bluuebunny/crossref_metadata_2025_split huggingface dataset:
Refining the accuracy of right ventricular-pulmonary arterial coupling in patients undergoing transcatheter tricuspid valve treatment
Authors: Sugiura A , Tanaka T , Zimmer S , Nickenig G , Weber M 
Published: October 2022

Abstract

Background
Assessing right-ventricular (RV) function is paramount for risk stratification but remains challenging in patients with TR. RV-pulmonary artery (PA) coupling seems more feasible for the assessment of RV function.

Methods
We assessed RV-PA coupling by the ratio of TAPSE and PASP at baseline, in which PASP was measured both by echocardiography (ePASP) and invasively using a right-heart catheter (iPASP). We also assessed the RV fractional-area change (RVFAC) as measured by transthoracic echocardiography. Participants for the present study comprised patients undergoing TTVR from June 2015 to July 2021 at the University Hospital of Bonn. Patients lacking either echocardiographic or invasive measurements for the assessment of RV-PA coupling were excluded from the analysis. The outcome was defined as a composite of mortality and rehospitalization due to heart failure within one year after the procedure.

Results
A total of 206 patients were included in the present analysis. The participants were at an advanced age (78.5±7.1 years), predominantly female (58.3%), and at a high risk for surgery (EuroSCORE II: 7.4±4.8%). Massive/torrential TR was observed in 100 of these patients. With the median follow-up duration of 201 days (interquartile range 98–424 days), the outcome occurred in 57 patients. Compared to TAPSE/ePASP, TAPSE/iPASP showed better predictability for the outcome: the AUCs were 0.582 for TAPSE/ePASP and increased to 0.714 when iPASP was applied to the formula (i.e. TAPSE/iPASP). The trend was also true for RV-PA coupling using RVFAC (AUCs: 0.561 for RVFAC/ePASP, 0.693 for RVFAC/iPASP). There was a significant correlation between ePASP and iPASP, whereas the correlation was attenuated in patients with TR beyond severe (i.e. massive/torrential TR) (interaction p = 0.01). In addition, a semiquantitative echocardiographic estimation of right atrial (RA) pressure was not correlated with the invasive measurement.

Conclusion
The present analysis confirms that RV-PA coupling, measured as TAPSE/PASP, is a powerful predictor of mortality and rehospitalization due to heart failure in patients undergoing TTVR. The predictability is even more improved if PA pressure is measured invasively and applied to the formulas.

Funding Acknowledgement
Type of funding sources: None.
Detection of lymphatic circulation abnormalities in adult Fontan Kreutzer patients using magnetic resonance imaging
Authors: Nicolosi L N N , Choe H J , Moros C G , Pacheco Otero M , Grippo M 
Published: October 2022

Abstract

Background
Altered lymphatic circulation could be an indicator of risk of complications after Fontan-Kreutzer surgery.

Purpose
To determine the degree of lymphatic circulation abnormality in adult patients who underwent the Fontan-Kreutzer procedure (FKP) and explore association between type of abnormality and complications during follow-up.

Methods
A retrospective observational study was conducted in patients (p) with grown-up congenital heart disease included on the GUTI-GUCH database. Lymphatic circulation of patients who had undergone FK procedure (FKP) was assessed using Cardiac Magnetic Resonance (CMRI). Lymphatic abnormalities were divided into four types according to the classification by Dori; type III and IV abnormalities were considered complex. Association between complex abnormalities and complications during follow-up was explored. Statistical analysis was performed using SPSS 22 software.

Results
One-hundred and thirty-eight (4.7%) of the 2920 p on the database had undergone FKP; the 47 patients (34%) who had had a CMRI for lymphatic assessment were included. Fifty-three percent (25p) were women; mean age was 26.5 years ± 7.8 years.
Analysis of patient data showed the following prevalence of lymphatic abnormalities according to Dori's classification: Type I: 14p (29.8%); Type II: 17p (36.2%); Type III: 13p (27.7%); Type IV: 3p (6.4%); severe/complex Types III+IV: 16p (34%). Prevalence of the studied complications was as follows: presence of ascites: 6p (12.8%); aortopulmonary collaterals: 7p (14.9%); NYHA functional classification more than II: 19p (40.4%); ventricular dysfunction: 14p (29.8%); tube mismatch: 11p (23.4%); moderate or severe AV valve dysfunction: 11p (23.4%); left-type ventricle: 30p (63.8); congestive heart failure (CHF): 4p (8.5%); arrhythmias: 16p (34%) hospitalization: 7p (14.9%); use of furosemide: 11p (23.9%); use of spironolactone: 25p (53.2%); use of IECA 38p (80.9%); and use of beta blockers: 28p (59.6%).
The presence of type III+IV abnormalities (Dori) observed in 16p (34%) was associated with ascites p=0.006 R: 13 (1.4–130). No significant correlation was observed between type of lymphatic abnormality and the remaining studied complications.

Conclusions
One third of patients had complex lymphatic circulation abnormalities. The presence of severe complications was significantly associated with the presence of ascites, a late sign of dysfunction of the Fontan-Kreutzer system.
Lymphatic circulation abnormalities are very frequent in patients who have undergone a Fontan-Kreutzer procedure. Further studies are necessary to determine their prognostic value.

Funding Acknowledgement
Type of funding sources: None.
Concomitant tricuspid repair in mitral regurgitation surgery: a systematic review and meta-analysis
Authors: Costa G , Cardoso J , Donato H , Goncalves L , Teixeira R 
Published: October 2022

Abstract

Background
Tricuspid Regurgitation (TR) is common in patients with severe mitral disease. However, the evidence is insufficient to inform a decision about whether to perform prophylactic tricuspid-valve repair during mitral-valve surgery in patients who have moderate TR or less-than-moderate regurgitation.

Purpose
To compare the outcomes of concomitant tricuspid repair in mitral valve surgery versus no concomitant tricuspid repair in less-than-severe TR patients.

Methods
We systematically searched PubMed, Embase and Cochrane databases, in December 2021, for interventional studies comparing concomitant tricuspid repair in mitral valve surgery versus no tricuspid intervention. Random-effects meta-analysis was performed.

Results
Four randomised trials were included, providing a total of 651 patients (323 in prophylactic tricuspid intervention group and 328 patients in conservative group). Our meta-analysis showed a similar all-cause mortality for concomitant prophylactic tricuspid repair compared with no tricuspid intervention (pooled OR, 0.54; 95% CI [0.25, 1.15], P=0.11; I2=0%). Additionally, there is a similar New York Heart Association (NYHA) III–IV classes in both groups, despite a lower trend in the tricuspid intervention group (pooled OR, 0.63; 95% CI [0.38, 1.06], P=0.08; I2=0%) (Figure 3). However, there was a significant lower progression of TR (pooled OR, 0.06; 95% CI [0.02, 0.24], P&lt;0.01; I2=0%) and moderate-severe TR (pooled OR, 0.23; 95% CI [0.11, 0.46], P&lt;0.01; I2=27%).

Conclusions
Our pooled analysis suggests that a tricuspid-valve repair at the time of mitral-valve surgery in patients with moderate or less-than-moderate TR does not impact perioperative or postoperative all-cause mortality, despite reducing TR severity and progression of TR following intervention.

Funding Acknowledgement
Type of funding sources: None.
Early aortic valve replacement in asymptomatic severe aortic stenosis with preserved ejection fraction
Authors: Costa G , Cardoso J , Goncalves L , Teixeira R 
Published: October 2022

Abstract

Background
Aortic stenosis (AS) is the most common valvular disease in developed countries. Specific timing of intervention for asymptomatic patients with severe aortic stenosis and preserved ejection fraction remains controversial.

Purpose
To compare the outcomes of early aortic valve replacement (AVR) versus watchful waiting (WW) in asymptomatic AS patients with preserved ejection.

Methods
We systematically searched PubMed, Embase and Cochrane databases, in November 2021, for both interventional or observational studies comparing early-AVR with WW in the treatment of asymptomatic severeAS with preserved ejection fraction criteria. Random-effects meta-analysis was performed.

Results
Eight studies were included in which two were randomized clinical trials. A total of 2672 patients were included, providing a 642 pooled death events (327 in early-AVR and 941 in watchful waiting). In our meta-analysis, early-AVR revealed a significant lower all-cause mortality (pooled OR, 0.39; 95% CI [0.30, 0.51], P&lt;0.01; I2=47%). Additionally, the early-AVR group presented a lower rate of cardiovascular mortality (pooled OR, 0.33; 95% CI [0.19, 0.56], P&lt;0.01; I2=64%). Both strategies had similar rate of stroke (pooled OR, 1.30; 95% CI [0.39, 4.27], P=0.67; I2=0%) and myocardial infarction (pooled OR, 0.49; 95% CI [0.14, 1.78], P=0.28; I2=0%). Heart Failure hospitalizations presented a lower trend early-AVR group (pooled OR, 0.22; 95% CI [0.05, 1.08], P=0.36; I2=36%).

Conclusion
Our pooled data suggests that early-AVR strategy is preferable for asymptomatic severe AS patients with preserved ejection fraction.

Funding Acknowledgement
Type of funding sources: None.
A decade of the twenty-first century of percutaneous balloon mitral valvuloplasty in rheumatic mitral stenosis: long-term outcomes and clinical risk score among the AF and non-AF patients
Authors: Kosallavat S , Meemook K 
Published: October 2022

Abstract

Backgrounds
Percutaneous balloon mitral valvuloplasty (PBMV) is the treatment of choice for anatomically suitable severe rheumatic mitral stenosis (MS). Atrial fibrillation (AF) is one of the most common arrhythmic conditions in rheumatic MS and may decrease successful or alter the long-term outcomes of rheumatic MS patients who are undergoing PBMV.

Purpose
The purpose of this study is to investigate the long-term outcomes of treatment in patients with AF compared to sinus rhythm (SR).

Results
Post-PBMV median follow-up time was 10.83±5.69 years. The incidence of the primary endpoint was 57.8% (95% confidence interval [CI]: 48.6% to 66.9%) and 20.0% (95% CI: 10.3% to 29.6%), p-valve &lt;0.001 in AF and SR patients respectively. The adjusted hazard ratio (HR) of the primary endpoint in the AF compare with SR group was 2.377 (95% CI: 1.250 to 4.520, p-valve = 0.008). Not only the rate of death that was greater in AF than SR group with 30% (95% CI: 22% to 39%) and 11% (95% CI: 4% to 19%), p-valve &lt;0.001 respectively but also as in MV surgery, the incidence rate was 30% (95% CI: 22% to 39%) and 10% (95% CI: 2% to 18%). Independence predictors of the primary endpoint were age &gt;55 years (hazard ratio [HR]: 1.765; 95% CI: 1.05 to 2.95, p=0.031) and echocardiographic score &gt;8 (HR: 2.94; 95% CI: 1.22 to 7.09, p=0.017). The MiTrAL-55 score has a C-statistic of 0.71±0.036 reflecting the good ability to predict long-term outcomes.

Conclusion
Severe rheumatic MS patients with AF had a worse long-term prognosis than SR after PBMV. An early decision to PBMV in patients with MS supporting with the predictive scoring system to minimize morbidity and mortality is necessary.

Funding Acknowledgement
Type of funding sources: None.
Perioperative cerebral microinfarction and quality of life following mitral valve surgery
Authors: Gorecka M , Nejadhamzeeigilani H , Craven T P , Chew P G , Dobson L E , Brown L A E , Chowdhary A , Jex N , Thirunavukarasu S , Sharrack N , Javed W , Kotha S , Levelt E , Goddard A J P , Greenwood J P 
Published: October 2022

Abstract

Introduction
Mitral regurgitation (MR) is the second most common valvular pathology worldwide. When untreated, severe MR is associated with significant morbidity and mortality. Mitral valve surgery is recommended in symptomatic patients and those with evidence of adverse left atrial or left ventricular remodelling. Although uncommon, stroke is a recognised complication of mitral valve surgery and is associated with unfavourable outcomes. While silent cerebral microinfarction has been described following cardiac surgery, its incidence in mitral valve surgery and its impact on quality of life is presently unknown. The main aim of this study was to assess the incidence of perioperative cerebral microinfarction following mitral valve surgery and its impact on medium-term health-related quality of life (HRQoL).

Methods
Cerebral diffusion-weighted magnetic resonance imaging (DWI-MRI) was conducted pre-operatively and prior to discharge in 31 patients undergoing mitral valve surgery for mitral regurgitation. Blinded analysis was conducted by a neuro-radiologist. HRQoL assessment was undertaken at baseline and at a 6-month follow up with EuroQoL-5 dimensions (EQ-5D-5L) and Hospital Anxiety and Depression Scale (HADS) questionnaires.

Results
Thirty-one patients underwent paired cerebral DWI-MRI (mitral valve replacement (MVR) n=16 [52%] and mitral valve repair (MVr) n=15 [48%]). Prevalence of atrial fibrillation was similar in both groups (MVR n=9 [56%] vs. MVr n=7 [47%], p=0.59). Peri-operative cerebral microinfarction occurred in 9 patients (29%). Embolic events were numerically higher in the MVR group versus MVr group, but not statistically significant (n=7 [44%] vs. n=2 [13%], p=0.06). Presence of multiple lesions, large lesions &gt;5mm, small lesions &lt;5mm and the total number of lesions did not differ significantly between the two groups. Median volume of lesions was higher in the MVR group versus MVr (0 [0–0.4] vs 0 [0–0], p=0.04) (Table 1).
There was no difference in the mean change in HRQoL during 6m follow up between patients with peri-operative cerebral microinfarction and those with no detectable embolic events (Table 2). Within group comparison (MVR group and MVr group) also did not demonstrate any significant difference.

Conclusions
Peri-operative cerebral microinfarction occurred in almost a third of patients undergoing mitral valve surgery, with higher volume of lesions following MVR. These lesions however, did not exhibit significant impact on medium term health-related quality of life.

Funding Acknowledgement
Type of funding sources: None.
Clinical and prognosis assessment of Atrial Fibrillation patients with significant valvular disease. Validation of the EHRA valve classification (Evaluated Heartvalves. Rheumatic or Artificial)
Authors: Escolar Conesa A , Esteve Pastor M A , Roldan Schilling V , Rivera Caravaca J M , Gil Perez P , Gonzalez Lozano E , Taboada Martin R , Arribas Leal J M , De La Morena Valenzuela G , Saura Espin D , Oliva Sandoval M J , Pinar Bermudez E , Garcia De Lara J , Marin F 
Published: October 2022

Abstract

Introduction
Historically, the definition of valvular heart disease in atrial fibrillation (AF) patients has been inconsistent. For this reason, in 2017 the EHRA proposed a more accurate classification, classifing AF patients in EHRA I (AF patients with mechanical prostheses or moderate/severe rheumatic mitral stenosis), EHRA II (includes the presence of significant valve disease, bioprosthetic valve replacement, TAVR – Transcatheter Aortic Valve Replacement – or mitraclip) and EHRA III (absence of valve involvement).

Purpose
The objective was to evaluate the prevalence of valve involvement in AF patients, clinical characteristics and adverse outcomes according to new EHRA classification, focusing in the EHRA II vs EHRA III comparison.

Methods
Observational, multicenter, retrospective study of stable anticoagulated AF patients was performed. Clinical, echocardiographic, demographic characteristics and adverse events after 2 years of follow-up were collected according to EHRA II vs EHRA III groups.

Results
981 patients were analyzed: 755 (76.9%) classified as EHRA II [440 (56.8%) with native valve involvement, 134 (17.8%) with surgical biological prostheses and 181 (23.4%) with TAVR] and 226 (23.1%) as EHRAIII. Higher comorbidity profile was observed in the different EHRA II subgroups compared to patients with EHRA III (Table 1). After 2 years of follow-up, the occurrence of adverse events was higher in EHRA-II than EHRA III patients (Figure 1). In the Cox analysis, weo bserved that patients with native valve involvement and TAVR had up to 3 times higher risk of mortality [HR 3.32, (95% CI 1.88–5.85; p&lt;0.001)], 2 times higher risk of Heart Failure [HR 2.14, (95 CI 1.30–3.5; p&lt;0.001)] and MACE [HR 2.01, (95% CI 1.14–3.52; p&lt;0.015)] than EHRA III patients.

Conclusion
The prevalence of valve involvement in patients with AF is high. Only 23% of AF patients did not present any valve disease. Patients with native valve involvement or TAVR had a high burden of comorbidities and cardiovascular risk factors. Patients with native involvement and TAVR also showed an 2.5-fold increased risk of adverse events during the follow-up. These findings highlight the increased risk related with the presence of valve disease in patients with AF.

Funding Acknowledgement
Type of funding sources: None.
Is it worthwhile to perform surgical aortic valve replacement in elderly patients with symptomatic aortic valve disease and malignancy: a short and long-term study in 2,500 patients
Authors: Mistiaen W P , Deblier I , Dossche K , Vanermen A 
Published: October 2022

Abstract

Introduction
Malignancy (all types) can be considered as limiting factor for the outcome of surgical aortic valve replacement (SAVR).

Purpose
How does the referral pattern evolve over time for patients with previously malignancy, referred for SAVR
What is their early and long-term outcome after SAVR?

Patients and methods
This is a retrospective file study of 2,500 patients referred for SAVR with a biological prosthesis between 1987 and 2017. Mechanical valves and valve prosthesis in another position were excluded. A chi-square analysis was used to compare patients with and without cancer with respect to age, gender, era of referral (2008, the year of introduction of transcatheter aortic valve implantation, TAVI), preoperative cardiovascular (parameters for ventricular function, severity of valve disease, coronary disease, arrhythmias and conduction defects) and non-cardiac (pulmonary, renal, diabetes, cerebral) comorbid conditions, operative variables (bypass time, associated CABG and mitral valve repair), need for resources (blood products, stay on ICU) and early postoperative mortality, cardiac and non-cardiac events. A Kaplan-Meier (log-rank) analysis was used to evaluate the effect of malignancy on long-term outcome.

Results
Of the 2,500 patients, 388 (15.5%) patients had a documented prior malignancy There was a total of 18.917 patient-years for follow-up. For cancer patients, this was 2,489 patient-years.
The referral of patients increased after 2008 (from 9.1% to 17.7%, p=0.006). Cancer patients had more chronic pulmonary (14.6% vs. 17.9%, p=0.044) and kidney (15.5% vs. 21.5%, p=0.009) disease, more prior CVA (14.8% vs. 19.8%, p=0.038) and permanent pacemaker implant (14.9% vs. 24/19%, p=0.044). Obesity was less present (18.4% vs. 14.2%). Cardiovascular and operative parameters were comparable for both groups.
Postoperative cardiac and non-cardiac adverse events, need for resources and especially mortality (5.0% vs. 6.9%, p=0.105) were comparable.
Long-term survival was significantly reduced in patients with malignancy (p&lt;0.001), but this was acceptable: a mean survival time of 105 (98–113) months vs. 121 (118–125) months.
Five-year survival was 70.0±2.4% vs. 76.6±0.9%
Ten-year survival was 38.6%±1.3% vs. 48.9±2.9%
Fifteen-year survival was 14.1±2.7% vs. 20±1.3%
In a Cox' proportional hazard analysis, malignancy ranks 8th of 10 independent predictors for mortality (odds ratio 1.26).

Conclusion
Even after the introduction of TAVI, the number of valve patients with prior malignancy referred for SAVR increased significantly. Nevertheless, only non-cardiac preoperative factors differed significantly. Operative variables, use of resources and early outcome did not differ significantly. Malignancy reduces long-term survival in a significant but acceptable degree.

Funding Acknowledgement
Type of funding sources: None.
Prognostic implications of paradoxical low gradient severe aortic stenosis: a comprehensive analysis from a large multicentric registry
Authors: De Azevedo D , De Meester C , Hanet V , Altes A , Pouleur A C , Pasquet A , Gerber B , Marechaux S , Tribouilloy C , Vanoverschelde J L , Vancraeynest D 
Published: October 2022

Abstract

Background
Up to 40% of patients with severe aortic stenosis (SAS; indexed aortic valve area (AVAi) &lt;0.6 cm2/m2) present with low transvalvular mean gradient (MG) despite a normal left ventricular ejection fraction (EF). There is intense debate about the prognostic significance of such entity, with some referring to it as an advanced form of the disease, others as an intermediate form between a moderate and a severe form.

Objectives
To compare outcome of patients with paradoxical low gradient SAS (PLG-SAS; i.e., mean gradient &lt;40 mmHg and AVAi &lt;0.6 cm2/m2) vs. moderate aortic stenosis (MAS; i.e. mean gradient &lt;40 mmHg and AVAi &gt;0.6 cm2/m2) and high gradient SAS (HG-SAS; i.e. mean gradient &gt;40 mmHg and AVAi &lt;0.6 cm2/m2).

Methods
2582 consecutive patients with aortic stenosis (PLG-SAS, n=933; MAS, n=876 and HG-SAS, n=773) and a preserved EF (&gt;50%) from an international multicentric registry were studied. Five years mortality between groups was compared using Kaplan Meier analysis. Inverse probability weighting was used to adjust for clinical and imaging baseline characteristics. Additionally, to explore the impact of MG (&lt;40 mmHg vs. &gt;40 mmHg) in patients with AVAi &lt;0.6 cm2/m2 (PLG-SAS vs. HG-SAS) and to explore the impact of AVAi (&lt;0.6 cm2/m2 vs. &gt;0.6 cm2/m2) in patients with MG &lt;40 mmHg (PLG-SAS vs MAS) we performed 2 different propensity score analyses. Patients were censored at the time of surgery.

Results
Overall, during 23 [IQR,10–47] months of follow-up 1003 patients died and 770 patients underwent aortic valve replacement. IPW-adjusted natural history was significantly better in patients with MAS, intermediate for patients with PLG-SAS and worst in patients with HG-SAS (59 vs. 47 vs. 41%, p&lt;0.001, see Figure 1A). Furthermore, at equal MG (448 pairs), survival was significantly better in patients with MAS compared with PLG-SAS (54% vs. 39% p&lt;0.001, see Figure 1B) and at equal AVAi (377 pairs), survival was significantly better in patients with PLG-SAS compared with HG-SAS (43% vs. 32% p&lt;0.001, see Figure 1C).

Conclusions
In this large multicentric cohort, survival of PLG-SAS patients was better than that of HG-SAS patients and worse than that of MAS patients. Furthermore, with a comparable mean gradient, the smaller the calculated AVAi, the worse the prognosis whereas with a comparable AVAi, the higher the mean gradient, the worse the prognosis. Taking together, these data demonstrate that PLG-SAS is an intermediate form in the disease continuum, HG-SAS being the most malignant form of AS.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Fonds National de la Recherche Scientifique (F.R.S.–FNRS)