged from 0 to a maximum of 5 points.
The TRIVO-SCORE demonstrated satisfactory performance in both the derivation cohort (AUROC 0.78, 95% CI 0.73-0.84) and the validation cohort (AUROC 0.71, 95% CI: 0.65-0.77) at 2-year. TRIVO-SCORE accurately predicted separate endpoints for HF hospitalization or mortality. Per each point of TRIVO-SCORE, the risk of experiencing the composite endpoint increased by 1.5 times (HR 1.55 [95% CI 1.35–1.80], p&lt;0.001, for each stage increase). This progressive increase in risk persisted when stratifying the population into atrial and ventricular STR. The discrimination and calibration for mortality prediction were superior to those of TRI-SCORE (1) (AUROC 0.61) and TRIO-SCORE (2) (AUROC 0.57).

Conclusions
The TRIVO-SCORE, integrating both clinical and advanced echocardiographic variables, proved to be a robust tool for enhancing risk stratification in patients with moderate to severe STR, providing a stronger association with outcomes than previously validated risk scores.