bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic implications of left ventricular diastolic dysfunction in moderate aortic stenosis
Authors: Stassen J , Ewe SH , Butcher SC , Ammanullah MR , Hirasawa K , Singh GK , Ding ZP , Pio SM , Chew NWS , Sia CH , Kong WKF , Poh KK , Marsan NA , Delgado V , Bax JJ 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): ESC Training Grant App000064741
Background
Moderate aortic stenosis (MAS) is associated with an increased risk of adverse events. Although left ventricular (LV) diastolic dysfunction (DDF) has shown to carry an unfavorable prognosis in severe AS, the prognostic value of LV DDF in MAS has not been investigated.
Purpose
To investigate the prognostic impact of LV DDF in patients with MAS and preserved LV ejection fraction (EF).
Methods
LV diastolic function was evaluated in patients with MAS (aortic valve area &gt;1.0 and ≤1.5cm2) and preserved LVEF (≥50%) using echocardiography according to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Clinical outcomes were defined as all-cause mortality and a composite endpoint of all-cause mortality and aortic valve replacement (AVR).
Results
Of 1247 patients (age 74 ± 10 years, 47% men) with MAS and preserved LVEF, 396 (32%) had normal diastolic function, 316 (25%) had indeterminate diastolic function and 535 (43%) had DDF. Patients with DDF were more likely to be female, had more comorbidities (hypertension, atrial fibrillation, chronic kidney disease) and were more symptomatic (NYHA ≥2) than patients with normal diastolic function. Patients with DDF also had smaller aortic valve area and higher peak aortic velocities than patients with normal/indeterminate diastolic function. During a median follow-up of 53 (26 – 81) months, 484 (39%) patients died. For the composite endpoint, 770 patients (62%) underwent AVR (n = 376) or died (n = 394) during a median follow-up of 37 (IQR 15 – 62) months. Patients with DDF had significantly lower survival rates (p &lt;0.001) and event-free survival rates (p = 0.015) compared to patients with normal/indeterminate diastolic function (Figure 1). On multivariable analysis, DDF was independently associated with all-cause mortality (HR: 1.368; 95% CI: 1.085 – 1.725; p = 0.008) and the composite endpoint of all-cause mortality and AVR (HR: 1.241; 95% CI: 1.035 – 1.488; p = 0.020) (Figure 2).

Conclusion
LV DDF is associated with worse outcomes in patients with MAS. Assessment of LV diastolic function may contribute significantly to risk stratification of patients with MAS. Abstract Figure. Abstract Figure.
Left atrial reservoir strain is an independent prognostic predictor in patients undergoing percutaneous mitral valve repair
Authors: Galli E , Hubert P , Vely M , Panis V , L"official G , Donal E 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left atrial reservoir strain (LARS) is a well-known prognostic predictor in several cardiac diseases. Aim of the presence study was to assess the value of LARS in predicting the occurrence of major adverse cardiovascular events (MACEs) in patients undergoing percutaneous mitral valve repair (PMVR)

Methods and results
112 patients (62% males, age: 74 ± 10 years) undergoing PMVR for severe primary (n = 71, 63%) or secondary MR were retrospectively included in the study underwent a comprehensive echocardiography before the procedure. Thirty-eight MACES occurred during a median follow-up of 18 months. At multivariable Cox-regression analysis, ischemic cardiomyopathy [HR 2.41 (1.11-5.24, p = 0.02)], indexed left atrial volume [HR 1.01 (1.00-1.01), p = 0.03], and LARS [HR 0.93 (0.88-0.99), p = 0.03] were all significant predictors of MACEs. A cut-off of 13% for LARS (AUC 0.66, p = 0.008) was able to predict MACEs with a 71% sensitivity and 41% specificity (Table 1).

Conclusions
LARS is an independent predictor of MACEs in patients undergoing percutaneous mitral valve repair, independently of the etiology of mitral regurgitation. Abstract Figure.
Factors associated with favorable outcomes in patients undergoing transcatheter edge-to-edge mitral valve repair (TEER) with the mitraclip device
Authors: Andrianiaina H , Bonnet G , Torras O , Arregle F , Nguyen N , Resseguier N , Bonnet J-L , Habib G 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Introduction
Transcatheter edge-to-edge mitral valve repair (TEER) has over the years become a viable alternative to surgery in high-risk patients with severe symptomatic mitral regurgitation (MR). Selection of optimal candidates who will benefit from the procedure remains challenging.
Our study aims to determine clinical, echocardiographic and procedural factors associated with favorable outcomes after mitraclip implantation.
Methods
We retrospectively analyzed the data concerning patients who underwent MitraClip implantation for symptomatic severe MR in our institution.
All patients underwent a clinical evaluation and a transthoracic echocardiography before the procedure, and at follow up (between one and up to three months after the index procedure).
A clinical endpoint combining absence of cardiovascular death, absence of rehospitalization for heart failure and improvement of at least 1 class New York Heart Association NYHA at three months, was used to define a good response.
Results
Among 109 patients referred to our institution for TEER since January 2018, 106 had a successful clip implantation and were included in our study. 76 of them had a primary MR and 30 others a secondary mitral regurgitation (SMR). The primary endpoint was achieved in 65% of those patients. Reduction of MR severity to less than grade 2+ was achieved in 87% of the patients.
A high body mass index (p = 0.03), a high level of NT-proBNP at admission (p = 0.02), the association with at least a moderate tricuspid regurgitation prior to mitraclip implantation (p = 0.02) and a severe residual mitral regurgitation (p = 0.01) were predictive of a worse outcome in all patients. In the group of secondary MR, patients who reached the primary endpoint had significantly a lower telediastolic diameter (p = 0.02). A post procedural transvalvular mitral gradient superior to 4.4 mmHg was associated with a worse prognosis in patients with primary mitral regurgitation (p = 0.004) but not in the group of secondary mitral regurgitation (p = 0.7). Furthermore, the ratios EROA/LVEDV and VR/LVEDV defining proportionate mitral regurgitation were not correlated to any benefit in the secondary MR group.

Conclusion
Our study in real life patients found some elements supporting the results of former studies about predictors of outcomes after mitraclip treatment. Tricuspid regurgitation prior to the procedure and an elevated mitral valve pressure gradient after clip implantation are correlated with a worse prognosis. In accordance with recent literature, an elevate mean gradient seems to have less impact on prognosis in SMR, fostering to get optimal MR reduction in those patients. Identifying criteria that would predict insufficient benefit of Mitraclip implantation is necessary to avoid futility.
Right ventricular-arterial coupling in severe tricuspid regurgitation: prognostic relevance of longitudinal strain
Authors: Margonato D , Ancona F , Melillo F , Ingallina G , Stella S , Biondi F , Montorfano M , De Bonis M , Agricola E 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
BACKGROUND. Right ventricular-to-pulmonary artery (RV-PA) coupling integrates RV systolic function at a given afterload and has been shown to have a prognostic impact in different clinical settings. In the context of severe functional TR, it reflects RV adaptation to both volume and pressure overload. However, its prognostic relevance has not been extensively examined in patients suffering from severe TR, and available data evaluated RV-PA coupling using the TAPSE/PASP ratio, with its intrinsic limitation especially in the setting of concomitant severe TR. In patients with severe TR, right ventricular free-wall longitudinal strain (RVFWLS) has been demonstrated to be more senstie in evaluation of subtle RV systolic dysfunction and to reclassify patients with impaired RV systolic function although conventional echocardiographic parameters within normal limits.
PURPOSE. To analyze whether the noninvasive evaluation of RV-PA coupling with the use of the RVFWLS/PASP ratio could improve risk stratification in patients with severe TR.
METHODS. Baseline clinical and echcardiographic parameters and correlation with long-term outcome were assessed in 250 consecutive patients with severe TR referred at our center from December 2015 to December 2018.
RESULTS. Patients were predominantly female, with severe cardiovascular risk factors and major comorbidities, history of heart failure (HF) and atrial fibrillation.
RVFWLS/PASP ratio ≤ 0.32 (AUC 0.72, p &lt; 0.001, sensitivity 70%, specificity 67%) marginally predicted the presence of baseline clinical RV HF (p = 0.05). After univariate and multivariate analyses, RV-PA coupling as assessed by RVFWLS/PASP ratio, but not by TAPSE/PASP, was independently associated with all-cause mortality (OR 0.007, p = 0.03) and, at follow-up, "RV-PA coupled patients", defined by RVFWLS/PASP ratio &gt;0.26 (AUC 0.74, p &lt; 0.001, sensitivity 77%, specificity 52%) showed higher surival rates (p = 0.02).
CONCLUSIONS. RVFWLS/PASP ratio was systematically measured to possibly evaluate RV-PA coupling as a novel echocardiographic parameter in the context of patients with severe TR: it is independently associated with poor long-term prognosis and different values seem to improve irsk stratification in this cohort of patients.
Severe isolated mitral stenosis: are we facing different phenotypes?
Authors: Vriz O , Anwar M , Fawzy N , Eltayab A , Wahid N , Alsomali A , Mushtaq A , Elshaer A , Shaik A , Alanazy A , Alamro B 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Rheumatic mitral valve stenosis (MS) causes progressive left atrial (LA) fibrosis and functional impairment, pulmonary artery systolic hypertension and right ventricular (RV) dysfunction.

Purpose
The aim of the study was the evaluate the different characteristics between high gradients (HG) and low gradient (LG) MS and, within the LG group those with high (LG-HF) or low flow (LG-LF). Moreover, we wanted to evaluate if there was any difference in overall complications and atrial fibrillation (AF) incidence.

Methods
A total of 147 patients with isolated severe MS were retrospectively enrolled from the institutional echo database. Echocardiograms were read offline and clinical information were obtained from patients` records. Patients were divided into a group with HG (31 patients, mean MS gradient &gt; 10 mmHg) and LG (116 patients, mean MS gradient ≤ 10 mmHg). The group of LG was then divided in low flow (Stroke volume index (SVi) ≤ 35 ml/m2, LF-LG: 68 patients) and in high flow (SVi &gt; 35 ml/m2, HF-LG: 48 patients).

Results
The HG group was younger, although the difference did not reach statistical significance, higher percent of males (45% M vs 22% F, p = 0.02), higher heart rate (HR), left atrial volume, higher tricuspid regurgitation velocity (TVR) and derived pulmonary artery systolic pressure (PASP), RV fractional area changes (RV FAC) but similar RV longitudinal contraction. Moreover, the HG group had more severe MS calculated according to PHT. The group of LG was divided according to SVi: LF-LG group compare to HG-MS had higher percent of females (45% F vs 13% M, p &lt; 0.001), similar AF (43% vs 32%, p = ns) and pre surgical complications (19% vs 16%, p = ns). LF-LG group had smaller LA systolic volume (117 ± 51 51 ml vs 148.6 ± 38 ml, p &lt; 0.0001), lower LV-S` (5.3 ± 1.4 vs 6 ± 1.6 cm/s, p = 0.004), lower TRV (2.47 ± 0.5 vs 3.24 ± 0.7 m/s, p &lt; 0.0001), higher TAPSE/PASP (0.64 ± 0.3 vs 0.45 ± 0.29, p &lt; 0.001), lower RV S` (9.79 ± 2.01m/s vs 11.25 ± 3.1 m/s, p = 0.01), higher RVFAC (38.5 ± 9.6% vs 30.9 ± 9.2%, p = 0.0005). The group of LG-LF had also less severe MS (1.3 ± 0.6 cm2 vs 1.15 ± 0.3 cm2, p &lt; 0.01).

Conclusion
Patients with HG MS were those with worst left ventricular involvement, higher PASP and lower RV function. The LF-LG MS were older, and more females were included and even though they had smaller LA, lower values of PASP they had significantly higher percent of AF and similar pre surgical complications. It could be speculated that LF-LG severe MS patients could be a different phenotype of the disease.
The indexed systolic volume as a new tool for transcatheter aortic valve implantation further evaluation
Authors: Gonzalez Maniega C , Echarte-Morales J , Minguito Carazo C , Martin Centellas A , Borrego Rodriguez J , Larrabide-Eguren I , Santos Garcia C , Bergel Garcia R , Menendez Suarez P , Sanchez Munoz E , Maillo Seco J , Cuellas Ramon C , Perez De Prado A , Lopez Benito M , Fernandez Vazquez F 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The transcatheter aortic valve implantation (TAVI) it´s an alternative to surgery in patients with low, moderate and high risk. The indexed systolic volume (ISV) is a parameter that has been associated with adverse events in this scenario. However, there are conflicting reports. The aim of this study was to evaluate the impact of the ISV in patients with severe aortic stenosis in which TAVI was performed.

Methods
Observational, retrospective and single institution study of patients in which a TAVI was performed between 2010 and 2020. The baseline characteristics of the patients were recorded and then the data were analyzed in two cohorts depending on the presence or not of an increase 3.5 ml/m2 of the ISV after TAVI in relation to the baseline (cohort A and cohort B). The cut-off point of 3.5 ml/m2 was chosen due to the fact that it was the median of the difference in the ISV before and after the TAVI.

Results
A total of 131 patients were included with a mean age of 84 years old (81-86). 74 patients (56.5%) presented an increase 3.5 ml/m2 of the ISV after TAVI, while there was an increment less than 3.5 ml/m2 in 57 patients (43.5%). The cohort A patients were older and had less prevalence of high blood pressure (Picture 1). Differences in survival weren´t found between the two cohorts, neither in the patients that before the TAVI had an ISV &lt;3.5ml/m2 in relation to those with an ISV 3.5 ml/m2.

Conclusions
In our population, an increase of the ISV after TAVI wasn´t associated with less adverse events in the follow up. The survival was similar between the patients that before the TAVI had an ISV &lt;3.5ml/m2 and those with an incremented ISV. Prospective studies with bigger cohorts are needed in order to prove these results. Abstract Figure. Baseline Characteristics and Events Abstract Figure. Kaplan Meier Graphics
Magnetic resonance derived regurgitant fraction, 3D vena contracta area, and B-natriuretic peptide: the most accurate prognostic markers in patients with chronic asymptomatic aortic regurgitation
Authors: Kockova R , Linkova H , Hlubocka Z , Tuna M , Medilek K , Maly J , Rezacova J , Penicka M 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health of the Czech Republic 17-28265A.

Background
The optimal timing of surgical treatment is challenging in asymptomatic patients with severe aortic regurgitation (AR). A significant number of patients undergoing aortic valve surgery as per current guidelines have irreversible left ventricular (LV) myocardial damage with a negative impact on their long-term postoperative outcome.

Purpose
We aimed to determine the value of magnetic resonance-, advanced echocardiography–derived indices and serum B-natriuretic peptide level (BNP) to identify patients with chronic asymptomatic AR who are at risk of early disease progression.

Methods
We prospectively enrolled a group of asymptomatic patients with pure chronic severe AR, without an indication for surgical treatment as per the current guidelines, in a multicenter study. Baseline examination consisted of serum BNP level analysis, comprehensive echocardiography including 3D vena contracta area (VCA) and 2D global longitudinal strain (GLS), and a comprehensive MRI including regurgitant fraction (RF) measurement; all imaging data were analyzed in Corelab. Patient follow-up was every 6 months. The primary endpoint was a new guideline-directed indication for surgical treatment.

Results
In total, 129 patients were enrolled between 2015 and 2019, the endpoint occurred in 43 patients during a median follow-up of 1375 (IQR 1041-1783) days. Baseline clinical data did not differ between patients with the endpoint (surgical group) and stable patients (medical group). Baseline BNP levels were significantly higher in the surgical group (55 vs. 21 ng/L, P = 0.008). MRI-derived LV ejection fraction was not different (61 vs 61 %, P = 0.815) at baseline while both CMR-derived end-systolic and end-diastolic LV volumes were significantly higher in the surgical group (all P &lt; 0.01). Both baseline 3D VCA and 2D GLS were different between the surgical and medical groups (33 vs. 25 mm2, P = 0.006 and 18 vs 19 %, P = 0.07). Magnetic resonance derived RF was significantly higher in the surgical group (46 vs 32 %) with P &lt; 0.01. A combined model including independent markers such as BNP (cut-off &gt; 31 ng/L), MRI RF (cut-off value &gt; 34 %), 3D VCA (cut-off value 36 mm2) or 2D GLS (cut-off value &lt; 17 %) showed the highest predictive accuracy (P = 0.002) to predict the primary endpoint. (Figure 1).

Conclusion
A combination of baseline parameters of AR severity (3D VCA, MRI-derived RF) and myocardial impairment (2D GLS, serum BNP level) present an accurate tool for the identification of patients with chronic asymptomatic AR who are at risk of early disease progression. Abstract Figure 1
Functional mitral regurgitation in advanced heart failure
Authors: Dias Ferreira Reis JP , Bras P , Goncalves A , Pereira Da Silva T , Soares R , Timoteo AT , Galrinho A , Branco L , Ferreira R 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Moderate-to-severe functional mitral regurgitation (fMR) is present in about one-third of patients with heart failure (HF) with reduced left ventricular (LV) ejection fraction (HFrEF) and contributes to progression of the symptoms of HF and is and independent predictor of worse clinical outcomes.

Objective
To characterize the population of advanced HF patients with severe fMR and assess its prognostic impact.

Methods
Prospective evaluation of adult patients with advanced HFrEF were referred to our Institution for evaluation with HF team and possible indication for urgent heart transplantation (HT) or MCS. Patients were followed up for 1 year for the primary endpoint of cardiac death and HT. Severe fMR was defined by an EROA ≥ 20 mm2 and/or a regurgitant volume (RVol) ≥ 30 mL either taken from TTE or TOE. A survival analysis was performed to evaluate the prognostic impact of fMR and survival curves were compared using the log-rank test.

Results
A total of 450 HFrEF patients (mean age of 56 ± 12 years, 80% male, mean LVEF of 29 ± 4%) of which 14.4% had severe fMR, with a mean EROA of 29.2 ± 3.1 mm2 and a mean RVol of 43.6 ± 4.7 mL. Thirty patients (6.7%) met the primary endpoint. Patients with severe fMR were more likely to be female (69.2% vs 81.5%, p = 0.026) and to have atrial fibrillation (27.0% vs 14.1%, p = 0.028), had a higher NT-proBNP value (3625.8 ± 496.9 vs 1940 ± 212.4 pg/mL, p = 0.001), a lower LVEF (25.9 ± 6.8 vs 29.0 ± 6.7, p = 0.001), more dilated LV (LV end-diastolic diameter: 72.8 ± 13.3 vs 66.9 ± 9.0 P = 0.036), a lower HFSS value (8.1 ± 1.0 vs 8.6 ± 1.0). There was no difference regarding HF etiology, NYHA class or cardiopulmonary fitness (pVO2: 16.6 ± 5.6 vs 16.5 ± 6.3 ml/kg/min, p = 0.19; VE/VCO2 slope: 35.4 ± 9.9 vs 34.0 ± 9.7, p = 0.328). EROA was an independent predictor of the primary outcome (OR 1.23, 95% CI 1.08-1.54, p = 0.039) and patients with severe fMR had a lower survival free of events during the first follow-up year (log-rank p = 0.012).

Conclusion
Severe fMR was associated with worse clinical outcomes in advanced HF population. Abstract Figure.
The five phenotypes of tricuspid regurgitation: insight from cluster analysis of clinical and echocardiographic variables
Authors: Anand V , Hyun MC , Lara-Breitinger K , Scott CG , Nkomo VT , Pislaru C , Kane GC , Schulte PJ , Pislaru SV 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Tricuspid regurgitation (TR) is a prevalent valvular lesion with three broad morphologic subtypes: primary due to intrinsic pathology of the valve or subvalvular apparatus; secondary due to pulmonary hypertension; and isolated TR associated with chronic atrial fibrillation. The complex pathophysiological, clinical and echocardiographic features between these subtypes require further investigation.

Purpose
We aimed to identify the different phenotypes of TR using cluster analysis, and determine differences (if present) in clinical outcomes associated with these phenotypes.

Methods
We included 13611 patients with ≥ moderate TR, either primary or secondary, in the final analyses. The demographic, clinical and echocardiographic data of these patients were evaluated using Ward’s minimum variance cluster analysis including a total of 38 variables. Survival analysis for all-cause mortality was performed using the Kaplan-Meier method, and groups were compared using the log-rank test.

Results
The mean age of patients was 72.5 ± 13.4 years, 7590 (56%) were females. The clustering identified 5 distinct phenotypes. Cluster 1 represented "low-risk TR" with lesser severity likely related to chronic atrial fibrillation. This cluster had less severe TR, normal sized right ventricle and fewer comorbidities. Clusters 2-5 represented "higher severity TR", "TR associated with lung disease", "TR associated with coronary artery disease and ischemic cardiomyopathy" and "TR associated with chronic kidney disease" respectively (Figure 1). Cluster 1 had the best overall survival, followed by clusters 2, 3 and 4, and lastly cluster 5, with the worst outcome (Figure 2).

Conclusions
Cluster analysis identifies 5 phenotypically distinct novel subgroups of TR with differences in all-cause mortality. This phenotype-based classification improves our understanding of interaction of different co-morbidities with this complex valve lesion and can inform clinical decision making. Abstract Figure. Cluster Dendrogram Abstract Figure. Kaplan-Meier survival curves