bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcome of transcutaneous edge-to-edge mitral valve repair in patients with diabetes mellitus: results from a real-world cohort
Authors: Kirschfink A , Alachkar M N , Vogt F , Schroeder J , Lehrke M , Frick M , Almalla M , Marx N , Altiok E 
Published: October 2022

Abstract

Background
Transcutaneous edge-to-edge repair (TEER) has become a treatment option for selected patients with severe mitral regurgitation (MR). Analysis of the COAPT trial indicated patients with diabetes mellitus to have higher death rates and a trend to higher rates of heart failure hospitalization (HFH) than those without diabetes. However, in that study only patients with secondary MR with specific criteria were included and there are only limited data on diabetes patients in real-world settings.

Purpose
This study sought to evaluate safety and efficacy of TEER in patients with diabetes mellitus in comparison to non-diabetics.

Methods
In this monocentric study 340 consecutive patients with severe primary and secondary MR who underwent TEER were included. Immediate results of the procedure, intrahospital as well as one-year outcome were compared between patients with and without diabetes.

Results
Diabetes was present in 109 patients (32%) of the study group. Patients with diabetes were younger (75±8 vs. 78±8 years; p=0.003), had more often ischemic cardiomyopathy (68% vs. 48%, p&lt;0.001), previous coronary-artery bypass graft (35% vs. 20%; p=0.002) and arterial hypertension (89% vs. 75%; p&lt;0.001) compared to those without diabetes. All other baseline clinical and imaging characteristics including NYHA class, left ventricular dimensions and function (ejection fraction: 38±13% vs. 41±14%; p=0.10) as well as severity of MR were not different between both patient groups (Table 1).
Success of the procedure was comparable between patients with and without diabetes (95% vs. 95%; p=0.84). There was no difference in intrahospital mortality between both groups (5.5% vs. 4.8%; p=0.98). At one-year follow up, there was no difference regarding all-cause mortality (24.2% vs. 23.0%; p=0.72), HFH (37.4% vs. 31.0%, p=0.23), NYHA class (p=0.11) or MR severity (p=0.20) between both groups (Table 2).

Conclusion
In contrast to previous published data on patients with diabetes and severe MR TEER seems to be similar safe and effective in a real-world setting compared to non-diabetics.

Funding Acknowledgement
Type of funding sources: None.
Trans-catheter edge-to-edge mitral valve repair in patients with acute decompensated heart failure due to severe mitral regurgitation – a single centre experience
Authors: Makmal N , Silbermintz N , Faierstein K , Raphael R , Moeller C , Canetti M , Maor E , Kuperstein R , Hai I , Butnaru A , Oren D , Guetta V , Fefer P 
Published: October 2022

Abstract

Introduction
Recent series have demonstrated the benefit of trans-catheter edge-to-edge mitral valve repair (TEER) in acutely ill hospitalised patients with severe mitral regurgitation (MR) and intractable heart failure despite intensive intravenous therapy. We describe our cumulative experience with such patients at the Sheba Medical Centre over a 10 year period.

Purpose
The purpose of this study was to evaluate the safety and efficacy of TEER in hospitalized patients with acute decompensated heart failure and severe MR that was deemed to play a major role in the patients' deterioration.

Methods
We included 30 hospitalised patients with intractable heart failure and MR ≥3+ (20 males; mean age 74.2±10.6 years; 10 had cardiogenic shock). MR was primary in 4, secondary in 24 and mixed in 2 patients. Acute results were assessed by echocardiography prior to discharge and safety was evaluated clinically, according to the occurrence of procedure-related adverse events. Mortality data were drawn from the national death registry.

Results
TEER devices were successfully implanted in 28 patients. Early (POD 1) procedure-failure was noted in one patient due to recurrence of flail. There was no peri-procedural mortality. Two patients were hemodynamically unstable during the procedure. One patient had peri-procedural access site bleeding necessitating blood transfusion. Following intervention, 16 patients required ICU care (mean stay 4.8±2.5 days), shock was recorded in 7 patients, 16 required hemodynamic support, and 8 required invasive ventilation. At 30 days 7 patients had died and an additional 4 died 1 to 6 months following intervention. However, mortality in the remaining patients was low with only 3 additional deaths up to 4 years after the procedure (80% of patients alive at 6 months). MR reduction was achieved in 24 patients (to ≤mild in 10 and to moderate in 11). At 12 months follow up MR severity was mild in 3 (37.5%) and moderate in 5 (62.5%) patients. Only 1 patient reported HF rehospitalisation during the year following the procedure.

Conclusion
TEER for hospitalised patients with severe MR and intractable heart failure is safe, associated with high early mortality, and good long-term outcome for patients alive 6 months after the procedure. More research is needed to better characterise patients likely to benefit from TEER in this clinical scenario.

Funding Acknowledgement
Type of funding sources: None.
Effect of frailty on in-hospital outcomes after transcatheter mitral valve repair
Authors: Lopez J , Karpel D , Obaed N , Mark J , Wahood W , Ramos F , Jazaerly M , Chait R 
Published: October 2022

Abstract

Background
Mitral regurgitation (MR) is a common valvular disorder associated with significant morbidity and mortality. Transcatheter mitral valve repair (TMVr) is a minimally invasive procedure indicated for the treatment of selected patients with moderate-severe or severe primary MR. Despite a lack of a universal definition, frailty has been associated with poor post-procedural outcomes. Albeit several trials have examined individual prognostic factors in this population, there is a paucity of data regarding the effect of frailty on in-hospital outcomes after TMVr.

Purpose
To further elucidate the association of frailty with in-hospital outcomes in patients undergoing TMVr.

Methods
The national inpatient sample (NIS) database, which is part of the Healthcare Cost and Utilization Project (HCUP), was queried from 2016 to 2019 to identify all who underwent TMVr. International classification of diseases, tenth revision clinical modification (ICD-10-CM) codes were used to divide patients into frail and non-frail study groups. Frailty was defined using Johns Hopkins Adjusted Clinical Groups diagnosis cluster for frailty. Multivariate linear and logistic regression analysis was performed to compare in-hospital mortality, hospital length of stay, non-home discharge, and iatrogenic cardiac complications among Frail and Non-Frail groups.

Results
A total of 30,660 patients who underwent TMVr were identified. The mean age was 76±11.6 years. Of those, 2,950 (9.6%) were identified as frail. The overall in-hospital mortality rate for the entire study population was 1.89%. Compared to non-frail patients, those identified as frail had greater odds of in-hospital mortality (AOR= 2.13, 95% CI 1.29–3.51, p&lt;0.001) and non-home discharge (AOR= 4.34, 95% CI 3.54–5.32, p&lt;0.001). However, there was no statistically significant difference in hospital length of stay and rates of iatrogenic cardiac complications.

Conclusions
Frailty models continue to be underutilized as a prognostic tool in clinical practice. After following HCUP guidelines, our analysis found that frailty is independently associated with increased in-hospital mortality and non-home discharge in patients undergoing TMVr. Therefore, we recommend that further efforts in incorporating frailty models in the pre-procedural assessment of patients undergoing TMVr should be sought along with a standardized predictive model for defining frailty.

Funding Acknowledgement
Type of funding sources: None.
Right ventricular reverse remodeling after mitral valve transcatheter edge-to-edge repair
Authors: Stolz L , Weckbach L , Doldi P , Orban M , Braun D , Stocker T , Higuchi S , Orban M , Wild M , Massberg S , Hagl C , Naebauer M , Hausleiter J 
Published: October 2022

Abstract

Background
Right ventricular dysfunction (RVD) is an important predictor for outcome in patients undergoing transcatheter mitral or tricuspid valve edge-to-edge repair (M/T-TEER). Due to the unique anatomy and contraction pattern of the RV, three-dimensional echocardiography (3DE) has emerged as a valuable tool in the assessment of RV function. While 3DE data showed RV reverse remodeling (RVRR) following T-TEER, respective data are absent in the setting of M-TEER.

Purpose
We sought to assess RVRR after M-TEER using 3DE comparing baseline and follow-up RV measurements.

Methods
Patients undergoing M-TEER treatment for relevant MR between August 2016 and February 2021 with eligible transthoracic 3DE of the RV at baseline and follow-up were included in the study. 3DE comprised RV end-diastolic and end-systolic volumes (RVEDV3D, RVESV3D), total RV stroke volume (RVSV3D) and RV ejection fraction (RVEF3D). Further, RV length (RVL3D) as well as RV basal (RVbase3D) and mid-ventricular diameters (RVmid3D) were derived from 3DE. RVRR was assessed as change in the respective 3DE parameters of RV dimensions between baseline and follow-up.

Results
A total of 66 patients (45.5% female; age 78.5±8.2 years; EuroScore II 4.6±3.6%) were included in the study. From baseline to latest available follow-up (median interval 364 days, interquartile range 180–728 days), a significant reduction of RVEDV3D and RVESV3D was observed (RVEDV3D 140.2±50.2 ml to 128.1±46.1 ml, p&lt;0.01 and RVESV3D 93.1±37.8ml to 87.1±34.7ml, p=0.04). The decrease in 3D-derived linear RV dimensions primarily occurred in the septolateral direction, while RV length did not change significantly. The observed RVRR was associated with significant reduction of TR severity. Of note, patients with RVRR showed also left ventricular reverse remodeling (LVRR).

Conclusion
M-TEER is an effective treatment option for patients with MR which leads to LVRR and RVRR.

Funding Acknowledgement
Type of funding sources: None.
Transcatheter tricuspid annuloplasty with band implantation and its safety profile: a single-center experience
Authors: Martinez Moya R R , Ortega Perez R , Pardo Sanz A , Salido Tahoces L , Sanchez Recalde A , Abellas Sequeiros M , Mestre Barcelo J L , Fernandez Golfin C , Garcia Martin A , Hinojar Baydes R , Rivas Garcia S , Manjon Rubio H , Zamorano Gomez J L 
Published: October 2022

Abstract

Introduction
Severe tricuspid regurgitation is a prevalent valve disease with a negative impact on the prognosis and quality of life of patients. Transcatheter tricuspid annuloplasty with band implantation is an alternative for the treatment of this pathology in patients with high surgical risk. Due to the recent development of this device, data regarding its safety are scarce. The objective of this study was to describe the adverse events and complications related to transcatheter tricuspid annuloplasty with band implantation in our center in order to assess its safety.

Methods
In a series of 27 patients, the incidence of adverse events related to the procedure was analysed, considering death, stroke, myocardial infarction (MI), bleeding complications (extensive or life-threatening), vascular complications (pseudoaneurism), coronary complications, device-related secondary intervention (DRSI), device-related cardiac surgery (DRCS), renal failure (RF) or conduction system disturbance (CSD). Likewise, the incidence of death and hospitalizations due to heart failure in a 15-month follow-up was evaluated.

Results
No deaths, stroke, MI, DRCS, RF or CSD were recorded in relation with the percutaneous band implantation. There was 1 (3.7%) bleeding related to femoral venous vascular access that required suture and compression for 30 minutes. Development of 1 (3.7%) pseudoaneurysm was observed which was resolved with ultrasound-guided thrombin injection and 2 (7.4%) perforations of the right coronary artery (1 requiring stent implantation and another one self-limited without flow compromise). There was 1 (3.7%) patient with failed band implantation and eventual percutaneous bicaval prosthesis implantation was required. After a follow-up of 15 months, 2 (7.4%) deaths from non-cardiological causes (exacerbation of chronic obstructive pulmonary disease and traumatic brain injury) and 3 (11.1%) admissions due to decompensated heart failure were documented.

Conclusion
Transcatheter tricuspid annuloplasty with band implantation appears to be a safe technique with a low incidence of complications for treating patients with severe tricuspide regurgitation and high surgical risk.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Gobierno de España
Machine learning models for 1-year mortality prediction in hypertensive patients undergoing coronary artery bypass grafting surgery
Authors: Behnoush A H , Khalaji A , Hosseini K , Jameie M , Fallahzadeh A , Sheikhy A 
Published: October 2022

Abstract

Background
A significant proportion of patients undergoing coronary artery bypass grafting (CABG) surgery has a variety of comorbidities such as hypertension. Hypertensive patients tend to have poorer prognoses and higher mortality from acute coronary syndrome in short- and mid-term follow-ups. Machine learning (ML) prediction methods are now widely used in different clinical settings, operating more accurately and efficiently than clinicians and traditional scores in many instances.

Purpose
This study was designed to develop and evaluate the ML prediction models of 1-year mortality in hypertensive patients undergoing CABG in our institute during 2005–2015.

Methods
Several baseline and procedural characteristics of CABG hypertensive cases were collected. Train and test data were divided with the proportion of 70:30. Due to a high 1-year survival rate, the synthetic minority oversampling technique (SMOTE) was implemented. In addition, the optimal threshold for determination of sensitivity and specificity was found using 10-fold cross-validation in the train data. After performing feature selection using the random forest method, prediction models were developed using: Support Vector Machine (SVM), Naïve Bayes (NB), Logistic Regression (LR), K-Nearest Neighbors (K-NN), Extreme Gradient Boosting (XGB), and Random Forest (RF) algorithms. Area Under the ROC (Receiver Operating Characteristic) Curve (AUC) in addition to sensitivity, specificity, and accuracy were used to assess the performance of the models.

Results
Among 8943 hypertensive CABG patients with 1-year follow-up, the mean age was 68.27±9.29 years, of whom 303 died during the study period. Eleven features from a total of 26 were chosen to train the models. The most important prediction features being selected were total ventilation time, ejection fraction, triglyceride, and age. LR (AUC=0.819) and XGB (AUC=0.812) outperformed RF (AUC=0.804), NB (AUC=0.791), SVM (AUC=0.715) and KNN (AUC=0.718). The LR model demonstrated the highest specificity (83.00%) and accuracy (82.37%) while the XGB model was the most sensitive one (88.00%).

Conclusion
An applicable prediction system can help clinicians' decision-making for the risk of 1-year mortality in hypertensive CABG patients which may have higher death rate compared with normal population. Although LR, RF, and XGB performance were almost similar and more favourable than the other three, LR remained the most promising predictor, given its AUC.

Funding Acknowledgement
Type of funding sources: None.
Revascularization strategies versus optimal medical therapy in chronic coronary syndrome: a systematic review and network meta-analysis
Authors: Galli M , Benenati S , Zito A , Capodanno D , Biondi-Zoccai G , Ortega-Paz L , D'Amario D , Porto I , Burzotta F , Trani C , De Caterina R , Escaned J , Gaudino M , Angiolillo D J , Crea F 
Published: October 2022

Abstract

Background
Whether revascularization reduces ischemic events and improves prognosis in patients with chronic coronary artery syndrome (CCS) without left main (LM) disease or reduced left ventricle ejection fraction (LVEF) remains a topic of debate. Nevertheless, the impact of revascularization on outcomes in patients with CCS may be influenced by the revascularization strategy adopted.

Purpose
We aimed at evaluating the comparative effects of different revascularization strategies in patients with CCS.

Methods
A total of 18 randomized controlled trials including angiography-guided percutaneous coronary intervention (PCI), physiology-guided PCI and coronary artery bypass graft (CABG), were included. Effect estimates included direct comparisons for all treatments and direct and indirect evidence were in agreement for all included outcomes, fulfilling the consistency assumption. Incidence rate ratios (IRR) and associated 95% confidence intervals (CIs) were used to adjust outcomes according to follow-up durations. Medical therapy was used as reference strategy.

Results
Compared with medical therapy, at a mean follow-up of 5.1 years, all revascularization strategies were associated with a reduction of the primary endpoint, as defined in each trial, the extent of which was modest with angiography-guided PCI (IRR 0.86, 95% CI 0.75–0.99) and greater with physiology-guided PCI (IRR 0.60, 95% CI 0.47–0.77) and CABG (IRR 0.58, 95% CI 0.48–0.70). Moreover, angiography-guided PCI was associated with increased primary endpoint compared to physiology-guided PCI (IRR 1.43, 95% CI 1.14–1.79) and CABG (IRR 1.49, 95% CI 1.27–1.74). CABG was the only strategy associated with reduced myocardial infarction (IRR 0.68, 95% CI 0.52–0.90), cardiovascular death (IRR 0.76, 95% CI 0.64–0.89), and all-cause death (IRR 0.87, 95% CI 0.77–0.99), but increased stroke (IRR 1.69, 95% CI 1.04–2.76). Results were consistent at secondary analysis exploring the impact on outcomes of baseline characteristics, such as 3-vessel disease, diabetes mellitus, year of publication or stents used.

Conclusions
In CCS patients without LM disease or reduced LVEF, physiology-guided PCI and CABG were associated with better outcomes than angiography-guided PCI. Compared with medical therapy, CABG was the only revascularization strategy associated with a reduction of myocardial infarction and death rates, at the cost of higher risk of stroke.

Funding Acknowledgement
Type of funding sources: None.
Soluble urokinase plasminogen activator receptor predicts survival and hospitalization for heart failure in elective cardiac surgery
Authors: Koller L , Steinacher E , Hofer F , Kazem N , Laufer G , Fleck T , Wojta J , Steinlechner B , Richter B , Hengstenberg C , Niessner A , Sulzgruber P 
Published: October 2022

Abstract

Aims
The study investigated the prognostic value of soluble urokinase plasminogen activator receptor (suPAR) patients undergoing cardiac surgery and calculated a simplified biomarker score comprising suPAR, N-terminal pro B-type natriuretic peptide (NT-proBNP) and age.

Methods and results
Biomarkers were assessed in a cohort of 478 patients undergoing elective cardiac surgery. After a median follow-up of 4.2 years a total of 72 (15.1%) patients died. SuPAR, NT-proBNP and age were independent prognosticators of mortality in a multivariable Cox regression model after adjustment for EuroScoreII. We then calculated a simplified biomarker score comprising age, suPAR and NT-proBNP, which had a superior prognostic value compared to EuroScoreII (Harrel's C of 0.76 vs 0.72; P for difference = 0.02). Besides long-term mortality, the biomarker score had an excellent performance predicting one-year mortality and hospitalization due to heart failure.

Conclusion
The biomarker suPAR and NT-proBNP were strongly and independently associated with mortality in patients undergoing cardiac surgery. A simplified biomarker score comprising only 3 variables (age, suPAR and NT-proBNP) performed better than the established EuroScoreII with respect to intermediate and long-term outcome as well as hospitalization due to heart failure. As such, integration of established and upcoming biomarkers in clinical practice may provide improved decision support in cardiac surgery.

Funding Acknowledgement
Type of funding sources: None.
Outcomes of heart transplantation in adults and pediatrics congenital heart disease: a systematic review and meta-analysis
Authors: Mendel B M , Holiyono H I H , Angellia P A , Prakoso R P , Siagian S N S 
Published: October 2022

Abstract

Background
Heart transplantation (HTx) has progressed from an experimental therapy option to a well-established therapeutic option for congenital heart disease (CHD) patients in end-stage heart failure, thus we can expect a large number of people with CHD to be evaluated for HTx in the next decades.

Objective
To create a systematic review and meta-analysis regarding short-term and long-term outcomes of HTx in end-stage adults and pediatrics CHD patients.

Methods
Four online databases were screened from the date of inception to January 2022, where the acquired studies were assessed using the PRISMA statement. The inclusion criteria were cohort studies that evaluated outcomes of heart transplantation in end-stage congenital heart disease patients. The mortality of adults and pediatrics population were analyzed using random-effect model, showed as summary statistics of overall risk ratio (RR) with 95% confidence interval (CI). Quality appraisal was conducted using the STROBE statement.

Result
Ten studies met the inclusion criteria and were eligible to be analyzed. The pediatric population had stronger 1-year mortality risk [Std. Mean difference 0.62, 95% CI, 0.12 to 3.07; P&lt;0.00001] and 5-year mortality risk [Std. Mean difference 0.82, 95% CI, 0.37 to 1.84; P&lt;0.00001], while adult population were found to have higher overall post-transplantation mortality risk [Std. mean difference 1.17, 95% CI 0.66 to 2.08; P&lt;0.00001].

Conclusion
Adults CHD patients experienced higher mortality rate following heart transplantation, with improved long-term survival in comparison to pediatrics CHD recipients. However, further study should be conducted with standardized subjects as there is moderate quality of evidence and higher heterogeneity during our meta-analysis.

Funding Acknowledgement
Type of funding sources: None.