bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical impact of right atrium function on tricuspid regurgitation
Authors: Rocca B , Pilan M , Benfari G , Bergamini C , Maffeis C , Tafciu E , Ribichini F L 
Published: January 2025

Abstract

Background
tricuspid regurgitation (TR) is frequent, and its related systemic venous congestion is associated with mortality.

Purpose
This study aims to evaluate the role of right atrial (RA) function, measured using the strain technique, on the medium- to long-term clinical effects of tricuspid regurgitation (TR). Our primary objective was to analyze the impact of RA function, measured at baseline, on a composite endpoint consisting of death and/or hospitalization for predominantly right-sided heart failure. The secondary endpoints are hospitalizations, worsening of renal function, and an increase in diuretic dosage (DD).

Methods
We performed a single center, prospective, observational study regarding adult patients with tricuspid regurgitation and measurable effective regurgitant orifice area (EROA) and a state of hemodynamic stability that underwent a complete echocardiography and full cardiologic evaluation in our Institution, from January 2020 to February 2023. Those patients with acute HF, poor quality imaging, previous repair or prosthetic replacement of the tricuspid valve, and severe renal or hepatic insufficiency were excluded. Patients were assessed clinically at each follow up.

Results
134 patients were included (females 62%, mean age 73 ± 13 years old). Median follow up was 23,5 months (12 - 34 months). TR was functional in 87% of cases and was more than moderate in 52% of cases. Mean RA strain was 18,7 ± 11,2%, and divided patients in low strain (LS) and high strain (HS). HS was associated with lower increase and frequently a decrease in DD (-5,5 ± 44,7 mg vs 20,8 ± 63,2 mg, p = 0,009) but no echocardiographic variable independently predicted an increase in DD. Patients with worsening renal function had significantly lower RA (16.7 ± 10.6% vs 20.7 ± 10.9%, p 0.042). LS independently predicted a worsening renal function (OR 3,07; 95% CI 1,026-9,2). RA strain was significantly lower in hospitalized patients (13.1 ± 8 vs 20.3 ± 11.4, p&lt;0.001). Cox regression analysis showed a LS to be an independent predictor of the composite endpoint (adjusted HR 3.1, 95% CI 1.101 – 8.74) correcting for other clinical and echocardiographic variables. ROC curve analysis showed an RA strain cut-off of 18.5% to have a sensitivity of 79% and specificity of 56% in predicting the combined endpoint.

Conclusions
RA strain is associated with DD and LS patients have higher DD at follow up. RA strain is an independent predictor of worsening renal function. RA function measured by strain is an independent predictor of the composite endpoint of death and/or hospitalization.
Prediction of mortality and heart failure admission with the mitraScore after percutaneous mitral valve repair: an external validation study
Authors: Barreiro Mesa L , Ruiz Ortiz M , Esteban Martinez F , Delgado Ortega M , Rodriguez Almodovar A , Ojeda Pineda S , Roldan Guerra A , Urbano Sanchez C , Aguayo Cano N , Suarez De Lezo J , Lopez Aguilera J , Gonzalez Manzanares R , Pan Alvarez Osorrio M , Mesa Rubio D 
Published: January 2025

Abstract

Background
Prediction of events is critical in decision-making for transcatheter edge-to-edge mitral valve repair (TEER). A new score has been reported for this aim, the MitraScore, that showed adequate performance for predicting death and heart failure rehospitalization in an external validation cohort described in the original publication.

Purpose
Our aim was to perform an external validation of this prognostic score in an independent sample.

Methods
The MitraScore assigned 1 point to each independent predictor of mortality found in the validation cohort: age ≥75 years, anemia, glomerular filtrate rate &lt;60 mL/min/1.73 m2, left ventricular ejection fraction &lt;40%, peripheral artery disease, chronic obstructive pulmonary disease, high diuretic dose, and no therapy with renin-angiotensin inhibitors. We calculated the MitraScore in every subject of a prospective cohort of patients treated with TEER in a single institution from November 2011 to January 2024. Association of the score with mortality and the combined end-point of heart failure admission or death was assessed by the Cox proportional hazard method and Kaplan Meier curves. Discrimination was studied by receiver operating characteristics (ROC) curve.

Results
A total of 191 consecutive patients (median age [p25-75] 74 [64-80] years, 33% female) were included in the study. Our sample differed significantly from the original derivation and validation cohorts in several baseline variables (figure 1). After a median follow up of 24 [9-50] months, 92 patients (48.4%) had 160 admissions for heart failure and 73 patients died (38.2%). MitraScore, as a continuous variable, had a significant association with mortality and the combined end-point in follow-up, either by univariate Cox analysis (HR 1.36 [1.11-1.66] per each score point, p=0.003 for all-cause mortality, and HR 1.35 [1.11-1.65] per each score point, p=0.003 for the combined end-point), and Kaplan Meier analysis (figure 2). Discrimination by ROC analysis was nearly significant for both end-points (C statistics 0.58 [0.50-0.67], p=0.052 for all-cause mortality, and HR 0.58 [0.49-0.66], p=0.068 for the combined end-point).

Conclusion
The MitraScore, considered as a continuous variable, was significantly associated with mortality and the combined end-point of heart failure admission or death in follow-up in the present external validation study. These data support the use of this prognostic index in risk stratification for patients treated with TEER.
PISA method correction by leaflet tethering angle and regurgitant jet velocity, and its association with outcomes in patients with secondary tricuspid regurgitation
Authors: Gagliardi M F , Tomaselli M , Penso M , Badano L P , Clement A , Radu N , Heilbron F , Gavazzoni M , Hadareanu D R , Oliverio G , Fisicaro S , Pece C , Delcea C , Muraru D 
Published: January 2025

Abstract

Background
Although the correction of the proximal isovelocity surface area (PISA) method has been shown to improve the accuracy of assessing the severity of secondary tricuspid regurgitation (STR), its clinical impact remains to be investigated.

Purpose
To compare the strength of the association of the quantitative parameters of STR severity obtained from the corrected and conventional PISA methods with outcomes in patients with either atrial- or ventricular STR.

Methods
We used both the conventional and corrected PISA method to obtain effective regurgitant orifice area (EROA and EROAc, respectively), regurgitant volume (RegVol and RegVolc, respectively), and regurgitant fraction (RegFr and RegFrc, respectively) in 519 consecutive patients (75±12 years, 44% men, 74% ventricular STR) with moderate and severe STR. The endpoint was a composite of heart failure hospitalization and all-cause death.

Results
EROAc, RegVolc, and RegFrc were significantly larger than EROA (bias= 21 mm2, Limits of agreement, LOA= 25 mm2), RegVol (bias= 18 mL, LOA= 18 mL), and RegFr (bias= 24%, LOA= 17%) (P &lt; 0.001 for all). After a follow-up of 19±15 months, 210 patients reached the endpoint. Threshold values for an excess of events using the corrected PISA parameters were larger in patiets with ventricular (EROAc = 51 mm², RegVol = 42 mL) than atrial STR (EROAc = 46 mm², RegVolc = 30 mL), except the RegFr that was significantly smaller in patients with ventricular STR (56% vs. 69%). Using time-dependent ROC curves, the AUCs of the parameters obtained from the corrected PISA were more closely associated with outcomes at two years than those obtained with the conventional PISA: EROAc vs. EROA (0.62 vs. 0.60, p&lt;0.001), RegVolc vs. RegVol (0.63 vs. 0.62, p=0.001), and RegFrc vs. RegFr (0.66 vs. 0.63, p&lt;0.001) in patients with ventricular STR. Conversely no significant differences between AUCs were detected in patients with atrial STR. In both univariable and multivariable analyses, both EROA and EROAc, RegVol and RegVolc, or RegFr and RegFrc consistently emerged as independently associated with outcomes in patients with ventricular STR (p&lt;0.001 for all). Conversely, in patients with atrial STR, although EROA and EROAc retained their independent predictive power, neither uncorrected nor corrected RegVols and RegFrs were found to be independent predictors of outcomes after multivariable adjustment.

Conclusions
Correcting the PISA method for the leaflet tethering angle and the velocity of the regurgitant jet provides larger quantitative parameters of STR severity. In patients with ventricular STR, the parameters obtained with the corrected PISA method are more closely associated with those obtained with the conventional PISA.
Prognostic significance of tricuspid regurgitation grading using different echocardiographic approaches
Authors: Mattig I , Romero Dorta E R , Frumkin D , Kretzschmar H , Sommer A , Redel A M , Buchstaller J , Sanchez Gomez O J , Pieske-Kraigher E , Stangl K , Hindricks G , Dreger H 
Published: January 2025

Abstract

Introduction
Tricuspid regurgitation (TR) is routinely graded using quantitative and qualitative echocardiographic parameters. The current grading scheme consists of five TR grades and primarily incorporates vena contracta (VC) and effective regurgitation orifice area (EROA) assessed by the proximal isovelocity surface area (PISA) method. Additionally, an angle-corrected PISA method was proposed as the standard approach seem to underestimate especially ventricular TR.

Purpose
Since different measurements may lead to different TR severity grades, the present study aimed to evaluate the prognostic significance of TR grading using various approaches.

Methods
Hospitalized patients with heart failure (HF) according to current guidelines of the European Society of Cardiology (ESC) were enrolled from 2020 to 2022 (NCT04570098). Inclusion criteria comprised an echocardiographic examination up to three months prior to study participation. TR was graded into the categories moderate to torrential according to the recommended standard, including all quantitative and qualitative parameters as proposed by the guidelines, biplane VC, PISA EROA, and angle-corrected PISA EROA. Survival status was assessed during twelve-month follow-up. Cox regression analysis and log-rank test were used to evaluate the prognostic value of TR grades according to the different echocardiographic methods with the reference category none or mild TR.

Results
A total of 1003 HF patients were enrolled, including 66% with none or mild TR. The prevalence of moderate to torrential TR depending on the use of the different methods was as follows: 18% moderate, 10% severe, 2% massive, and 3% torrential TR according to quantitative and qualitative parameters; 12% moderate TR, 6% severe TR, 4% massive TR, and 4% torrential TR assessed by PISA EROA; 9% moderate TR, 6% severe TR, 3% massive TR, and 6% torrential TR according to angel-corrected PISA EROA; as well as 13% moderate TR, 14% severe TR, 4% massive TR, and 1% torrential TR measured by VC. During the study period, the overall-mortality rate reached 15%. A more severe TR was associated with an increase in mortality regardless of the TR grading approach (log-rank test p&lt;0.001). As shown in Table 1, only TR grading based on VC consistently demonstrated an increased mortality risk across all severity grades.

Conclusion
There are various parameters for TR quantification used in clinical routine. Overall, a more severe TR was associated with an increase in all-cause mortality in HF patients. VC may be superior to PISA EROA and angle-corrected PISA EROA to differentiate the mortality risk of moderate to torrential TR.
The response of total isovolumic time (t-IVT) to transcatheter aortic valve implantation (TAVI)
Authors: Tsigkriki L , Koulaouzidis G , Lazaridis P , Leptopoulos E , Grammenos O , Tsaousidis A , Tzalamouras V , Siarkos M , Maligkos G , Giannakopoulou P , Mavrogianni A D , Henein M Y , Zarifis I 
Published: January 2025

Abstract

Background
Total isovolumic time (t-IVT), the period of neither filling nor ejection, reflects global cavity dyssynchrony. It is free of geometric assumptions and has been demonstrated to serve as a reliable predictor of early response to various heart failure management strategies, medical and interventional.

Purpose
The aim of this prospective study is to assess the response of t-IVT to transcatheter aortic valve implantation (TAVI) as well as its relation to other echocardiographic parameters of myocardial function.

Methods
This is a single-center prospective study, which included patients with symptomatic, severe aortic stenosis (AS) who underwent TAVI. Echocardiographic myocardial function parameters included LV ejection fraction (EF), Tei-index and t-IVT and were assessed at three occasions; at baseline; within one month of TAVI and 3 months after procedure.

Results
The studied population consisted of 35 consecutive (81.6 ± 5.4 years, 19 males) patients. No deaths or major cardiovascular events were reported during the study period of 3 months after the TAVI. Seven (7) patients had LV EF ≤45%. After TAVI LV EF increased (from 51.7 ± 6.6 to 53.7 ± 5.6%; p=0.008), while Tei-index remained normal (from 0.33 ± 0.09 to 0.39 ± 0.06, p=0.02). Likewise, t-IVT shortened (from 9.1 ± 4.7 to 6.8 ± 4.8 s/min, p=0.005). Neither E/A (0.93 ±0.43 vs.0.94± 0.47, p=0.9) nor E/E’ (18±10.6 vs. 17.2± 8.7, p= 0.6) demonstrated any significant change. Finally, the BNP levels were reduced after TAVI (from 408.9 ± 497.9 to 289.5 ±276.9, p=0.03). An increase in LV EF&gt;10% was observed in 17 patients in whom there was a significantly profound fall in t-IVT compared to the rest (36.3 ±16.2 vs. 24±12.2, p=0.001).

Conclusion
In patients with severe AS, t-IVT is prolonged particularly in those with worse LV EF. The significant recovery of both markers reflect better procedure related systolic and synchronous function recovery.
Discriminative power of dobutamine echocardiography in patients with discordant low gradient aortic stenosis and preserved left ventricular ejection fraction.
Authors: Galli E , Le Ven F , Coisne A , Bernard A , Le Pabic E , Donal E 
Published: January 2025

Abstract

Aims
to explore the value of dobutamine stress-echocardiography (DSE) to identify severe aortic stenosis (AS) in patients with discordant low-gradient AS and preserved left ventricular ejection fraction (LVEF&gt;50%).

Methods
Among 52 patients (age 79±7 years; males 46%, mean aortic gradient: 31±5 mmHg) with low gradient AS stenosis and preserved LVEF prospectively enrolled in the ROTAS trial, 42 underwent both DSE and CT aortic calcium score.
An aortic calcium score &gt; 1200 AU in women and &gt; 2000 AU in men was used as a referral limit to identify severe AS. The Youden method was used to identify the best cut-off rest and stress echocardiography aortic parameters able to predict AS severity.

Results
In the overall population, DSE-parameters such as aortic valve area (AVA), indexed AVA (AVAi), aortic maximal velocity (AVMax), mean aortic gradient (MAG) and projected AVA (AVAproj) were modest predictors of AS severity
Limiting the analysis to patients with stroke volume index &lt; 35 ml/m², a DSE AVMax&gt; 4.5 m/sec was a fair predictor of AS severity (AUC 0.73, Se 60%, Sp 95%, PPV 86%, NPV 81%, accuracy 82%) (Table1).

Conclusions
in patients with discordant low-gradient AS and preserved LVEF, echo-derived parameters have a modest predictive value for the detection of severe AS. A slightly better performance is observed when limiting the analysis to patients with low-flow.
Hemodynamic forces assessment in severe aortic stenosis undergoing transcatheter aortic valve intervention
Authors: Angotti D , Monosilio S , Cimino S , Netti L , Ciuffreda A , Tocci M , Improta R , Di Pietro G , Mancone M , Vizza C D , Maestrini V 
Published: January 2025

Abstract

Background
Estimated hemodynamic forces (HDFs) are a novel and validated marker of cardiac function evaluation computed by standard echocardiography. They have been demonstrated to be altered in many cardiac diseases, such as heart failure. However, their application in valvular disease is still not completely known.

Aim
to analyze left ventricular (LV) HDFs in patients with severe aortic stenosis before and immediately after transcatheter aortic valve implantation to reveal whether cardiac changes occur early after the procedure.

Methods
All the patients with severe aortic stenosis referred to ourutively enrolled. Transthoracic echocardiography (TTE) was performed before and early after the procedure (within five days). Standard TTE parameters for volume dimension and function were collected along with peak and mean aortic gradients and aortic valve area. TTE cine loops in 3-2 and 4 chambers were analyzed offline with a dedicated speckle tracking echocardiography (STE) software to compute global longitudinal strain (GLS) and HDFs using LV endocardial displacement and the estimated mitral and aortic valve areas as input. HDFs were computed during the entire cardiac cycle, in systole and diastole, in their two main directions: apex-to-base (AB) and lateral-septal (LS). The LS over AB ratio was also calculated, representing HDFs’ distribution into the LV. HDFs were normalized with LV volumes and expressed as a percentage of the force of gravity.

Results
31 patients undergoing TAVI were enrolled (mean age 82 years ± 7, 45 % females, Euroscore II 4.2% ± 2.1, 71% history of CAD). Baseline standard and advanced TTE parameters are described in the table. After the procedure, no significant changes in ejection fraction (55±9 vs. 57±10, p=0.105) were observed, while a trend in GLS improvement was observed even without statistical significance (-16.6±9.1 vs -19.1±5.8, p=0.63). HDFs in the entire cycle showed a significant improvement in terms of magnitude, apical-base (p=0.08) and lateral septal (p=0.01), but no significant changes in the LS/AB ratio were observed, even if there was a slight reduction (p=0.670).
A slight improvement in HDFs AB and LS and a reduction in LS/AB ratios were observed in both systole and diastole, even if they were not statistically significant (Table).

Conclusions
Preliminary data suggest that HDFs by TTE, representing advanced LV function evaluation, showed a trend in improvement after acute pressure unloading in TAVI patients. A greater cohort is needed to expand these data.
Figure 1
Table 1
Long-term temporal and seasonal trends of infective endocarditis
Authors: Pereira Mateus C , Gerardo F , Miranda I , Sarmento M , Lima Lopes J , Passos M , Bicho Augusto J 
Published: January 2025

Abstract

Background
Over the past two decades, the epidemiology of infective endocarditis (IE) has changed significantly with the increase of life expectancy, use of cardiac implantable devices, and more invasive procedures. There is an ongoing shift in the incidence of IE, but a temporal/seasonal association with specific pathogens is yet to be investigated.

Aims
In this study, we aimed to assess (1) whether there is a temporal trend / increase in IE incidence in recent years, and (2) if there is a seasonality among specific IE-related pathogens.

Methods
We conducted a single center retrospective study of all consecutive patients in a 6-year period between 2017 and 2022, with a diagnosis of definite infective endocarditis as assessed by the modified Duke criteria. All electronic medical records were reviewed for demographics, blood cultures dates and results, and echocardiographic results were analyzed. The blood cultures collection date was used to define the time of the year for IE. Seasons were defined according to the northern hemisphere as Winter (January to March), Spring (April to June), Summer (July to September) and Autumn (October to December). If blood cultures were negative, the date of the first echocardiography with signs of infective endocarditis was noted.

Results
A total of 103 cases of IE were identified over a 6-year period. Mean age of IE patients was 70±13 years, 31.1% were female (n=32). No significant difference was found over the years. Overall, 76.7% had one isolated pathogen (n=79), 3.9% had 2 different pathogens (n=4), and 19.4% had persistent negative blood cultures (n=20). The most predominant infective agent was Streptococcus species (30.1% of cases, n=31), followed by Staphylococcus species (29.1%, n=30) and Enterococcus species (18.4%, n=19). The most affected valve was native aortic valve (35.9%, n=37), followed by native mitral valve (30.1%, n=31) and biological prosthetic aortic valve (17.5%, n=18). Summer had the fewer cases of IEs (18.4%), while Spring is the season with more IEs (32.0%). Negative blood cultures were more frequent in the Spring (24.2%). In Autumn, the proportion of Staphylococcus IE increases to 36% of all infections in this season. The most frequent pathogen in Winter and Spring is Streptococcus, representing 34.6% and 36.4% of IEs in these seasons.

Conclusion
In our population, there was no significant increase in the incidence of IEs over the years. However, there was a seasonal trend both in frequency and in specific pathogens: Summer had fewer IEs and Spring was the season with the highest frequency; Streptococcus is the most frequent pathogen in both Winter and Spring. These results may not represent the reality nationwide, and further epidemiological studies would be necessary to establish a trend.