bluuebunny/crossref_metadata_2025_split huggingface dataset:
A novel echocardiographic risk score predicts prognosis in AL-amyloidosis
Authors: Geenty P , Sivapathan S , Stefani L D , Zada M , Boyd A , Kwok F , Thomas L 
Published: October 2022

Abstract

Background
Prognosis in light chain (AL) amyloidosis is largely determined by the severity of cardiac involvement. Conventional (Mayo) staging includes 1) hs troponin 2) N-terminal pro-beta natriuretic peptide (NT-pro BNP) and 3)free light chain difference.

Methods
In a retrospective study of 75 AL amyloidosis patients referred to a quaternary amyloid clinic, all patients underwent comprehensive echocardiographic assessment. Echocardiographic parameters included left ventricular (LV) ejection fraction, LV mass, diastolic function, global longitudinal strain (GLS) and indexed left atrial volume (LAVI). Mortality was assessed through review of clinical records.

Results
Over a median follow up of 51 months, 29/75 (39%) of patients died. LAVI, E/e', e', LVGLS, were univariate predictors of mortality (p&lt;0.1). LAVI was the only independent echocardiographic predictor in a multivariable model. Kaplan Meir analysis evaluated LAVI, LVGLS and E/e' using clinical cutoffs as a predictor of survival; only LAVI and LVGLS were significant. A novel “Echo score” comprising of LAVI (&gt;42 ml/m2) and LVGLS (&lt;−12%) was a predictor of mortality with similar prognostic performance as Mayo stage. (Echo score AUC 0.745, 95% CI 0.64–0.85 vs Mayo score AUC 0.752 95% CI 0.66–0.86, p=0.9).

Conclusion
LAVI, a simple, echocardiographic parameter was as an independent predictor of mortality in AL amyloidosis. A composite echocardiographic score combining LAVI and LVGLS stratified AL-amyloidosis patients into 3 distinct groups with similar prognostic power as Mayo stage for all-cause mortality.

Funding Acknowledgement
Type of funding sources: None.
Heart rate control and hemodynamic improvement with Ivabradine in cardiogenic shock patients on mechanical circulatory support
Authors: Colombo C N J , Dammassa V , Battistini L , Erba M , Camporotondo R , Pellegrini C , Mojoli F , Tavazzi G 
Published: October 2022

Abstract

Background
Cardiogenic shock (CS) is a life threatening condition due to primary cardiac dysfunction. First line therapy involves drug administration (including inotropes and/or vasopressors) up to mechanical circulatory support. Tachycardia is a compensatory mechanism in response to hypotension and low cardiac output or a side effect related to inotropic drugs. Ivabradine selectively acts on IKf channel in the sinoatrial node to reduce sinus heart rate without affecting inotropism. Its use in small non-randomized series of patients with CS was safe and well tolerated [1].

Methods
We present the use of ivabradine in six patients with CS undertaking veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Data regarding haemodynamic and echocardiographic monitoring were collected before, at 12, 24 and 48 hours after ivabradine administration.

Results
Ivabradine was administered through naso-gastric tube with a median time of 23 hours [IQR 18–28] since VA-ECMO implantation at the starting dose of 2.5 mg twice a day. Haemodynamic and echocardiographic parameters are shown in table. Ivabradine was well tolerated and led to a significant reduction of heart rate after first administration (p&lt;0.01) (Fig. 1, panel A). Echo-derived stroke volume increased significantly (p&lt;0.001) (Fig. 1, panel B); so did cardiac index (p&lt;0.001) and left ventricular cardiac power index (p 0.005) (Fig. 1, panel C). VA-ECMO rate pump and blood flow significantly decreased (respectively p 0.002, p 0.001). No significant changes were observed in arterial blood pressure (p&gt;0.05). Norepinephrine was down-titrated in all patients (p 0.01). Patients presented with cardiac arrest died due to neurological injury whereas the others were weaned off VA-ECMO and discharged alive.

Conclusions
Ivabradine administration resulted in an effective reduction of heart rate leading to ventricular stroke volume allowing the reduction of extracorporeal flow support and vasopressors administration.

Funding Acknowledgement
Type of funding sources: None.
15-year survival of comatose OHCA patients according to initial rhythm
Authors: Tadel-Kocjancic S , Jazbec A , Noc M 
Published: October 2022

Abstract

Introduction
Long-term outcome of comatose survivors of out-of-hospital cardiac arrest (OHCA) is largely unknown. We therefore investigated 15-year survival of consecutive patients who were admitted to our hospital after reestablishment of spontaneous circulation (ROSC) on the field.

Methods and results
Between January 2003 and January 2022, 851 patients with shockable and 247 patients with non-shockable rhythms were admitted. Patients with shockable rhythm were significantly younger (61.5±13,3 versus 66.8±14.8 years), had more often bystander life support (64% versus 35%), shorter delay to emergency team arrival (7.3±5.1 versus 8.3±5.9 minutes), shorter time from advanced life support to ROSC (16.6±15.27 versus 18.5±14.3) and more aggressive hospital treatment including hypothermia (89% versus 74%), coronary angiography/PCI strategy (81% versus 52%) and more IABP/ECMO support (18% versus 10%). Survival with good neurological outcome in patients with shockable rhythm decreased from 51% at hospital discharge to 35% at 15 years (Figure 1). In patients with non-shockable rhythm, survival decreased from 14% at hospital discharge to 8% at 15 years.

Conclusion
If comatose OHCA patient survives to hospital discharge, annual death rate during the following 15 years is 1.07% for shockable and 0.40 for non-shockable rhythms indicating good long-term outcome.

Funding Acknowledgement
Type of funding sources: None.
Comparison of mechanical support with Impella or extracorporeal life support in post-cardiac arrest cardiogenic shock: a propensity scoring matching analysis
Authors: Chatzis G , Markus B , Ahrens H , Luesebrink U , Karatolios K , Schuett H , Patsalis N , Divchev D , Schieffer B , Syntila S 
Published: October 2022

Abstract

Background
Out of hospital cardiac arrest (OHCA) is a major public health problem and a leading cause of death in industrialized nations. Post-cardiac arrest cardiogenic shock (CS) occurs frequently after resuscitation from CA and may lead to multi-organ failure and death, even in patients with good neurologic prognosis. Mechanical circulatory support (MCS) may be considered at that time in order to augment cardiac output, stabilize hemodynamics and ensure adequate organ perfusion. However, optimal selection of the device type remains unclear and, so far, no specific guideline recommendation exists. The Impella pump and extracorporeal circulatory support (ECLS) are the most frequently used device types for temporary percutaneous MCS in this context.

Purpose
Our aim was to compare outcomes of Impella with extracorporeal life support (ECLS) in patients with post-cardiac arrest cardiogenic shock (CS) complicating acute myocardial infarction (AMI).

Methods
Reetrospective study of patients resuscitated from OHCA with post-cardiac arrest CS following AMI (May 2015 to May 2020) treated with MCS in terms of Impella or ECLS. Outcomes were compared using propensity score-matched analysis to account for differences in baseline characteristics between groups of MCS.

Results
159 patients were included (Impella, n=105; ECLS, n=54). Hospital and 12-month survival rates were comparable in the Impella and the ECLS group (p=0.16 and p=0.3, respectively). After adjustment for baseline differences, both groups demonstrated comparable hospital and 12-month survival (p=0.36 and p=0.64, respectively) (Figure 1). Impella patients had a significantly greater left ventricle ejection-fraction (LVEF) improvement at 96 hours (p&lt;0.01 vs p=0.44 in ECLS) and significantly fewer device-associated complications than ECLS patients (15.2% versus 35.2%, p&lt;0.01 for relevant access site bleeding, 7.6% versus 20.4%, p=0.04 for limb ischemia requiring intervention). In subgroup analyses, Impella was associated with better survival in patients with lower-risk features (lactate &lt;8,6 mmol/L, time from collapse to return of spontaneous circulation &lt;28 min, vasoactive score &lt;46 and Horowitz index &gt;182) (Figure 2).

Conclusions
In the biggest so far homogenous study of OHCA, the use of Impella 2.5/CP or ECLS in post-cardiac arrest CS after AMI was associated with comparable adjusted hospital and 12-month survival. Impella patients had a greater LVEF improvement than ECLS patients, while it was associated with a better survival in patients with low risk profile after OHCA. Device-related access-site complications occurred more frequently in patients with ECLS than Impella support.

Funding Acknowledgement
Type of funding sources: None.
SARS-CoV-2 is associated withabnormal biomarkers of oxidative stress,and endothelial function linked with cardiovascular dysfunction four months after the infection
Authors: Ikonomidis I , Kountouri A , Mitrakou A , Thymis J , Katogiannis K , Korakas E , Varlamos C , Bamias A , Thomas K , Andreadou I , Tsoumani M , Kavatha D , Antoniadou A , Dimopoulos M A , Lambadiari V 
Published: October 2022

Abstract

Introduction
COVID-19 infection has been associated with increase arterial stiffness, endothelialdysfunction, and impairment in coronary and cardiac performance. Inflammation and oxidative stress have beensuggested as possible pathophysiological mechanisms leading to vascular and endothelial deregulation afterCOVID-19 infection.

Purpose
The objective of our study is to evaluate premature alterations in arterial stiffness, endothelial,coronary, and myocardial function markers four months after SARS-CoV-2 infection.

Methods
In a case-control prospective study, we included 70 patients 4 months after COVID-19 infection, 70 age- and sex-matched untreated hypertensive patients (positive control) and 70 healthy individuals. We measured (i) perfused boundary region (PBR) of the sublingual arterial microvessels (increased PBR indicates reduced endothelial glycocalyx thickness), (ii) flow-mediated dilatation (FMD), (iii) coronary flow reserve (CFR) by Doppler echocardiography, (iv) pulse wave velocity (PWV) and central systolic blood pressure (cSBP), (v) global left and right ventricular longitudinal strain (GLS), (vi) malondialdehyde (MDA), an oxidative stress marker, thrombomodulin and von Willebrand factor as endothelial biomarkers.

Results
COVID-19 patients had similar CFR and FMD with hypertensives (2.48±0.41 vs 2.58±0.88, p=0.562, 5.86±2.82% vs 5.80±2.07%, p=0.872 respectively) but lower values than controls (3.42±0.65, p=0.0135, 9.06±2.11%, p=0.002 respectively). Compared to controls, both COVID-19 and hypertensives had greater PBR5–25 (2.07±0.15μm and 2.07±0.26μm p=0.8 vs 1.89±0.17μm, p=0.001), higher PWV, (12.09±2.50 vs 11.92±2.94, p=0.7 vs 10.04±1.80m/sec, p=0.036) increased cSBP (128.43±17.39 vs 135.17±16.83 vs 117.89±18.85) and impaired LV and RV GLS (−19.50±2.56% vs −19.23±2.67%, p=0.864 vs −21.98±1.51%, p=0.020 and −16.99±3.17% vs −18.63±3.20%, p=0.002 vs −20.51±2.28%, p&lt;0.001). MDA and thrombomodulin were higher in COVID-19 patients than both hypertensives and controls (10.67±2.75 vs 1.76±0.30, p=0.003 vs 1.01±0.50nmole/L, p=0.001 and 3716.63±188.36 vs 3114.46±179.18, p=0.017 vs 2590.02±156.51pg/ml, p&lt;0.001). COVID-19 patients displayed similar vWF values with hypertensives but higher compared with healthy controls (4018.03±474.31 vs 3756.65±293.28 vs 2079.33±855.10 ng/ml, p=0.718 and p=0.016 respectively).

Conclusions
SARS-CoV-2 infection is associated with oxidative stress, endothelial and vascular dysfunction, which are linked to impaired longitudinal myocardial deformation 4 months after COVID-19 infection.

Funding Acknowledgement
Type of funding sources: None.
Tricuspid regurgitation: frequency, management and outcome among patients with severe left-sided valvular heart disease in Europe. Insights from the ESC-EORP valvular heart disease II survey
Authors: Dreyfus J , Komar M , Attias D , De Bonnis M , Ruschitzka F , Popescu B A , Laroche C , Tribouilloy C , Prokophiev A B , Mizariene V , Bax J J , Maggioni A P , Vahanian A , Iung B 
Published: October 2022

Abstract

Background
Tricuspid regurgitation (TR) is frequent among patients with severe left-sided valvular heart disease (LS-VHD).

Objectives
This study sought to assess TR frequency, management and outcome in this population.

Methods
Among 6883 patients with severe LS-VHD or previous valvular intervention in the EURObservational Research Programme prospective VHD II survey, we analyzed frequency and grade of TR according to LS-VHD, and 6-month survival according to TR grade. Among 2081 patients who underwent an intervention for severe LS-VHD, we analyzed frequency and outcome of concomitant TV intervention, and concordance between Class I indications for concomitant TV surgery (patients with severe TR) and real-practice decision-making.

Results
Moderate to severe TR was very frequent among patients with severe mitral VHD (≥30%), especially in patients with secondary mitral regurgitation (46%), and rare among patients with aortic VHD (&lt;5%). Higher TR grade was associated with a poorer 6-month survival (P&lt;0.001). Rates of concomitant tricuspid valve (TV) intervention at the time of left-sided heart valve surgery were high at the time of mitral valve surgery (more than 40%). Concomitant TV intervention at the time of left-sided heart valve surgery (LS-HVS) was not associated with an increase in-hospital mortality (P=0.93). Concordance between Class I indications for concomitant TV surgery at the time of LS-HVS according to guidelines and real-practice decision-making was very good (88% overall).

Conclusion
TR was frequent in patients with mitral VHD and was associated with a poorer outcome as TR grade increased. Compliance to guidelines for Class I indications for concomitant TV surgery at the time of LS-HVS was very good. With the trend toward more transcatheter treatment for left-sided VHD, there is a critical need for safe and efficient tricuspid valve transcatheter treatment for patients with concomitant TR.

Funding Acknowledgement
Type of funding sources: None.
Extent and predictors of exercise-induced changes in ischemic mitral regurgitation during handgrip exercise
Authors: Spieker M , Sidabras J S , Lagarden H , Veulemans V , Akhyari P , Horn P , Kelm M , Westenfeld R 
Published: October 2022

Abstract

Background
Mitral regurgitation (MR) is frequent in patients with ischemic heart disease and carries a dismal prognosis. Recent studies suggest that ischemic MR is a dynamic condition influenced by global and regional left ventricular (LV) remodeling as well as mitral valvular deformation. Handgrip exercise may serve as alternative exercise intervention to bicycle exercise.

Purpose
To assess degree and determinants of exercise-induced changes in ischemic MR during handgrip exercise.

Methods
We prospectively enrolled 205 patients with at least mild ischemic MR that underwent echocardiography at rest and during three minutes of handgrip exercise according to a standardized protocol.

Results
Mean age in our patient cohort was 75±10 years, 30% were female, and 58% suffer from atrial fibrillation. Median NT-proBNP was 2657 (1331–6599) ng/l. Mean left ventricular ejection fraction was 44±14%. At rest, MR severity was graded as mild in 57% of patients, moderate MR in 34% and severe in 9%. Mean effective regurgitant orifice area (EROA) at rest was 15±6 mm2 and regurgitation volume was 25±11 ml. During handgrip exercise, 58 patients (28%) showed an increase in MR severity in at least one grade; 30 patients (15%) with non-severe MR at rest, developed severe MR during handgrip exercise. The EROA decreased (&gt;5 mm2) in 5% of patients, remained unchanged in 50% (between −5 mm2 and +5 mm2), and increased (&gt;5 mm2) in 45% of patients (Fig. 1B). A small increase (5–10 mm2) was observed in 30%, while 15% of patients revealed a marked increase in EROA (&gt;10 mm2) (Fig. 1B). The degree of MR at rest was not associated with exercise-induced increases in EROA (r=−0.03; p=0.641)(Fig. 1C). However, echocardiographic parameters of local (e.g. tenting height) and global (e.g. LVESVi) LV remodeling, as well as mitral valvular deformation correlated with exercise-induced changes in EROA (Table 1).

Conclusion
In patients with secondary MR due to ischemic heart disease, handgrip echocardiography unmasks exercise-induced increases of MR severity in a significant proportion of patients. Dynamic MR during handgrip exercise is associated with parameters of global and local LV remodeling as well with parameters of mitral valvular deformation. Future studies need to address the prognostic importance of exercise-induced changes in MR severity in patients with ischemic cardiomyopathy.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by the Forschungskommission of the Medical Faculty of the Heinrich Heine University Düsseldorf to Maximilian Spieker for a Clinician Scientist Track.
No cardiac sequelae after COVID-19: results of the one year follow-up with echocardiography and biomarkers
Authors: Radvan M , Kamenik M , Koc L , Matejova G , Bartecku E , Horinkova J , Stepanova R , Kala P 
Published: October 2022

Abstract

Objective
To evaluate the need for cardiac monitoring of unselected patients recovered from COVID-19 and to estimate the risk of heart failure development after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Methods
During March 2020 and January 2021, 106 patients recovered from SARS-CoV-2 (alfa and beta variants) were enrolled in the prospective observational cohort study, CoSuBr (Covid Survivals in Brno). The diagnosis was established by reverse transcription polymerase chain reaction on swab test of the upper respiratory tract.
Demographic parameters, patient history, clinical evaluation, cardiac biomarkers, ECG and echocardiography were recorded within three visits (V1 at least six weeks after infection, V2 three months later and V3 one year after V1).

Results
The study group (n=106) included 58% women, mean age was 46 years (range 18–77 years). Mean time interval between the onset of the infection and the follow-up visit was 107 days. One quarter (24.5%) of the patients required hospitalisation during the acute phase of the disease, the rest recovered at home. 74% suffered from mild form, 3.8% moderate, 18.3% severe and 2.9% of critical form of the disease. At the time of enrolment 63.5% of the patients were referring the ongoing symptoms, while more than half of the whole group (50.9%) mentioned at least one symptom of possible cardiac origin (breathing problems, palpitations, exercise intolerance, fatigue).
During one year follow up after COVID-19 infection there was no decrease of left ventricle ejection fraction (V1: 62.1±5.26% to V3: 60.8±6.24%, p=0,150), no changes of troponin (4.8±3.41 to 4.7±3.31ng/L; p=0.417) and NT-proBNP (74.3±75.15 to 95.3±137.28pg/mL; p=0,315). There was a mild decrease of right ventricle end diastolic diameter (28.9±5.59 to 26.8±3.83mm, p&lt;0.001), while no right ventricle dysfunction was detected. There was a very mild progress in a left ventricle diastolic diameter (47.9±6.34 to 49.3±4.21mm; p&lt;0.001) between V1 a V3, a mild enlargement of left atrium (37.1±5.85 to 38.2±5.65mm; p=0,021) and non-significant trend to impairment of left ventricle diastolic dysfunction. There was a mild change of pulmonary artery systolic pressure (24.7±7.92 to 27.5±6.97mmHg; p=0,038).

Conclusion
Despite many information regarding cardiac impairment of SARS-CoV-2 our study does not suggest increased risk of development of heart failure during the one year follow-up. Based on our results the routine echocardiography and biomarkers collection is currently not recommended after COVID-19 recovery.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): MH CZ - DRO; MEYS - RI CZECRIN
Identification of distinct subgroups in moderately severe rheumatic mitral stenosis using data-driven phenotyping of longitudinal hemodynamic progression
Authors: Ko K , Cho I S , Kim S B , Seong Y C , Kim D Y , Seo J W , Shim C Y , Hong G R , Ha J W , You S C 
Published: October 2022

Abstract

Background
Rheumatic mitral stenosis (MS) is a significant cause of valvular heart disease. Pulmonary artery systolic pressure (PASP) reflects the hemodynamic consequences of MS and is used to determine treatment strategies. However, PASP progression and expected outcomes in patients with moderately severe MS remain unclear.

Purpose
We aimed to examine the impact of progression rate of PASP in moderately severe MS.

Methods
A cohort of 866 consecutive patients with moderately severe rheumatic MS (1.0 cm2.

Results
Data-driven phenotyping identified two distinct trajectories based on PASP progression: a rapid progression group (N=38, 8.7%) and a slow progression group (N=398, 91.3%). Patients in the rapid progression group were older and had more comorbidities than patients in the slow progression group, including diabetes, and atrial fibrillation (all P&lt;0.05). The initial mean diastolic pressure gradient and PASP were higher in the rapid progression group than in the slow progression group (6.2±2.4 mmHg vs. 5.1±2.0 mmHg, P=0.001, and 42.3±13.3 mmHg vs. 33.0±9.2 mmHg, P&lt;0.001, respectively). During a mean follow-up of 7.0±3.0 years, the event-free survival rate was significantly lower in the rapid progression group than in the slow progression group (log-rank P&lt;0.001). Rapid PASP progression was a significant risk factor for composite outcomes even after adjusting for comorbidities (hazard ratio: 3.08, 95% confidence interval (CI): 1.68–5.64, P&lt;0.001). Multivariate regression analysis revealed that PASP&gt;40 mmHg was independently associated with the probability of rapid progression group allocation (odds ratio: 4.95, 95% CI: 2.08–11.99, P&lt;0.001).

Conclusions
Two groups with distinct patterns of PASP progression were identified. Rapid PASP progression was associated with a significantly higher risk of the composite outcomes. The main independent echocardiographic predictor for rapid progression group allocation was initial PASP&gt;40 mmHg.

Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): This study was supported by a Severance Hospital Research fund for Clinical excellence (SHRC) (C-2020-0041) and a faculty research grant of Yonsei University College of Medicine (6-2020-0156).