bluuebunny/crossref_metadata_2025_split huggingface dataset:
High- vs. low-intensity statin therapy and changes in coronary artery calcification density after one year
Authors: Vogel L , Dykun I , Raggi P , Schmermund A , Rassaf T , Mahabadi A 
Published: October 2022

Abstract

Introduction
High-dose statin therapy (HIST) halts coronary plaque progression and reduces the risk of cardiovascular events by increasing atheroma calcification. The Agatston score is well established in the clinical routine for assessment of coronary artery calcification using non-contrast computed tomography. However, randomized controlled trials failed to detect an influence of HIST vs. low-to-intermediate statin therapy (LIST) on the Agatston and CAC volume score after one year. Coronary plaques with lower density including spotty calcifications may represent dynamic and early stages of atherosclerosis. We evaluated whether CAC density differentiates in HIST- vs. LIST-treated patients after one year.

Methods
The meta-analysis contains data from two prospective, randomized, double-blind studies (BELLES, EBEAT) that were designed to detect CAC changes after one year comparing HIST vs. LIST. In both studies, patient's coronary calcification burden was measured at baseline and one-year follow-up using electron beam computed tomography (EBCT). Patients data were pooled and stratified by intensity of statin therapy. Furthermore, the cohort was divided into several subgroup analyses, accounting for LDL-Cholesterol reduction, initial Agatston score and a consistent number of lesions.

Results
Data from 852 patients, 66% female were included. The amount of CAC overall increased after 1 year [Agatston score: 169.3 (80.0, 377.1) vs. 214.9 (95.4, 450.0); p&lt;0.0001NP; volume score: 292.1±445.4 vs. 355.5±482.4; p&lt;0.0001; number of lesions: 6 (3,10) vs. 7 (4,12); p&lt;0.0001NP, at baseline and follow-up, respectively]. Likewise, the average CAC density was higher at follow-up [CAC density: 228.8±35.4 vs. 232.6±37.0; p&lt;0.0001]. HIST vs. LIST more effectively reduced LDL-cholesterol (annualized change: −58.6±50.9 vs. −44.4±43.7 mg/dL, p=0.005). Comparing patients on HIST vs. LIST, CAC density at follow-up (231.9±36.1 HU vs. 233.3±37.7, p=0.59) and its change from baseline (4.0±19.1 HU vs. 3.6±19.6 HU, p=0.73) did not differ. Subgroup analyses, stratifying by LDL-reduction (

Conclusion
HIST vs. LIST leads to a higher reduction in cholesterol levels, which does not translate into relevant differences in the change of CAC density at one-year follow-up.

Funding Acknowledgement
Type of funding sources: None.
Comparison of the safety and efficacy of antithrombotic regimens following TAVR in patients without having an indication for chronic oral anticoagulation
Authors: Guedeney P , Roule V , Mesnier J , Chapelle C , Portal J J , Laporte S , Ollier E , Zeitouni M , Kerneis M , Barthelemy O , Sorrentino S , Silvain J , Vicaut E , Montalescot G , Collet J P 
Published: October 2022

Abstract

Aims
To compare the safety and efficacy of antithrombotic regimens following transcatheter aortic valve replacement (TAVR) in patients without having an indication for chronic oral anticoagulation

Methods and results
We conducted a Prospero-registered systematic review and network meta-analysis of randomized controlled trials evaluating post-TAVR antithrombotic regimens up to March 2021. We estimated the relative risk and 95% confidence intervals using a fixed effect model in a frequentist pairwise and network metanalytic approach. We included 6 studies comprising of 3,777 patients with a mean weighted follow-up of 13.3 months. Single antiplatelet therapy (SAPT) was associated with a significant reduction of life-threatening, disabling, or major bleeding compared to dual antiplatelet therapy (DAPT) (Risk Ratio [RR] 0.44, 95% confidence interval [CI]: 0.28–0.69), apixaban (RR: 0.47, 95% CI 0.26–0.84) and low-dose rivaroxaban + 3-month SAPT (RR: 0.30, 95% CI: 0.16–0.57). Risk of all-cause death was significantly reduced with DAPT compared to low-dose rivaroxaban + 3-month SAPT (RR: 0.60, 95% CI: 0.41–0.88) and a consistent reduction was observed with SAPT and DAPT compared to apixaban (RR: 0.60, 95% CI: 0.31–1.16 and RR: 0.58, 95% CI: 0.32–1.04, respectively). There were no differences between the various regimens with respect to myocardial infarction and stroke. Apixaban significantly reduced the risk of pulmonary embolism, valve thrombosis and grade 3 or 4 reduced leaflet motion.

Conclusion
Following TAVR in patients without an indication for chronic oral anticoagulant, SAPT was associated with the lowest risk of bleeding compared to DAPT and direct oral anticoagulant-based regimens without significant ischemic offset.

Funding Acknowledgement
Type of funding sources: None.
Prognostic impact of left ventricular ejection fraction recovery in patients undergoing pecutaneous aortic valve replacement
Authors: Lopez Otero D , Bastos Fernandez M , Sanmartin Pena X C , Gonzalez Salvado V , Agra R , Cid Alvarez B , Trillo Nouche R , Iglesias Alvarez D , Pena Gil C , Gonzalez Juantey J R 
Published: October 2022

Abstract

Background
A lot of studies have shown a positive effect of transcatheter aortic valve implantation (TAVI) on left ventricular ejection fraction (LVEF). However, the association between long-term outcomes and LVEF recovery after TAVI has not yet been well investigated.

Purpose
To detect differences in long-term all cause mortality between patients who recover LVEF at six mounths after TAVI and those who do not.

Methods
This is a retrospective, single-center study of 1092 patients undergoing TAVI. LVEF was determined before the intervention and at 6 months. The primary outcome was long-term all-cause mortality. Left ventricular dysfunction was defined as LVEF &lt;50% and recovered LVEF as LVEF &gt;50%.

Results
Of the 1.092 patients included, 250 (22.8%) had LVD. Of these, adequate follow-up was only achieved in 188, which were the ones included in the analysis. At 6 months, 86 patients (45.7%) had RLVEF. Table 1 shows the baseline characteristics of patients with RLVEF versus those who did not. No significant differences were found between the two groups in terms of comorbidity, procedural complications, or discharge therapy. There were no differences in baseline LVEF or severity of aortic valve disease, although the transaortic peak gradient (63.9±15.6 vs 73.6±19.7; p=0.019) and transaortic mean peak gradient (38.7±11.2 vs 45±12.7; P=0.026) were significantly higher in the RLVEF group. On the other hand, the group where the LVEF did not recover presented a higher percentage of moderate-severe mitral regurgitation (MR) (25.4 vs 8.1; p=0.005). These data could explain a more advanced state of cardiomyopathy and be an explanation for the different evolution of LVEF. In the multivariate analysis, only moderate-severe MR was associated as a predictor of non-recovery of LVEF after TAVI (HR 1.12; (1.09–1.45); p=0.023). During follow-up RLVEF was associated with a reduction in long-term all-cause mortality (p&lt;0.001) (Figure 1)

Conclusions
Up to 25% of patients undergoing TAVI have baseline LVD. Of these, almost half recover it within six months. Patients who recover LVEF have a significant reduction in mortality in the medium term. The presence of a moderate-severe MR was associated with the non-recovery of LVEF after TAVI, probably because it was a more advanced cardiomyopathy.

Funding Acknowledgement
Type of funding sources: None.
Effect of TAVR generation on conduction abnormalities – is newer always better?
Authors: Masoudian B A , Azzu M , Mihkli E , Vincent A , Shaukat J , Speight M , Fearon W , Liang D 
Published: October 2022

Abstract

Objective
Transcatheter aortic valve replacement has become an established approach to treat severe symptomatic aortic stenosis in patients of all risk levels. Development of conduction abnormality and the need for a permanent pacemaker are known complications of TAVR. The introduction of third generation valves with cuffs has resulted in a significant decrease in post-deployment perivalvular regurgitation. However, there is concern for an increase in development of a new onset left bundle branch (LBBB) and the need for permanent pacemaker (PPM) implantation. This study aimed to identify whether newer valve generations along with the move away from transesophageal echocardiography (TEE) guidance for valve deployment is associated with changes in frequency of conduction block.

Methods
601 consecutive patients who underwent transfemoral TAVR implantation with a balloon expandable valve in a native aortic valve at a single institution from July 2009 to March 2019 were included in the study. 40 patients with LBBB and 91 patients with pacemakers prior to TAVR were excluded from the LBBB analysis. Multivariate logistic regression was used to test for significance.

Results
New LBBB occurred significantly more frequently with the newer generation valves, 1st Gen 2/104 (1.9%), 2nd Gen 9/88 (10.2%), 3rd Gen 33/278 (11.9%) (p&lt;0.01). There was no statistically significant increase in pacemakers across valve generations, 1st Gen 7/113 (6.2%), 2nd Gen 7/92 (7.6%), 3rd Gen 30/305 (9.8%). Use of TEE guidance had no effect on either LBBB or pacemaker. There was a strong trend (p=0.057) toward need for pacemaker as larger valves where used, with OR of pacemaker relative to 29 mm valve for 23 mm valve of 0.26 and for 26 mm valve of 0.63.

Conclusion
Newer TAVR valves, although beneficial in reducing perivalvular regurgitation, increases the risk of LBBB, without increasing risk need for pacemaker, suggesting possibly different mechanisms for the two complications. Understanding the mechanism for avoiding these complications may be important to avoiding them, as we move to a lower risk population where complication free results are even more important.

Funding Acknowledgement
Type of funding sources: None.
Prognostic value of right ventricular dysfunction in patients undergoing transcatheter aortic valve replacement
Authors: Jimeno Sanchez J , Perez Guerrero A , Fuertes Ferre G , Gambo Ruberte E , Peiro Aventin B , Ferrer Gracia M C , Sanchez-Rubio Lezcano J , Galache Osuna G , Cortes Villar C , Simon Paracuellos T , Gomez Martin D , Ortas Nadal M R , Diarte De Miguel J A 
Published: October 2022

Abstract

Introduction
Right ventricular dysfunction (RVD) in patients with severe aortic stenosis seems to increase the risk of worse long-term outcomes after transcatheter aortic valve replacement (TAVR). The purpose of this study was to investigate the association between RVD at baseline and the prognosis after TAVR (readmission for heart failure and death).

Methods
A cohort study was conducted. Consecutive patients undergoing TAVR from January 2012 to December 2020 were included and analysed depending on the right ventricular function prior to the procedure. RVD was assessed using tricuspid annular plane systolic excursion (≤17 mm). Clinical and follow-up characteristics were recorded. The median follow-up was 26±22 months.

Results
Of 292 patients who underwent TAVR, 64 (21.9%) met the criteria for RVD at baseline. Patients with RVD undergoing TAVR were significantly more often male (65% vs 46%) and smokers or former smokers (42% vs 23%). They had significantly a higher EuroScore risk score (9.1±7.2 vs 5.3±4) with greater prevalence of atrial fibrillation (55% vs 32%), previous heart valve surgery (20% vs 4%) or pacemaker implant (25% vs 14%), less left ventricular ejection fraction (48±15% vs 58±11%), lower aortic valve mean gradient (41±13 vs 50±13 mmHg) and higher estimated pulmonary artery pressure (50±18 vs 42±13 mmHg) compared with patients with preserved RV function. Procedural characteristics and complications were similar in both groups. Normalization of right ventricular function after TAVR was found in 50.8% of patients with RVD at baseline. Readmission for heart failure during the follow-up was more common in patients with RVD at baseline (29.7% vs 13.3%, p 0.04), also observing a higher trend in terms of mortality (29.7% vs 19.1%, p 0.08).

Conclusions
Patients with RVD undergoing TAVR had an increased risk of readmission for heart failure and a higher trend in mortality.

Funding Acknowledgement
Type of funding sources: None.
Influence of gender on coronary atherosclerosis and inflammatory biomarker profile: a CT angiographic study
Authors: Bittner D , Roesner C , Goeller M , Raaz-Schrauder D , Dey D , Kilian T , Achenbach S , Marwan M 
Published: October 2022

Abstract

Background and aims
The burden of coronary atherosclerosis differs between men and women. Beyond traditional cardiovascular risk factors, inflammatory biomarkers can influence plaque formation and progression. We analyzed the influence of gender difference on coronary atherosclerosis and inflammatory cytokines.

Methods
Coronary CT-Angiography was performed in 301 patients and plaque morphology was quantitatively and qualitatively assessed using semi-automated software (Autoplaque version 2.5, Cedars-Sinai Medical Center, Los Angeles, CA). We analyzed total (TPV), non-calcified (NCPV), calcified (CPV) and low-density plaque volume in mm3 (LDPV, defined as plaque attenuation &lt;30HU). Serum was analyzed for various cytokines including Interleukin (IL)-1a, IL-1b, IL-2, IL-4, IL-6, IL-7, IL-8, IL-10, IL-13, Il-15, IL-17, TNF-a, IFNg, CRP, MCP-1, MIP-1a, Eotaxin, G_CSF and GM-CSF using Luminex assay.

Results
Out of 301 patients, 94 (31%) were female and 207 (69%) were male. As compared to women, men were significantly younger (62 vs. 57 years, p&lt;0.001) and showed a higher BMI (28 vs. 26 kg/m2, p=0.005). No differences were seen for hypertension, hyperlipidemia, diabetes, smoking habits and family history of CAD. All plaque characteristics showed significant higher values in men as compared to women (all p&lt;0.05). In men, cytokine profile showed significantly lower serum levels for IL-2 (3.20 [3.20; 7.01] vs. 4.31 [3.20; 9.68]; p=0.01) and Interferon-gamma (3.20 [3.20; 14.72] vs. 8.76 [3.20; 26.26]; p&lt;0.001) and significantly higher levels for MCP-1 (224 [117; 327] vs. 155 [49; 260]; p&lt;0.001). In multivariable logistic regression analysis, Interferon-gamma showed significant inverse association to male gender (OR 0.35; 95% CI: 0.17–0.72; p=0.004), but IL-2 and MCP-1 did not. The association of Interferon-gamma to gender was independent of age (OR 0.57; 95% CI: 0.43–0.76; p&lt;0.001) and BMI (OR 2.12; 95% CI 1.25–3.62; p=0.006)

Conclusion
Coronary plaque volume and morphology significantly differs between men and women and so does the inflammatory cytokine profile. Albeit significantly lower coronary plaque burden in women, serum levels of interferon-gamma - a known pro-inflammatory cytokine - was significantly higher in women with independent association to gender. Whether interferon-gamma plays contradicting roles in the process of coronary atherosclerosis in men and women needs to be explored in future studies to identify potential gender-specific targets for therapeutic interventions.

Funding Acknowledgement
Type of funding sources: None.
Transcatheter aortic valve implantation (TAVI) with zero contrast in patients with impairment of renal function. A single centre experience
Authors: Travaglio N , Elicio A , Pignatelli G , Cavalla F , Pantaleo P 
Published: October 2022

Abstract

Transcatheter aortic valve implantation (TAVI) represents nowaday a safe and effective alternative to traditional surgery for patients with high and intermediate surgical risk. However, the risk of contrast induced nephropathy still remains a major concern and a real challenge in patients with baseline chronic kidney disease (CKD). Aim of our new approach, has been to find a solution capable to reduce or contain the incidence of acute renal damage after TAVI caused by the use of contrast dye in CKD patients.
In the last twelve months, out of 85 patients admitted to our Center for severe symptomatic aortic stenosis, addressed to TAVI, 18 patients (mean age: 81.8 years, NYHA class III) presented CKD with mean creatinine value: 2.39 mg/dl; GFR: 24.46 ml/min/1.73 m2. Three patients had previously undergone surgical revascularization with coronary artery bypass graft and in 3 cases we performed a valve-in-valve procedure for degeneration of valvular bioprostheses.They were selected for our zero contrast protocol; all these patients underwent pre-procedural chest and abdomen CT scan without dye, together with a Lower Limb Eco-Color Doppler scan.Coronary angiography had been carried out in a previous hospitalization.
The valve size choice was determined after measurements of the CT scan and echo images (both two- and three-dimensions) were compared. Data obtained (valve perimeter, area and the two main valve diameters) were strongly similar with the two techniques, without significant differences. The new valve deployment was monitored under constant fluoroscopy and transesophageal (TOE) visualization. A single pig tail catheter was placed in the non coronary sinus to facilitate valve annulus localization on fluoroscopy. The TOE selected view for TAVI deployment was the mid esophageal long axis. Proper prosthesis positioning was determined by measuring the protruding portion through the left ventricle outflow tract, and prevent possible impairment of diastolic mitral valve movement. In 17 cases a transfemoral percutaneous approach was used and only in one case surgical isolation of the right carotid artery was necessary due to the occlusion of every other peripheral access. Four patients needed a post implant dilatation for significant residual left ventricle/aortic gradient. All patients underwent the TAVI procedure successfully. In the post-TAVI phase, two patients underwent definitive PM implantation for third degree atrioventricular block despite adequately high implantation of the valve.At discharge, mean creatinine value was 1.9 mg/dl and mean GFR was 32.2 ml/min/1.73 m2. All patients survived the procedure and were discharged alive, after a further mean Hospital stay of four days. In conclusion, TAVI zero contrast is a safe, feasible and winning procedure to consider in patients with severely impaired renal function.

Funding Acknowledgement
Type of funding sources: None.
Bioprosthetic valve fracture during valve-in-valve transcatheter aortic valve replacement: multicenter propensity matched analysis
Authors: Bonnet G , Panagides V , Vincent F , Faroux L , Corona S , Modine T , Metz D , Van Belle E , Pibarot P , Leroux L , Rodes-Cabau J , Ternacle J 
Published: October 2022

Abstract

Background
Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) can be completed by bioprosthetic valve fracture (BVF) to reduce final transvalvular gradients. The aim was to compare outcomes in ViV-TAVI patients with versus without BVF.

Methods
Consecutive patients undergoing ViV-TAVI procedure in four international centers were included, from 2010 to 2021. We used a 1:2 propensity score-matching method to compare postprocedural hemodynamic, complications, and long-term outcomes. Patients were matched for baseline characteristics, time since prior surgery, and characteristics of surgical bioprothesis (type and size).

Results
A total of 390 patients were analyzed, including 40 BVF. Propensity matching 1:2 yielded 38 patients in BVF group and 76 patients in no-BVF group. There was no difference in procedural complications rate and in-hospital deaths (5.1%) between the two groups. Post-procedural hemodynamic parameters significantly improved using BVF: aortic valve area (1.4 cm2 [IQR: 1.23 to 2.3] vs. 1.3 cm2 [IQR: 1.05 to 1.61], p=0.008), mean aortic gradient (12mmHg [IQR: 7.5 to 16.5] vs. 17mmHg [IQR: 11 to 22], p=0.008) and peak velocity (2.2m/s [IQR: 1.8 to 2.7] vs. 2.6m/s [IQR: 2.2 to 3.1], p=0.027). BVF had an additional benefit in the smallest surgical valve (≤21 mm). The use of BVF was independently associated with improved hemodynamic parameters. Overall survival in the matched cohort was 87.8±3.7% at 2-year follow-up, without difference between groups (87.5±6.9% in the BVF group vs. 88.4±4.2% in the no-BVF group, p=0.85).

Conclusion
Compared to ViV-TAVI alone, BVF was safe and improved immediate hemodynamic and long-term outcomes, especially in patients with small surgical aortic bioprosthesis.

Funding Acknowledgement
Type of funding sources: None.
5-year outcomes of patients with mitral structural valve deterioration treated with transcatheter valve in valve implantation
Authors: Schamroth Pravda N , Mishaev R , Levi A , Witberg G , Shapira Y , Orvin K , Talmor Barkan Y , Hamdan A , Sharoni R , Perl L , Sagie A , Vaknin Assa H , Kornowski R , Codner P 
Published: October 2022

Abstract

The Valve-in-Valve (ViV) technique is an emerging alternative for the treatment of bioprosthetic structural valve deterioration (SVD) in the mitral position. We report on intermediate-term outcomes of patients with symptomatic SVD in the mitral position who were treated by transcatheter mitral valve-in-valve (TM-ViV) implantation during the years 2010–2019 in our center. Three main outcomes were examined during the follow-up period: NYHA functional class, TM-ViV hemodynamic data per echocardiography, and mortality. Our cohort consisted of 49 patients (mean age 77.4±10.5 years, 65.3% female). The indications for TM-ViV were mainly for regurgitant pathology (77.6%). All 49 patients were treated with a balloon-expandable device. The procedure was performed via transapical access in 17 cases (34.7%) and transfemoral vein / trans-atrial septal puncture in 32 cases (65.3%). Mean follow-up was 4.4±2.0 years. 98% and 91% of patients were in NYHA I/II at 1 and 5 years respectively. Mitral regurgitation was ≥ moderate in 86.3% of patients prior to the procedure and this decreased to 0% (p&lt;0.001) following the procedure and was maintained over 2 years follow-up. The mean trans-mitral valve gradients decreased from pre-procedural values of 10.1±5.1mmHg to 7.0±2.4mmHg at one month following the procedure (p=0.03). Mortality at one year was 16% (95%, CI 5–26) and 35% (95%, CI 18–49) at 5 years. ViV in the mitral position offers an effective and durable treatment option for patients with SVD at high surgical risk.

Funding Acknowledgement
Type of funding sources: None.