bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of pacemaker leads on the severity of tricuspid regurgitation after successful mitral valve edge to edge repair
Authors: Alsaad M , Lawrenz T , Marx K , Stellbrink C 
Published: October 2022

Abstract

Background
After percutaneous mitral-valve edge-to-edge repair (MVER) for mitral regurgitation (MR) in patients with baseline tricuspid regurgitation (TR), about one third of patients shows improvement in TR severity. It is unknown whether this improvement may depend on the presence of a right ventricular (RV) pacemaker (PM) lead.

Aim
We investigated whether the presence of an existing RV PM lead influences TR severity after successful MVER due to symptomatic secondary MR.

Methods and results
We retrospectively analyzed 115 consecutive patients with symptomatic secondary high-grade MR (age 78.1±9.4 years, 50 women (43%) and baseline TR grade &gt; or =1 (semiquantitative grading from 0 to 5) treated with MVER using the MitraClipTM device (Abbott, Cardiovascular, USA) and separated them in 2 groups, 43 patients with a PM lead compared to 72 pts without (see Table). TR grading by echocardiography was performed before and 3 months after MVER. (median follow up duration was 3 months). Procedural success with reduction of MR to &lt; or =2/4 grades was 100% in both groups (p&lt;0,001 vs. baseline). There was an overall significant change in TR grade after MVER in 46 pts (p 0,032): but both increase in TR in 17 pts (16.7%, p=0.58), in 10 pts with and in 7 pts without PM lead (58.8% vs. 41.2%, respectively; p=0.84) was not significant; the decrease in TR in 29 patients (28.4%, p=0.57), in 20 pts with and in 9 pts without PM lead (69% and 31%, respectively; p=0.47) also failed to reach statistical significance. TR reduction was associated with RV dilatation at baseline (p=0.006) but not the presence of pulmonary hypertension (p=0.83).

Conclusion
There was an overall significant change in TR after successful MVER. Although there was a trend towards an increase in TR after MVER in pts with PM lead there was no overall significant correlation between changes in TR severity and the presence of an RV PM lead but rather with baseline RV dilatation.

Funding Acknowledgement
Type of funding sources: None.
Infective endocarditis in diabetic patients: a different profile with prognostic
Authors: Biezma Lopez M , Munoz Garcia P , De La Villa Martinez S , Farinas Alvarez M C , Arnaiz De Las Revillas F , Gutierrez Carretero E , De Alarcon Gonzalez A , Rodriguez Garcia R , Llopis J , Goenaga Sanchez M A , Gutierrez Villanueva A , Plata Ciezar A , Vidal Bonet L , Martinez-Selles M 
Published: October 2022

Abstract

Background
Infective Endocarditis (IE) is a severe condition. Diabetes mellitus (DM) has been associated with a poor prognosis in other settings. Our aim was to describe the profile and prognosis of IE with and without DM and to analyse the prognostic relevance of DM-related organ damage.

Methods
Retrospective analysis of the Spanish IE Registry (2008–2020).

Results
The cohort comprises 5.590 IE patients with a mean age of 65.0±15.5 years, 3.764 (67.3%) were male. DM was found in 1.625 patients (29.1%) and 515 presented DM-related organ damage. DM prevalence during the first half of the study period was 27.6% vs. 30.6% in the last half, p=0.015. Patients with DM presented higher in-hospital mortality than those without DM (521 [32.1%] vs 924 [23.3%] p&lt;0.001) and higher one-year mortality (640 [39.4%] vs 1.131 [28.5%] p&lt;0.001). Among DM patients, organ damage was associated with higher in-hospital (200 [38.8%] vs 321 [28.9%], p&lt;0.001) and one-year mortality (247 [48.0%] vs 393 [35.4%], p&lt;0.001). Multivariate analyses showed an independent association of DM with in-hospital (odds ratio [OR] = 1.34, 95% confidence interval [CI]: 1.16–1.55, p&lt;0.001) and one-year mortality (OR = 1.38, 95% CI: 1.21–1.59, p&lt;0.001). Among DM patients, organ damage was independently associated with higher in-hospital (OR = 1.37, 95% CI: 1.06–1.76, p=0.015) and one-year mortality (OR=1.59, 95% CI: 1.26–2.01, p&lt;0.001)

Conclusions
The prevalence of DM among patients with IE is increasing and is already above 30%. DM is independently associated with a poor prognosis, particularly in the case of DM with organ damage.

Funding Acknowledgement
Type of funding sources: None.
Risk calculator to predict 30-day mortality in left-sided infective endocarditis. The EURO-ENDO score
Authors: Lozano Torres J , Sambola A , Magne J , Olmos C , Ternacle J , Calvo F , Tribouilloy C , Reskovic Luksic V , Separovic-Hanzevacki J , Park S W , Cam Bekkers S , Chan K L , Iung B , Lancellotti P , Habib G 
Published: October 2022

Abstract

Background/Introduction
Infective endocarditis (IE) is associated with high in-hospital mortality, despite improvements in therapeutic strategies. Nonetheless, there is no prospective risk model to estimate IE mortality.

Purpose
We sought to develop and validate a calculator to predict 30-day mortality risk regarding to perform surgery or medical treatment alone in left-sided IE.

Methods
This is a prospective, multicenter registry that included patients between January 2016 and March 2018 with a diagnosis of IE based on ESC 2015 diagnostic criteria. Patients with possible or definite left-sided IE were included in the analyses. Clinical, biological, microbiological and imaging data were collected. The primary end point was 30-day mortality in patients with left-sided IE. The risk calculator was based on multivariable Cox regression models. The accuracy of the logistic regression models was assessed by discrimination and calibration using C-statistic and Hosmer-Lemeshow test.

Results
Among 3116 patients included, 2171 patients presented left-sided IE and 257 patients (11.8%) died during the first 30 days of IE diagnosis. After multivariable Logistic regression analysis, eleven variables were associated with 30-days mortality and were included in the calculator: previous cardiac surgery, previous stroke/TIA, creatinine &gt;2 mg/dL, S. aureus infection, embolic events on admission, heart failure or cardiogenic shock, vegetation size &gt;14 mm, presence of abscess, severe regurgitation, double left-sided IE and no left valve surgery. There was an excellent correlation between the predicted 30-days mortality in both models with or without performing left valve surgery (area under the receiver operator curve: 0.798 and 0.758, respectively). Moreover, calibration by Hosmer-Lemeshow were 0.085 and 0.09, respectively).

Conclusion(s)
Our risk score in patients with left-sided IE provides an accurate individualized estimation of 30-day mortality according to perform or not perform left-valve surgery. It allows medical professionals to determine whether submitting patients to surgery or not, and thus improve their prognosis.

Funding Acknowledgement
Type of funding sources: None.
Characteristics, management, and outcomes of patients with left-sided infective endocarditis complicated by heart failure: a substudy of the ESC-EORP EURO-ENDO (European infective endocarditis) regist
Authors: Bohbot Y , Habib G , Stohr E , Chirouze C , Hernandez-Meneses M , Melissopoulou M , Scheggi V , Branco L , Olmos C , Reye G , Pazdernik M , Iung B , Sow R , Lancellotti P , Tribouilloy C 
Published: October 2022

Abstract

Background/Introduction
Congestive heart failure (CHF) is a strong prognostic factor in infective endocarditis (IE), but data are lacking regarding its current management and outcome in Europe.

Purpose
To evaluate the current management and survival of patients with left-sided IE complicated by CHF.

Methods
We used data of the ESC-EORP EURO-ENDO registry, which is a prospective multicentre observational study conducted between January 1, 2016 and March 31, 2018 in 156 centres in 40 countries. The primary endpoints were 30-day and one-year mortality.

Results
Among the 3116 patients enrolled in this prospective registry, 2449 (mean age: 60 years, 69% male) with left-sided (native or prosthetic) IE were included in this study. Patients with CHF (n=698, 28.5%) were older, with more comorbidity and more severe valvular damage (mitro-aortic involvement, vegetations &gt;10mm and severe regurgitation/new prosthesis dehiscence) than those without CHF (all p≤0.019). Patients with CHF experienced higher 30-day and one-year mortality than those without (20.5% vs. 9.0% and 36.1% vs. 19.3%, respectively) and CHF remained strongly associated with 30-day (OR [95% CI]: 2.37 [1.73–3.24]; p&lt;0.001) and one-year mortality (HR [95% CI]: 1.69 [1.40–2.05]; p&lt;0.001) after adjustment for established outcome predictors, including early surgery, or after propensity matching for age, sex, and comorbidity (n=618 [88.5%] for each group, both p&lt;0.001). Early surgery, performed on 49% of these patients with IE complicated by CHF, remained associated with a substantial reduction in 30-day mortality following multivariable analysis, after adjustment for age, sex, Charlson index, cerebrovascular accident, staphylococcus aureus IE, Streptococcal IE, uncontrolled infection, vegetation size &gt;10mm, severe valvular regurgitation and/or new prosthetic dehiscence, perivalvular complication, and prosthetic IE (OR [95% CI]: 0.22 [0.12–0.38]; p&lt;0.001) and in one-year mortality (HR [95% CI]: 0.29 [0.20–0.41]; p&lt;0.001).

Conclusion
CHF is common in left-sided IE and is associated with older age, greater comorbidity, more advanced lesions, and markedly higher 30-day and one-year mortality. Early surgery is strongly associated with lower mortality but is performed on only approximately half of patients with CHF, mainly because of a surgical risk considered prohibitive.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Abbott Vascular Int. (2011–2014) Amgen Cardiovascular (2009–2018),
Temporal trends in the incidence of endocarditis among patients with a prosthetic heart valve: a nationwide study
Authors: Hadji-Turdeghal K , Jensen A D , Bruun N E , Iversen K , Bundgaard H , Smerup M H , Koeber L , Oestergaard L , Fosboel E L 
Published: October 2022

Abstract

Background
The incidence of infective endocarditis (IE) is increasing in the adult population, as is the insertion of prosthetic heart valves. Patients with prosthetic heart valves are considered at high risk of IE – a complication with a high mortality. However, data on temporal changes in the incidence of IE among patients with prosthetic heart valves from unselected cohorts are sparse

Purpose
We aimed to examine nationwide temporal trends in the incidence of IE in patients with an implanted prosthetic heart valve in Denmark from 1999 to 2018.

Methods
Using Danish nationwide health-care registries we identified all patients, who underwent heart valve implantation between 1996–2018. Crude annual incidence rates per 1,000 person years (PY) of IE were computed and presented in two year intervals. Analyses were stratified by sex and age groups (&lt;50, 50–59, 60–69, 70–79, &gt;80 years).

Results
We identified 26,604 patients with first time prosthetic valve implantation with a median age of 72.7 years at the time of implantation, 63.1% were men with a median follow-up of 6.5 years. We found 1,442 cases of first time IE. The IE incidence rate ranged from 5.4 /1,000 PY (95% CI 3.9–7.4) in calendar period 2001–2002 to 10.0/1,000 PY (95% 8.84–11.11) in calendar period 2017–2018 with an unadjusted increasing trend during the study period (ptrend&lt;0.0001), (Figure 1). Overall, men had a higher crude incidence rate compared with women, however no significant temporal changes were seen in the incidence rate during the study period. For age groups, a trend of stepwise increase in the incidence rate of IE was observed for increasing age groups, however no temporal changes were observed (Figure 2).

Conclusion
The incidence of IE following prosthetic heart valve implantation has increased slightly over the last 20 years in Denmark.

Funding Acknowledgement
Type of funding sources: None.
Infective endocarditis in adults with congenital heart disease – 11 years data from Hungary
Authors: Bence A , Balint H , Borbas S , Denes M , Andreka P 
Published: October 2022

Abstract

Background
Despite recent preventive strategies and advances in antimicrobial and surgical treatment the incidence and mortality rate of infective endocarditis (IE) remains high in adult Congenital Heart Disease (ACHD) patients.

Purpose
The aim of our retrospective study was to assess the clinical and microbiological characteristics, inhospital and one year mortality rates of ACHD patients admitted with IE in our tertiary referral hospital between 2010 and 2020.

Methods
Definitive diagnosis of IE were in agreement with modified Duke's criteria. Inhospital baseline data and up to one year follow-up data were collected from the hospital records. ACHD patients were classified based on their lesion severity (ESC guideline classification). Survival data and mortality predictors were analysed by Kaplan-Meier estimator and by uni- and multivariate model.

Results
60 cases had been treated with IE. Mean age was 37±11.3 years (18–69), and most of them (76.6%, n=46) were men. ACHD complexity was as following: simple 66.7% (n=40), moderate 20% (n=12) and severe 13.3% (n=8). The most common pre-existing congenital cardiac abnormality was bicuspidal aortic valve seen in 52% (n=31) of cases. Sixty four percent (n=37) of patients had previous heart surgery (n=16, artificial heart valve surgery). Majority of patients had a left sided valve endocarditis (85%, n=51). IE related hospital stay was mean 28±9 days. Infection route was presumed in 30% of patients (n=18), they had an invasive procedure within 6 months preceding the IE diagnosis. Besides common bacterinemia caused by Staphylococcus (33%, n=20) and Streptococcus (25%, n=15), 18% (n=11) of patients had a negative blood culture. IE affected 36 patients with a native valve, and all 16 with an artificial valve. Seventy seven percent of patients required surgical intervention, immediate or urgent surgery in 22 and elective in 24 patients. Overall inhospital mortality was 13%, the majority 5 out of 8 patients having an immediate/emergent surgical intervention. IE was complicated by acute heart failure in 17 (28%) and by stroke in 4 (6.7%) patients. During one year follow-up 21 patients (38%) remained with chronic heart failure, and 3 more died. There was no significant difference in mortality between ACHD complexity groups, and no significant predictors of mortality were found.

Conclusion
The most common ACHD lesion affected by IE was bicuspid aortic valve. Two-third of patients required surgical intervention, those with immediate/emergent surgery having a 22% early mortality rate. ACHD complexity was not related to early or late outcome in this population.

Funding Acknowledgement
Type of funding sources: None.
Renin-angiotensin and endothelin systems in patients post takotsubo syndrome
Authors: Khan H , Rudd A , Gamble D , Mezincescu A M , Cheyne L , Horgan G , Dhaun N , Newby D E , Dawson D K 
Published: October 2022

Abstract

Background
We investigate if renin-angiotensin and endothelin-1 response pathways follow the same pattern of recovery as left ventricular ejection fraction in patients with takotsubo syndrome.

Purpose
To provide better insight into the pathophysiology underlying this condition.

Methods
Ninety takotsubo syndrome patients [n=30 in each of “acute”, “convalescent” (3–5 months) and “recovered” (&gt;1 year) groups] who were on minimal or no medication and were free of any significant cardiac/metabolic co-morbidities, and 30 healthy controls were studied. Serum concentrations of renin, angiotensin converting enzyme, angiotensin II, big endothelin-1, endothelin-1 were measured using commercially available ELISA, and BNP was measured using an immunoassay.

Results
Left ventricular ejection fraction was 38±1.6% in acute, 63±2.0% in convalescent and 64±2.6% in recovered takotsubo syndrome patients. As shown in Figure 1, serum renin concentrations are persistently elevated after a takotsubo episode (p=0.03 vs controls). Angiotensin converting enzyme levels are significantly depressed during the acute phase compared to convalescent (p=0.004), recovered takotsubo (p=0.02) or controls (p=0.03). Angiotensin II is increased in takotsubo patients (p&lt;0.001 vs controls) remaining persistently elevated long-term in the recovered group (p=0.03 vs controls). B-type natriuretic peptide concentrations remain elevated after a Takotsubo episode compared to controls (p=0.003). Big endothelin-1 levels are unchanged, but endothelin-1 is significantly lower after takotsubo syndrome compared to controls (p=0.03).

Conclusions
Despite “normalisation” of the left ventricular ejection fraction, there is long-term maladaptive activation of renin-angiotensin system in takotsubo syndrome patients. This suggests therapy aimed at modulating this pathway may be beneficial in the long-term.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): British Heart Foundation
Changes in myocardial tissue velocities over a decade: the Copenhagen City Heart study
Authors: Sengelov M , Noergaard J L , Lassen M C H , Skaarup K G , Schoeps L B , Marott J L , Johansen N D , Joergensen P G , Jensen G B , Schnohr P , Prescott E , Soegaard P , Moegelvang R , Biering-Soerensen T 
Published: October 2022

Abstract

Background
The aim of the present study was to investigate the impact of cardiovascular risk factors – age, sex, hypertension, hypercholesterolemia, diabetes, smoking and obesity on Tissue Doppler imaging (TDI) measures of systolic and diastolic tissue velocities in the general population over a 10-year period. Identifying risk factors that are associated with changes in TDI velocities could lead to an improved understanding of the pathophysiology of the deteriorating heart and enable early preventive actions and strategies.

Methods
The study included 1128 members from the general population who participated in both the 4th and 5th Copenhagen City Heart Study. At both examination rounds, the participants underwent echocardiography. The examinations were 10 years apart. Conventional echocardiographic measures of cardiac structure and function and measures of TDI myocardial tissue velocities were obtained.

Results
Average change in s', e' and a' were −0.4±1.1 cm/s, −0.9±1.7 cm/s and 0.5±1.7 cm/s, respectively. After multivariable adjustments, older age (P&lt;0.001) and higher systolic blood pressure (BP) (P=0.029) were found to be associated with a decrease in s' at follow-up. Male sex (P&lt;0.001) was found to be associated with an increase in s'. Older age (P&lt;0.001) and greater number of smoking pack-years (P=0.004) were associated with a decrease in e' at follow-up after multivariable adjustments. In addition, greater BMI (P=0.004) was significantly associated with a decrease in a'. Higher diastolic BP (P=0.004) and male sex (P=0.004) were associated with an increase in a'.

Conclusion
In the general population, overall systolic and diastolic function declined over a 10-year period. Both systolic and diastolic function as assessed by myocardial TDI velocities were affected by multiple conventional cardiovascular risk factors.

Funding Acknowledgement
Type of funding sources: None.
Mechano-energetic efficiency in patients with hypertrophic cardiomyopathy with and without sarcomeric mutations
Authors: Borrelli F , Lombardi R , Canciello G , Frisso G , Todde G , Paoletta D , Esposito G , Losi M A 
Published: October 2022

Abstract

Background
Hypertrophic Cardiomyopathy (HCM) is mainly caused by sarcomeric mutations. In about 40% of cases the causal mutation is unknown. Myocardial mechano-energetic efficiency per unit of left ventricular (LV) mass (MEEi) is an echocardiographic parameter of LV pump performance. Sarcomeric mutations may affect energy efficiency.

Purpose
We investigated the effects of the presence of sarcomeric mutations on MEEi in patients with HCM.

Methods
We included 49 genetically screened HCM patients (50±10 years, 27% women) with LV ejection fraction &gt;50%, LV maximal wall thickness &gt;14 mm and no moderate to severe mitral regurgitation. MEEi was calculated as the ratio between stroke volume and heart rate, normalized by LV mass. Echo-LV mass was calculated as LV epicardial minus LV endocardial volumes in 4 and 2 chamber views multiplied by 1.05, a method validated with nuclear magnetic resonance.

Results
27 HCM patients carried a sarcomeric mutation (HCM-Sarc; 55%). As shown in the table, patients with and without sarcomeric mutations (HCM-Sarc vs HCM-NoSarc) had similar LV ejection fraction, heart rate, LV mass and LV outflow tract gradient. HCM-Sarc showed early age at diagnosis, higher frequency of HCM family history and significantly reduced MEEi as compared with HCM-NoSarc. Presence of sarcomeric mutation could be predicted by younger age, lower MEEi and by family history of HCM (overall p&lt;0.05).

Conclusions
In a population of HCM patients, the presence of a sarcomeric mutation is the only determinant of reduced the LV pump performance as estimated by MEEi. MEEi may be used as an imaging biomarker in sarcomeric mutation carriers.

Funding Acknowledgement
Type of funding sources: None.