bluuebunny/crossref_metadata_2025_split huggingface dataset:
A preliminary analysis regarding functional mitral regurgitation grading with echocardiography and CMR: in search of similarities and resolving discordances
Authors: Maltes S , Lima R , Santos R R , Freitas P , Lopes P M D , Marta L , Guerreiro S , Abecasis J , Ferreira A , Ribeiras R , Andrade M J 
Published: October 2022

Abstract

Background
Functional mitral regurgitation (fMR) severity grading by 2D transthoracic echocardiography (TTE) can be a complex task, especially in patients where PISA assumptions are not met (eg. non-circular orifice or multiple jets). Cardiac magnetic resonance (CMR) can provide further insight on the hemodynamic burden of fMR by accurately determining mitral regurgitant fraction (RegFrac). Our goal was to investigate the concordance and disagreement between the two modalities in assessing fMR.

Methodology
Single-center prospective study of fMR patients performing same-day TTE and CMR from Feb to Dec 2021. MR severity was classified according to 2020 ACC consensus: grade I (mild; EROA &lt;0.20 cm2), grade II (moderate; EROA 0.20–0.29 cm2), grade III (moderate-to-severe; EROA 0.30–0.39 cm2) and grade IV (severe; EROA ≥0.40 cm2). MR assessment by CMR was determined through regurgitant volume (RVol) and RegFrac quantification. A RegFrac ≥35% (recently shown as the best cut-off for prognostication) was considered hemodynamically significant.

Results
A total of 36 patients were included (age 65±14y; 74% male; left ventricle [LV] ejection fraction by TTE and CMR 35±13% and 34±11%, respectively). Mean RVol and EROA by TTE were 28±11mL and 0.18±0.8 cm2. Mean RVol and Regfrac by CMR were 20±13 mL and 25±12%, respectively. A moderate correlation between RVol by TTE and CMR was found (Pearson's R 0.58, p=0.001). According to TTE, there were 20 patients (56%) with grade I fMR, 12 patients (33%) with grade II fMR and 4 patients (11%) with grade III fMR. All patients considered to have mild (grade I) fMR by TTE had a RegFrac &lt;35% at CMR. However, amongst those with moderate and moderate-to-severe (grades II and III) fMR, there were 8 patients (50%) with hemodynamic significant fMR (RegFrac ≥35%) at CMR – see Figure 1. Those with RegFrac ≥35% by CMR had higher indexed LV diastolic (165±24 vs 139±48 mL/m2) and systolic (116±31 vs 95±48 mL/m2) volumes and higher pulmonary artery systolic pressures (48±14 vs 41±16 mmHg) when compared with patients whose RegFrac was &lt;35%, even though statistically significance was not reached.

Conclusion
Using the criterion of RegFrac ≥35%, CMR re-classifies (half for each side) the patients with moderate and moderate-to-severe regurgitations by TTE. Recognizing, overcoming and resolving the disagreements between the techniques is the way forward to reach excellence.

Funding Acknowledgement
Type of funding sources: None.
Adding troponin to echocardiography improves preoperative abscess detection in infective endocarditis. A REMOVE Trial analysis
Authors: Diab M , Franz M , Hamadanchi A , Faerber G , Safarov R , Kirov H , Lehmann T , Schulze P C , Doenst T 
Published: October 2022

Abstract

Background
Detection of cardiac abscess in patients with infective endocarditis (IE) is important for surgical planning and decision-making. While transesophageal echocardiography (TEE) is the method of choice for abscess detection, in many cases uncertainty remains. Since IE abscesses often affect ventricular muscle, biomarker release may be a helpful adjunct for abscess detection.

Purpose
We assessed the accuracy of TEE and the value of combining it with preoperative measurement of cardiac Troponin (cTn) in the diagnosis of abscess, using surgical inspection as a reference.

Methods
Data collected in the electronic clinical report form for patients included in the prospective, multicenter, randomized, controlled trial (REMOVE Trial) were analyzed. Continuous variables are presented as median (25th–75th percentile) and categorical data as absolute and relative frequencies. The diagnostic performance of TEE was identified by comparing preoperative TEE findings with intraoperative findings. The concordance rate is expressed as a percentage. Receiver operating characteristic (ROC) curve was used to assess the ability of cTn to predict the presence of abscess intraoperatively. Area under curve (AUC) with 95% confidence interval as well as sensitivity and specificity are provided as measures of accuracy. Youden index was used to estimate an optimal cut-off value for cTn.

Results
Among the 282 patients included, 84 had abscesses detected intraoperatively. The sensitivity and specificity of TEE to detect abscess were 58.3% and 86.4%, respectively. cTn-I and cTn-T were measured preoperatively in 113 and 96 patients, respectively. Median cTn-I in patients with abscess was 132 pg/ml (interquartile range (IQR): 54–1528) vs 53 pg/ml (IQR: 17–250) in patients without abscess, p=0.002. Median cTn-T in patients with abscess was 941 pg/ml (IQR: 387–1527) vs 697 pg/ml (IQR: 282–1423) in patients without abscess, p=0.353. The incidence of recent preoperative myocardial infarction was not different between patients with or without abscess (7.1% vs 5.6%, respectively, p=0.593). The AUC for predicting abscess was 0.69 (95% CI: 0.57 to 0.80, p=0.002) and 0.56 (95% CI: 0.43 to 0.69, p=0.353) for preoperative cTn-I and cTn-T, respectively. Optimal cut-offs according to the Youden index are 38 pg/ml for cTn-I and 1632 pg/ml for cTn-T. By adding preoperative cTn-I or cTn-T to the TEE findings, the AUC increased to 0.82 (95% CI: 0.73 to 0.91, p&lt;0.001) and 0.72 (95% CI: 0.59 to 00.84, p=0.001), respectively.

Conclusion
The results suggest that using TEE alone is a poor method for abscess detection in IE. Adding preoperative troponin values to TEE findings significantly improved IE abscess detection.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Federal Ministry of Education and Research (BMBF), Germany
Effects of Sacubitril/Valsartan on left ventricular pressure-volume relationship in heart failure
Authors: Stegmann T , Parentin L , Schirmer S H , Hagendorff A , Laufs U , Lavall D 
Published: October 2022

Abstract

Background
In patients with heart failure (HF) and reduced ejection fraction, Sacubitril/Valsartan (S/V) reduces the risk for death and hospitalisations. However, the underlying mechanism for these beneficial effects of S/V, is still lacking.

Methods
Consecutive patients with symptomatic HF and LV ejection fraction (EF) ≤40% who were assigned to S/V were prospectively included in this study (n=117). Non-invasive pressure volume loops were obtained from echocardiography with simultaneous arm-cuff blood pressure measurement. By this method, LV end-systolic elastance (Ees), effective arterial elastance (Ea) and ventricular-arterial coupling (Ea/Ees) were calculated. LV end-diastolic pressure was derived from the E/e' ratio. This is a prespecified interim analysis of 50 patients with completed 6 months of follow-up. The study is registered with ClinicalTrials.gov, NCT04498780.

Results
Mean age was 61.8±18.6 years and 12 (24%) patients were females. Ischaemic heart failure was present in 22 (44%), non-ischaemic aetiology in 24 (48%), and myocarditis in 4 (8%) patients. 34 (68%) patients were on the target dose of S/V after 6 months of treatment. At 6 months, LV end-diastolic volume (110±28 ml/m2 vs. 87±31 ml/m2, p&lt;0.0001) and end-systolic volume (78±26 ml/m2 vs. 52±26 ml/m2, p&lt;0.0001) were reduced, hence mean LVEF increased (30±7% vs. 42±11%, p&lt;0.0001). LV end-diastolic pressure was significantly reduced (21±3.9 mmHg vs. 18±2.7 mmHg, p&lt;0.0001). These hemodynamic changes were associated with improved NYHA functional class (8% class III vs. 20% at baseline), reduced median NT-proBNP level (2398 pg/ml, interquartile range [IQR]: 1185–6034 to 813 pg/ml, IQR: 299–1971, p&lt;0.001) and increased mean six-minute walk test (6MWT) distance (356.8m (±150.5) at baseline to 415.0m (±397.0) at six months, p=0.003). LV end-systolic elastance (Ees), arterial elastance (Ea) and the ventricular-arterial coupling ratio Ea/Ees remained similar at 6 months of follow-up compared to baseline (p=ns).

Conclusion
After 6 months of treatment with Sacubitril/Valsartan, LV remodelling and reduced LV filling pressures were observed. These changes were associated with improvements in functional capacity, natriuretic peptide levels and NYHA functional class. Thus, the study provides important mechanistic insides into the hemodynamics of angiotensin–neprilysin inhibition in heart failure which might help to individualize therapy.

Funding Acknowledgement
Type of funding sources: None.
Aortic valve calcium score: does it correlate with mean transaortic gradient?
Authors: Amador A , Martins Da Costa C , Calvao J , Carvalho J M , Proenca T , Pinto R , Marques C , Cabrita A , Santos L , Oliveira C , Pinho A , Palma P , Rocha M , Sousa C , Macedo F 
Published: October 2022

Abstract

Introduction
Aortic valvular calcium score (AVCS) is useful in patients with aortic stenosis for whom echocardiography was not conclusive in grading its severity. Transcatheter aortic valve implantation (TAVI) is an established procedure of treatment in symptomatic severe AS. The burden of aortic valve calcification has been associated with some TAVI related complications (as perivalvular leaks), but at the same time it is well accepted that some degree of calcification is needed to ensure stable anchoring of the prosthesis to the aortic annulus.

Purpose
To assess if there is a correlation between aortic valve calcium score and mean transvalvular gradient 6 months after TAVI – is a higher AVCS correlated with lower mean transaortic gradient after TAVI?

Methods
We performed a single-center, retrospective cohort study including patients who underwent TAVI with a preoperative standardized contrast enhanced MSCT with AVCS available. Clinical and echocardiographic data were collected previously to TAVI (pre-TAVI) and at 6 months follow up (6M-FUP).

Results
A total of 187 patients were included, with 54% female and a mean age of 79.4±9.0 years old. Most patients had tricuspid aortic valve (95.7%); 5 patients had aortic bicuspidy and 3 had aortic valve bioprothesis. Concerning the valve type, 73.3% had new generation prosthesis and the main valve used was the CoreValve Evolut Pro (33.7%). Also, 38,5% needed balloon pre-dilation before TAVI. The mean pre-TAVI aortic transvalvular maximum and mean gradients were 76.5±23.2 mmHg and 48.3±15.5 mmHg, respectively; mean aortic valve area was 0.75±0.16 cm2. The mean AVCS was 2851±1524 AU (Agaston Units); 81.2% of women had AVCS&gt;1300 AU and 74.4% men had AVCS &gt;2000 AU. Comparing transvalvular aortic gradients previously and 6M-FUP after TAVI, there was an average differential of maximum gradient of 61±22 mmHg and of mean gradient of 40±15 mmHg. A negative and weak correlation was found between the AVCS and the maximum gradient (pearson coefficient of −0.181, p=0.02) and between mean gradient at 6M-FUP (pearson coefficient of −0.191, p=0.014).

Discussion and conclusion
AVCS is a significant predictor for death, stroke and perivalvular leaks after TAVI. On the other hand, high AVCS is associated with better seating in the native annulus during deployment. Nevertheless, high AVCS did not strongly correlated with mean transaortic gradient 6 months after TAVI.

Funding Acknowledgement
Type of funding sources: None.
Clinical determinants of non-invasive global myocardial work index before and after transcatheter aortic valve implantation: a prospective study
Authors: Lakatos B K , Ruppert M , Ladanyi Z , Fabian A , Ujvari A , Turschl T , Molnar B , Straub E , Molnar A , Nagy A , Molnar L , Kovacs A , Merkely B 
Published: October 2022

Abstract

The estimation of non-invasive global myocardial work indices is a novel method of the left ventricular (LV) functional assessment, which may overcome the load-sensitvity of the traditional functional measures. The diagnostic and prognostic role of this approach may gain particular importance in pressure overload states, such as in patients with severe aortic stenosis. However, the longitudinal changes of this recently introduced measure are scarcely investigated, and data are also lacking about the main determinants of these measures.
Accordingly, our aim was to investigate the clinical determinants of preoperative and also postoperative GMWI in patients undergoing transcatheter aortic valve replacement (TAVR).
Fifty patients (62% male, age: 78±5 years) were enrolled. Prior to the procedure, subjects underwent echocardiographic investigation and the detailed medical history was also recorded. Speckle-tracking analysis was performed and global longitudinal strain (GLS) was measured. LV pressure curve was estimated by adding the mean aortic valve gradient to the systolic blood pressure. Using these measures, global myocardial work index (GMWI) and global constructive work index (CMWI) was quantified by commercially available software. A 6 months follow-up examination was also performed and at that time point we determined the aforementioned parameters.
At follow-up, GLS has significantly increased (−13.0±4.1 vs. −14.8±3.8%; p&lt;0.001), while GMWI was significantly lower compared to baseline (1789±748 vs. 1506±561 mmHg%, p&lt;0.01). CMWI did not differ between the two time points (2309±782 vs. 2086±609 mmHg%, p=0.11). Using multivariable analysis, age (β=0.30; p&lt;0.05) preoperative New York Heart Association (NYHA) class (β=−0.48; p&lt;0.001) and having a pacemaker (β=−0.44; p&lt;0.01) were found to be independent predictors of the preoperative GMWI (R2=0.39; overall p&lt;0.001). On the other hand, postoperative GMWI was determined (R2=0.48; overall p&lt;0.001) by gender (β=−0.25; p&lt;0.05), the presence of diabetes mellitus (β=−0.37; p&lt;0.01) and also by having a pacemaker (β=−0.38; p&lt;0.01).
TAVR significantly alters LV functional measures. Different clinical factors influence GMWI before and after the procedure: age, NYHA class-based symptom severity and having a pacemaker were found to be independently associated with preoperative GMWI, while gender, the presence of diabetes mellitus and pacemaker device are the most important clinical determinants of the postoperative GMWI value.

Funding Acknowledgement
Type of funding sources: None.
Prognostic value of left ventricular chamber stiffness and heart failure in patients with severe aortic stenosis undergoing aortic valve replacement
Authors: Wen S N , Anand V , Abdelrazek A S , Pislaru S V , Thaden J T , Pellikka P A , Nkomo V T , Kane G C , Greason K L , Pislaru C 
Published: October 2022

Abstract

Background
Increased left ventricular (LV) stiffness (LVStiffn) was shown to be associated with mortality in patients with severe aortic stenosis (AS), despite aortic valve replacement (AVR), and may contribute to future heart failure (HF) symptoms. The aim was to assess whether preoperative LVStiffn is a risk factor of HF in these patients.

Methods
A retrospective analysis was done in patients with severe AS who underwent AVR (93% surgical). LV end-diastolic pressure-volume relations (P=aVb) were reconstructed from LV end-diastolic volumes and estimated end-diastolic pressures (from E/e'); LVStiffn at 30 mmHg (CS30) and capacitance (V30) were then derived. Primary endpoint was development of symptomatic HF at &gt;1 month post AVR.

Results
1,837 patients were studied (age 76±10 years, 62% males, LVEF 61±12%; Table). Mean CS30 was 2.2±1.3 mmHg/mL and V30 64±17 mL/m2. Patients with higher CS30 ≥3 mmHg/mL were older, more frequently female, and had more comorbidities. During a median follow-up of 5.0 [3.0–7.9] years, 607 (33%) patients developed HF. A higher CS30 (≥3 mmHg/mL), but not V30 (P=0.32), was associated with higher risk of HF events (HR 1.86 [95% CI 1.52–2.27], P&lt;0.0001), along with other clinical and echo predictors (Table). In multivariate analysis, adjusting for age, sex, comorbidities, advanced NYHA class III–IV, creatinine &gt;1.5 mg/dL, medication use, severity of AS, reduced LVEF &lt;50%, diastolic dysfunction grade ≥2, right ventricular size and pulmonary hypertension, a higher CS30 ≥3 mmHg/mL remained independently associated with HF events (adjusted HR 1.61 [1.29–2.01], P&lt;0.0001; Figure).

Conclusion
Increased LVStiffn in patients with severe AS undergoing AVR is associated with HF at follow-up, despite the benefits brought by AVR, and can help identify patients with poorer outcomes who may need closer monitoring/more intensive treatment of comorbidities

Funding Acknowledgement
Type of funding sources: None.
Reliability of echocardiographic estimation of pulmonary artery pressure in patients with severe tricuspid regurgitation
Authors: Lemarchand L , Leurent G L , Auffret V A , Donal E D 
Published: October 2022

Abstract

Background
Transthoracic Echocardiography (TTE) seems to be mistaken for the estimation of systolic Pulmonary Artery Pressure (sPAP) especially in patients with severe Tricuspid Regurgitation (TR). This study aimed to determine the reliability of the assessment of sPAP by TTE in this population.

Methods
This is a monocentric analysis of 236 consecutive patients with concomitant Right Heart Catheterization (RHC) and TTE performed in the assessment of an heart failure syndrome. Lin's Concordance Coefficient (LCC) and Bland-Altman Analysis (BAA) were used to compare the values of RHC and TTE.

Results
The correlation between the two procedures was good in the total population (LCC = 0.80; 95% limits of agreement (LOA): 0.74; 0.84), but weaker in the 78 patients (33%) with severe TR (LCC = 0.67; 95% LOA: 0.49; 0.80), with a propensity to an underestimation by TTE. Altered Right Ventricular (RV) – Pulmonary Artery (AP) coupling did not lead to a misestimation, contrary to an elevated Right Atrial Pressure (RAP), which was associated with an underestimation by TTE of about 8 mmHg. The presence of “C-V waves” sign on the RAP curves (Odds-Ratio (OR) = 3.32; 95% Confidence Interval (CI): 1.02; 10.9; p=0.04) and invasive sPAP ≥50 mmHg (OR = 2.63; 95% CI: 1.35; 5.16; p&lt;0.01) were two independent predictors of a misestimation of sPAP by TTE.

Conclusion
Severe TR led to an underestimation by TTE, especially if the RAP curve shows a “C-V waves” sign, and in the case of high invasive sPAP.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): CHU Rennes Pontchaillou
Impact of TTVR on reverse remodeling of right-ventricular function and morphology in patients with severe tricuspid regurgitation
Authors: Primet Y , Menck N M , Alushi B A , Bisht O B , Loser S L , Duddek C D , Geweiler J G , Alsheri S A , Vathie K V , Beuster S B , Steinborn F S , Mattea V M , Schade A S , Schulz-Menger J S M , Lauten A L 
Published: October 2022

Abstract

Background
Tricuspidregurgitation (TR) is recognized as majorpublic health concern with significant impact on morbidity and mortality. Multiple innovative approaches for transcatheter tricuspidvalve repair (TTVR) are currently under development, however their impact on cardiac function and outcome is still unclear. Cardiac Magnetic Resonance Imaging (CMRI) is considered as reference technique for right ventricular (RV) volumetric and functional measurements. Therefore, the purpose of the present study was to evaluate the impact of TTVR with the TriClip Technique on CMRI measured RV function and morphology.

Methods and results
Pre- and postprocedural to TTVR, RV function and morphology were evaluated in CMRI. Clinical outcome and quality of life were evaluated based on New York Heart Association (NYHA) class and the KCCQ-Score at baseline and within 30 days after Triclip Implantation. In total, 16 patients underwent pre and post procedural CMRI. Mean age was 78.9±0.5 years, with 42.8% were male (n=7). All patients presented functional TR. Mean RV end-diastolic volume (RVEDV) and RV end-systolic volume (RVESV) at baseline were 192.7ml ±25.85ml and 97.9ml ±0.51ml, RV stroke volume (RVSV) was 94.84ml and the RV ejection fraction (RVEF) was 49.5%. After a meanfollow-up of 19.6±1.1d, RVEDV and RVESV haddecreased to 181.7ml ±0.01ml and 85.5 ml ±5.95ml, respectively. The RVSV and RVEF increased to 94.2ml ±8.15ml and 53.1% ±0.14%, respectively. The quality of life evaluation showed an improvement of KCCQ-Score in 13/16 patients and remained unchanged or worsened in 3/16 patients.

Conclusion
In this pilot study, we observed an improvement of RV function as well as a reduction of RVEDV and RVESV after TTVR. These functional and morphometric changes induced by TTVR suggest a more efficient RV stroke work. This was associated with an improved quality of life according to KCCQ-Score in the majority of patients.

Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): Helios Klinikum Erfurt
Prognostic relevance of mitral regurgitation at different follow-up timepoints after transcatheter aortic valve implantation (TAVI): implications for therapeutic decision making?
Authors: Franz M , Baez L , Moebius-Winkler S , Diab M , Ibrahim K , Kraeplin T , Schulze P C 
Published: October 2022

Abstract

Background
Transcatheter aortic valve implantation (TAVI) has developed rapidly in the last decade and is now recommended as state-of-the-art treatment for elderly patients suffering from severe symptomatic degenerative aortic stenosis (AS). The extent of mitral regurgitation (MR) following TAVI is likely to be of prognostic relevance. This raises the question whether treating MR following TAVI improves outcome of patients with significant MR.

Purpose
The current study was aimed to elucidate the prognostic value of MR at different follow-up (FU) timepoints after TAVI in a prospective real-world single-center registry study.

Methods
A total of 445 patients with severe AS, which were treated by transfemoral TAVI, were included and a wide range of clinical, laboratory, functional and imaging parameters were prospectively assessed. Mortality was recorded at 30 days, 1 year and 2 years after TAVI. Complete FU data including echocardiography were available at 6 to 8 weeks (n=334) as well as 6 months (n=235) after TAVI.

Results
All patients (mean age: 78.7±7.3 years, 52% female, mean STS score: 5±3.9%) were successfully treated by transfemoral TAVI using balloon- or self-expanding prostheses and showed mortality rates of 3.6% after 30 days, 16.4% after 1 year and 22.6% after 2 years. Moderate or severe (relevant) MR was detectable in 39% of the patients at baseline, in 27% of patients after 6 weeks (p=0.001) and in 28% of patients after 6 months (p=0.036, compared to baseline). Multivariate analysis identified independent predictors of 2-year mortality: clinical frailty scale and PAPsys at 6 to 8 weeks post-TAVI as well as BNP and relevant MR 6 months post TAVI. Among those parameters, MR after 6 months was the strongest predictor of long-term mortality (OR 3.192, CI 0.971–10.487, p=0.056). Kaplan-Meier survival analysis displayed significantly worse 2-year survival rates in patients suffering from relevant MR at 6 months (12.1% versus 4.8%, p=0.042).

Conclusions
Taken together, this real-life single-center experience underlines the prognostic value of relevant MR 6 months after TAVI with respect to long-term survival. Interestingly, MR was not predictive at the 6 to 8 weeks FU suggesting that early remodeling includes MR with prognostic relevance in those patients. Whether MR treatment, e.g., by transcatheter edge-to-edge repair, will improve patient outcomes post-TAVI has to be tested in prospective trials.

Funding Acknowledgement
Type of funding sources: None.