bluuebunny/crossref_metadata_2025_split huggingface dataset:
Aortic valve calcification and endomyocardial fibrosis determine adverse outcomes following transcatheter aortic valve replacement
Authors: Evertz R , Hub S , Beuthner B , Backhaus S , Lange T , Topci R , Toischer K , Kowallick J , Puls M , Zeisberg E , Hasenfuss G , Schuster A 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Aims
There is evidence to suggest that subtype of aortic stenosis (AS), degree of myocardial fibrosis (MF) and level of aortic valve calcification (AVC) are associated with adverse cardiac outcome in AS. Since little is known about their respective contribution, we sought to investigate their relative importance and interplay as well as association with adverse cardiac events.

Methods
100 consecutive patients with severe AS and indication for transfemoral transcatheter aortic valve replacement (TAVR) were prospectively enrolled between January 2017 and October 2018. Patients underwent transthoracic echocardiography, multi detector computed tomography (MDCT) and left ventricular endomyocardial biopsy at the time of TAVR.

Results
The final study cohort consisted of 92 patients with completed study protocol comprising of 39 (42.4 %) normal ejection fraction high gradient (NEFHG), 13 (14.1 %) low EF high gradient (LEFHG), 25 (27.2 %) low EF (flow) low gradient (LEFLG) and 15 (16.3 %) paradoxical low flow low gradient (PLFLG) AS. The high gradient phenotypes (NEFHG and LEFHG) showed the largest amount of AVC (807 ± 421; 813 ± 281 mm³ respectively) as compared to the low gradient phenotypes (LEFLG and PLFLG; 503 ± 326; 555 ± 594 mm³ respectively, p &lt; 0.05). Conversely, MF was most prevalent in low output phenotypes (LEFLG &gt; LEFHG &gt; PLFLG &gt; HEFHG, p &lt; 0.05). This was paralleled by larger cardiovascular mortality within 600 days post TAVR (LEFLG n = 7 &gt; PLFLG n = 4 &gt; LEFHG n = 2 &gt; NEFHG n = 1). In Patients with high MF burden a higher AVC was associated with a lower mortality (p = 0.045, HR = 0.261, 95%CI 0.07-0.97). Within LEFLG AS, patients with larger AVC (&gt;476.8 mm³) had larger MF (40.2%) and higher cardiovascular mortality (n = 5) as compared to patients with lower AVC (£476.8 mm³, 17.1% MF, p = 0.027, cardiovascular mortality n = 2).

Conclusion
MF is associated with adverse cardiovascular outcome following TAVR which is most prevalent in low ejection fraction situations. In the presence of large MF burden patients with large AVC have better outcome following TAVR. Conversely worse outcome in large MF and relatively little AVC may be explained by a relative prominence of an underlying cardiomyopathy while better survival rates in large AVC patients may indicate severe AS associated pressure overload relief and subsequently improved survival following TAVR.
Impact of changes in tricuspid regurgitation on clinical outcomes following mitral valve teer compared to guideline-directed medical therapy: a sub-analysis of the COAPT trial
Authors: Lehenbauer K , Asch F , Weissman NJ , Grayburn P , Kar S , Lim S , Li D , Puri R , Kapadia S , Sannino A , Lindenfeld J , Abraham W , Mack MJ , Stone GW , Hahn R 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation (COAPT)

Background
Prior studies suggest tricuspid regurgitation (TR) diminishes/resolves following mitral valve surgery and thus do not require treatment and may not influence outcomes.

Purpose
We sought to evaluate the change in TR (ΔTR) and its association with outcomes after transcatheter edge-to-edge repair (TEER) compared with guideline-directed medical therapy (GDMT) in the COAPT trial.

Methods
Patients from the COAPT trial with echo core lab TR assessment at baseline and 30-day follow-up (n = 504) were included and divided into 2 groups: those whose TR worsened (ΔTR-INC) and those with no change or improvement in TR (ΔTR-SAME/DEC). Two-year composite endpoints of death or heart failure hospitalization (HFH) and the individual components were analyzed, after excluding events occurring within the first 30 days.

Results
ΔTR-SAME/DEC occurred in 430 pts (228 TEER, 202 GDMT) while ΔTR-INC was noted in 74 pts (38 TEER, 36 GDMT) (Figure 1A). From 30 days to 2 years, ΔTR-INC pts had a higher rate of the composite outcome of death or HFH compared with ΔTR-SAME/DEC (p = 0.006, Figure 1B). Both 2-year death (HR 1.52, 95% CI 1.01-2.27; p = 0.04) and HFH (HR 1.52, 95% CI 1.04-2.22; p = 0.03) were associated with ΔTR-INC. Assessed by treatment group (Figure 1C and 1D), the relationship between ΔTR-INC and composite death or HFH was significant in GDMT alone pts (HR 1.86, 95% CI 1.21-2.86) but not in TEER pts (HR 1.33, 95% CI 0.79-2.23), although interaction testing demonstrated consistency between the two treatments (Pint = 0.31).

Conclusions
Worsening TR at 30 days occurred in ∼15% of pts in the COAPT trial whether they were treated with TEER or GDMT alone. DTRINC was associated with increased death and HFH during 2-year follow-up. Abstract Figure 1
Right ventricular remodelling in patients with significant tricuspid regurgitation undergoing tricuspid valve surgery
Authors: Galloo X , Meucci MC , Stassen J , Dietz MF , Prihadi EA , Van Der Bijl P , Ajmone Marsan N , Braun J , Bax JJ , Delgado V 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Inconsistent changes in right ventricular (RV) dimensions and function have been observed after tricuspid valve (TV) surgery and their associations with long-term outcomes have not been explored.

Purpose
To evaluate RV remodelling and RV function in patients with significant (moderate or severe) tricuspid regurgitation (TR) undergoing TV surgery and their association with outcome.

Methods
A total of 121 patients (mean age 63 ± 12 years, 47% male) with significant TR treated with TV surgery and who had an echocardiogram between 3 months and 1 year of follow-up, were included for this analysis. Remodelling was assessed by comparing dimensions and function at follow-up to baseline values. The population was stratified by tertiles of percentage reduction of RV end-systolic area (RVESA) and absolute change of RV fractional area change (RVFAC). Five-year mortality rates were compared across the tertiles of RV remodelling and the independent associates of mortality were investigated.

Results
Reduction in RVESA and improvement in RVFAC were significantly associated with better survival after TV surgery, whereas reduction in RV end-diastolic area was not (Figure 1). One third of the patients presented with a reduction in RVESA of at least 17.2% and improvement in RVFAC of at least 2.3%, constituting the third tertiles for comparison. Kaplan-Meier curves for overall survival according to RVESA- and RVFAC-tertiles are shown in Figure 2. Cumulative survival rates were significantly better in patients in the third tertile of RVESA reduction: 49%, 69%, and 90% for tertile 1, tertile 2, and tertile 3, respectively (log-rank chi-square: 12.526; p = 0.002); as well as according to RVFAC improvement: 57%, 65%, and 87% for tertile 1, tertile 2, and tertile 3, respectively (log-rank chi-square: 7.784; p = 0.02). Tertile 3 of RVESA-reduction as well as tertile 3 of RVFAC-change were both independently associated with better survival after TV surgery compared to tertile 1 (hazard ratio: 0.221 [95% CI: 0.074 to 0.658] and 0.327 [95% CI: 0.118 to 0.907], respectively).

Conclusion
The magnitude of RV reverse remodelling (based on reduction in RVESA) and improvement in RVFAC were associated with better survival at 5 years’ follow-up after TV surgery for significant TR. Abstract Figure 1: Spline curves Abstract Figure 2: KM curves for overal survival
Can aortic calcium score predict new conduction disturbances in pos-transcatheter aortic valve implantation?
Authors: Costa C , Calvao J , Amador A , Proenca T , Carvalho M , Pinto R , Marques C , Cabrita A , Grilo PD , Resende CX , Torres S , Sousa C , Macedo F 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Transcatheter aortic valve implantation (TAVI) may be the first line treatment for severe aortic stenosis according to overall patient characteristics. Semi-quantitative Agatston score (AS), which quantifies aortic calcium by cardiac computed tomography (CCT), has knowledgeable practical and clinical implications, and is performed in TAVI diagnostic workup. Since conduction disturbances continue to be the most frequent complication, further refinements are required to predict high-risk patients.

Purpose
To access if aortic AS relates with new conduction disturbances and permanent pacemaker (PPM) implantation in patients undergoing TAVI.

Methods
We retrospectively analyzed all patients who underwent TAVI at a tertiary center from October 2014 to November 2019; patients with previous permanent pacemaker (PPM) or had no aortic AS were excluded. Clinical and electrocardiogram (ECG) data were collected at admission and after the procedure. All categorical variables are reported as numbers and percentages. Continuous variables were analyzed using the two-tailed unpaired Student’s t-test and are reported as mean values and the standard deviation. Statistical analysis was performed using the IBM SPSS.

Results
172 patients with a mean age 79 ± 9.1 years old were included (see table 1 for baseline characteristics). AS was on average 3008 ± 2262 (see table 2 for remaining diagnostic workup and procedure characteristics).
Comparing AS with new conduction disturbances, no statistically significant difference was found for new complete left branch block (LBBB) (no vs new LBBB, AS: 3179 ± 2555 vs 2637 ± 1388, p= 0,15) and with new complete atrioventricular block (AVB) (no vs new AVB, AS: 2834 ± 1520 vs 4485 ± 5285, p = 0.2). Considering PPM implantation after TAVI, there was a tendency for higher AS and PPM implantation (no vs PPM implantation, AS: 2756 ± 1451 vs 4242 ± 4310, p = 0.07).
In patients who had pre-ballooning, there was no difference relating to AS; however, in patients who had no pre-ballooning there was a trend to higher AS and PPM implantation (no vs PPM implantation, AS: 2417 ± 1301 vs 4616 ± 4969, p = 0.06). No statistically significant difference was found when comparing earlier (Portico, CoreValve Evolut R) vs newer valves (CoreValve Evolut Pro; Edward Sapiens 3; Accurate Neo).

Conclusion
Aortic calcium measured by Agatston score did not show a correlation with new LBBB or new AVB after TAVI. Nevertheless, it seems to be a trend for higher AS and PPM implantation; this was more noticeable when pre-ballooning was not performed. Further studies are needed in order to further elucidate this association. Abstract Figure. Patients baseline characteristics Abstract Figure. TAVI diagnostic workup and procedure
Echocardiographic predictors of left ventricular reverse remodeling after aortic valve replacement in patients with paradoxical aortic stenosis
Authors: Zafirovska P , Georgievska - Ismail L , Andova V , Matveeva N , Idoski E , Mitrev Z 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Paradoxical aortic stenosis (AS) is low-flow (SVi ≤ 35ml/m2) , low- gradient (Mean PG ≤ 40mmHg) severe aortic stenosis (AVA &lt; 1cm2) in patients with preserved ejection fraction (EF ≥ 50%) usually associated with female gender, advanced age, small body size and history of hypertension. Left ventricular (LV) reverse remodeling presents with LV hypertrophy reversal following aortic valve replacement (AVR) and is associated with better long term prognosis.

Purpose
The purpose of our study was to asses echocardiographic predictors of better outcome in patients with paradoxical severe AS following AVR.

Methods
Detailed transthoracic echocardiographic (TTE) evaluation with left ventricular strain analysis was performed using 2D Philips Epique 7 in patients with severe aortic stenosis with AVR indication before and 4 months after the intervention.

Results
Among 75 patients with severe AS and indication for AVR, 20 (31, 7%) were paradoxical AS with low- flow, low –gradient and preserved ejection fraction. Sixty percent were female and eighty percent had hypertension where all echocardiographic parameters improved following AVR including improvement of LV global longitudinal strain (LS) as well as reduction of left ventricular mass indicating left ventricular reverse remodeling (Figure 1). The patients with paradoxical AS compared to the other forms of severe AS had the lowest values for MAPSE and s’TDI before and after AVR. Independent predictors of LV reverse remodeling before AVR were end systolic LV volume (ESV) , AVA/BSA and the number of segments with LS &lt; 13%.

Conclusion
Paradoxical severe AS is associated with worse post AVR prognosis compared to the high gradient severe AS. Echocardiographic predictors of LV reverse remodeling in patients with paradoxical severe AS following AVR are LV ESV, AVA/BSA and number of segments with LS &lt; 13%. Timely diagnosis and AVR referral of patients with paradoxical severe AS is of major importance in the management of aortic valvular disease. Abstract Figure. Descriptive of 20pts with paradoxical AS Abstract Figure. Predictors of LV reverse remodeling
Echocardiographic predictors of outcome after isolated tricuspid valvular surgery
Authors: Eggenspieler F , Huttin O , Erpelding ML , Filippetti L , Pace N , Popovic B , Sirbu C , Elfarra M , Maureira P , Selton Suty C 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Right ventricular (RV) function is one factor influencing outcome after isolated tricuspid valve surgery (ITVS). As it is highly load dependant, its echocardiographic assessment requires a multiparametric analysis.

Purpose
To assess prognostic value of RV echocardiographic parameters among patients undergoing ITVS.

Methods
Preoperative echocardiograms were retrospectively reviewed in 75 patients (mean age 54 ± 17 years) who underwent ITVS between 2007 and 2020. We assessed classical parameters of RV load, morphology and function, and calculated a load-remodeling-function index (LRFI) combining load (using tricuspid regurgitation time-velocity integral), remodeling (using ratio of RV diameter / length) and function (using strain rate (SR)). Those parameters were compared between alive and dead patients at 1-year follow-up.

Results
Mortality rate was 17.3% at 1 year and 22.7% at 5 years. Among standard RV function parameters, only S’ and SR were significantly lower in dead than in alive patients at 1 year.
LRFI was significantly higher in dead patients at 1-year. By analysis of ROC curve, LRFI (AUC 0.823 [0.678-0.968]; p = 0.002) was the best predictor of death at 1 year.
When associating a clinical variable (pre-existing right heart failure (RHF)) and LRFI, Kaplan Meier curves showed significantly higher mortality in patients with both RHF and altered LRFI.

Conclusion
Global RV analysis using a parameter combining load, remodeling and function may help in the prognostic assessment of patients undergoing ITVS, in addition to the presence of RHF.
Machine learning predicts all-cause mortality in patients with severe aortic regurgitation
Authors: Anand V , Hu H , Weston AD , Scott CG , Michelena HI , Pislaru SV , Carter RE , Pellikka PA 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Aortic regurgitation (AR) is a common valvular lesion associated with left ventricular (LV) enlargement and dysfunction and increased risk of death with onset of symptoms, significant LV enlargement, or systolic dysfunction. The current guidelines are based on symptoms, LV size and LV function to evaluate the candidacy for surgery in patients with severe AR.

Purpose
We propose a machine-learning (ML) based algorithm to identify patients at risk for death from AR independent of aortic valve replacement (AVR) surgery (patients were censored at AVR event unless the operation occurred within 100 days of the first visit, in which case baseline AVR is included as a predictor).

Methods
The model was trained with 5-fold cross-validation on a dataset of 1035 patients. Model performance is reported on an independent dataset of 207 patients. Optimal predictive performance was observed with a Conditional Random Survival Forest model. A subset of 19 / 41 variables were selected for inclusion in the final model. Variable selection was performed with 10-fold cross validation using Random Survival Forest model; variables that were on an average selected by less than 6/10 splits were excluded.

Results
The mean age of patients was 60 ± 17 years and 198 (18%) were females. The variables included in the models were age, end-diastolic volume, end systolic dimension, body surface area, ejection fraction, NYHA class, body mass index, diastolic blood pressure, bicuspid valve, regurgitant volume, filling pressure, mid ascending aorta diameter, mitral tissue early relaxation velocity, pulmonary artery systolic pressure, and comorbidities, and the relative variable importances averaged across five splits of cross validation in each repeat were evaluated (Figure). The predictive AUC for predicting survival of the best-performing model was 0.84 at 1 year, 0.86 at 2 years, and 0.87 overall, respectively.

Conclusion
Using commonly observed echo parameters and patient characteristics we successfully trained a ML model to predict survival in patients with severe AR. This technique could identify high-risk patients who would benefit from early intervention, thereby improving patient outcomes. Abstract Figure.
Left atrial myopathy and mitral regurgitation in hypertrophic cardiomyopathy
Authors: Zegkos T , Kamperidis V , Gossios T , Ntelios D , Parcharidou D , Papanastasiou CA , Katranas S , Rouskas P , Karvounis H , Efthimiadis GK 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Recent studies have shown that mitral regurgitation (MR) represents a major determinant of left atrial (LA) function in patients with heart failure with preserved ejection fraction. The role of MR in determining LA myopathy in hypertrophic cardiomyopathy (HCM) is unknown.

Purpose
The aim of this study was to examine the association of MR with LA myopathy, assessed by LA strain in HCM patients.

Methods
In total 250 consecutive patients (mean age 51 ± 16years, 67.2% male) with an established diagnosis of HCM and with sinus rhythm at index echocardiography evaluation were included. LA reservoir, conduit and booster strain were analyzed, besides LA size, left ventricular (LV) systolic and diastolic function. The predictors of LA strain values were identified with linear regression analysis.

Results
More than mild MR was a significant univariate predictor of all the three LA strain values. In multivariate linear regression analysis, independent predictors of LA reservoir strain were more than mild MR (r= -0.23), LV global longitudinal strain (r= -0.49), LA volume index (r= -0.27) and patient age (r= -0.22). More than mild MR was also an independent determinant of LA conduit (r=-0.17) and booster strain (r=-0.12) (Table 1). In patients with LA volume index &lt;34ml/m2 more than mild MR was an independent predictor of LA reservoir (r= -0.32) and conduit strain (r= -0.27), but not LA booster strain (Table 2).

Conclusion
The severity of MR is associated with LA myopathy with independently of the LV diastolic and systolic function and LA size. Abstract Table 1 Abstract Table 2
Cardiac masses and contrast echocardiography
Authors: Lanzoni L , Bonapace S , Dugo C , Chiampan A , Anselmi A , Ghiselli L , Molon G 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
echocardiography may be the first imaging modality detecting a cardiac mass. Although echocardiography cannot give the histopathology, certain imaging features and adjunctive tools such as contrast echocardiography may aid in the differential diagnosis. Methods: we describe five cardiac masses in which echo-contrast helped to assess the presence or not of vascularization. Panel A shows a left atrial mass attached to the fossa ovalis with a large stalk prolapsing to the mitral inflow. Contrast echocardiography showed late but homogeneous opacification of the mass. Gross pathology confirmed an atrial mixoma. Panel B shows two masses in a patient with non-small cell lung cancer one embedded in the inferior left ventricular wall and the other floating in the left atrium. Administration of echo-contrast showed late and inhomogeneous enhancement of the myocardial mass and absent opacification of the atrial mass suggesting a metastatic infiltration of the myocardium together with an avascular neoplastic thrombus in the left atrium. Panel C shows a multi-lobulated and mobile mass in the right atrium straddling the tricuspid valve. Contrast echocardiography highlighted an inhomogeneous diffusion of the contrast within the mass with a rapid opacification only of its atrial portion. Gross pathology confirmed a recurrent thymoma. Panel D shows an intraventricular mass arising from the interventricular septum with multiple hypoechoic areas in a patient with metastatic carcinoid. Contrast administration showed a very late and mild degree of inhomogeneous enhancement. Conclusion: the echo-contrast allows a good differentiation between vascularized and non-vascularized cardiac masses, providing an important indication to differentiate thrombus from tumor. In those hypervascularized masses the homogeneous or inhomogeneous distribution of the contrast could be an interesting clue that orientates between primary or secondary cardiac tumors. Abstract Figure.
Pulmonary artery pulsatility index by echocardiography predicts mortality in patients with pulmonary hypertension
Authors: Kane CJ , Chung SY , Anand V , Kane GC , Pislaru SV , Lin G 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulmonary hypertension (PH) is a progressive pulmonary vascular disorder with an elevated mortality risk due to right ventricular failure. Pulmonary arterial pulsatility index (PAPi) based on invasively acquired parameters has emerged as a potentially valuable hemodynamic risk predictor. Whether non-invasively derived PAPi (PA pulse pressure/ RA pressure) is valuable is unclear.

Purpose
To assess whether PAPi measured non-invasively by transthoracic echocardiography acts as a prognostic hemodynamic biomarker of patient risk.

Methods
Consecutive patients undergoing transthoracic echocardiography for known or suspected PH over a one year period were included. PA systolic and diastolic pressure were estimated in standard fashion from peak tricuspid and end-pulmonary regurgitant Doppler profiles. Right atrial pressure was estimated based on 2D & Doppler assessment of the inferior vena cava hepatic vein. In those patients with PH (mean PA pressure &gt; 20 mm Hg), PAPi was divided into 3 groups based on prior publications with invasive data as &lt;1.5, 1.5 to 3 and &gt;3. Mortality was assessed over 5 years.

Results
Of 1,045 patients enrolled 64% had PH. Patients with the lowest PAPi (table) had higher NT-proBNP levels, larger right ventricles, worse right heart systolic function (cardiac output, TAPSE, systolic annular velocity, free wall systolic strain) and greater degrees of tricuspid regurgitation (Table). In patients with PH, PAPi was inversely associated with death (figure, p &lt; 0.0001) with each group of PAPi correlating with incrementally worse survival. Patients with a PAPi of &lt;1.5 had worst right heart size and dysfunction on echo (table) and worst survival (figure).

Conclusions
In patients with PH, low PAPi derived non-invasively by transthoracic echocardiography is associated with markers of right heart failure, right ventricular dysfunction and worse survival. PAPi could be incorporated into the conventional echo parameters reported in patients with known or suspected PH and maybe a useful predictor of outcome. Abstract Table Abstract Figure