bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiac damage staging in patients undergoing TAVR. Incremental value of global longitudinal strain and right ventricular-arterial coupling
Authors: Gutierrez E , Carrion I , Olmos C , Jimenez P , Nombela L , Pozo E , Mahia P , Gil S , De Agustin A , Islas F 
Published: October 2022

Abstract

Background
Transcatheter aortic valve replacement (TAVR) is nowadays a safe and increasingly frequent option to treat severe aortic stenosis (AS). Cardiac damage staging has been proposed and validated in some studies as a prognostic tool; however, many patients continue to undergo aortic valve replacement only after there is evidence of cardiac damage. The aim of this study is to assess the potential incremental value of global longitudinal strain (GLS) and right ventricular-arterial coupling (RV-VAc) in the prognostic performance of the cardiac damage staging.

Methods
Consecutive patients with AS and undergoing TAVR were included in our hospital registry. Baseline echocardiography was performed before TAVR according to current guidelines. For this study, patients were classified based on the following stage of cardiac damage: Stage 0: no cardiac damage; Stage 1: left ventricular (LV) damage (LV ejection fraction (LVEF) &lt;50%, LV mass index &gt;95 g/m2 for women, &gt;115 g/m2 for men); Stage 2: left atrial (LA) or mitral valve damage (LA volume index &gt;34 ml/m2, mitral regurgitation moderate-severe, or presence of atrial fibrillation); Stage 3: pulmonary vasculature or tricuspid valve damage (systolic pulmonary artery pressure 60 mmHg, or tricuspid regurgitation moderate-severe); Stage 4: RV damage (TAPSE &lt;1.7 cm, S' &lt;9.5 cm/s).

Results
496 patients were studied. Mean age of the cohort was 81.9±6.2 years, mean aortic valve area was 0.86±0.6 cm2, mean LVEF was 57.9±12.3%, mean LV-GLS was −15.6±3.5% and RV-Vac was 0.61±0.34. Table 1 shows clinical and echo characteristics of patients. Only one patient (0.2%) met criteria for stage 0; 38 (7.7%) patients were in stage 1; 159 (32.1%) patients in stage 2, 157 (31.7%) patients in stage 3 and 141 (28.4%) patients in stage 4. 1-year mortality for stage 1 was (10.5%), for stage 2 (13.7%), for stage 3 (32.2%) and for stage 4 (19.5%). The area under the ROC curve (AUC) for 1-year mortality for the cardiac damage staging system was 0.622, CI (0.539–0.705); the best cut-off value for LV-GLS to predict 1-year mortality was −14% with an AUC of 0.634 CI (0.487–0.781) and RV-VAc had an AUC of 0.748 CI (0.638–858). Finally, the model that included the staging system, LV-GLS and RV-VAc had an AUC ROC of 0.875, CI (0.780–0.971) (Figure 1).

Conclusions
Cardiac damage staging is a good prognostic tool and it has been validated in several studies, however, the addition of feasible and widely available echo parameters such as LV-GLS and RV-VAc can significantly increase its prognostic yield.

Funding Acknowledgement
Type of funding sources: None.
Clinical outcome of patients with severe malignant pericardial effusion due to neoplastic disease undergoing percutaneous balloon pericardiotomy during COVID-19 pandemic
Authors: Alfonso Rodriguez E , Lopez Cabrera G , Llerena Rojas L L , Rodriguez Nande L , Lopez Ferrero L , Echarte Martinez J 
Published: October 2022

Abstract

Background
Neoplastic pericardial effusion (NPE) is a serious complication that occurs in the setting of advanced oncological disease and is associated with a high recurrence rate. Currently, pericardiocentesis (PCT) remains the first therapeutic option and the use of percutaneous balloon pericardiotomy (PBP) is limited to the treatment of recurrences. However, it is not known whether some aspects of the procedure during PBP lead to different outcomes in terms of survival and recurrence, and no such patients have been included in studies during COVID-19 pandemic.

Purpose
The aim is to analyses the success, complications and recurrence rate (defined as recurrence of NPE requiring PCT, PBP or surgical pericardial window (SPW) of both procedures (BP) in order to establish the optimal entry treatment for these patients.

Methods
This research analyzed the clinical characteristics and prognostic factors of patients with severe pericardial effusion of neoplastic etiology who underwent PBP during the COVID-19 pandemic. A prospective study was conducted involving 23 patients admitted between January 2020 and January 2022 for severe NPE who underwent PCT or PBP as initial treatment of NPE.

Results
We included 23 patients, 62.9% were male with a mean age of 51.2±14.9 years NPE was the first manifestation of the oncological process in 12 patients (52.1%) with lung cancer being the most frequently associated primary cancer (58.7%) followed by breast cancer in 12.7% of cases. A total of 26 procedures were performed, 10 PCT, 15 PBP, 1 SPW, with tumors cells identified in the pericardial fluid in 13.0% of cases. PCT was used as an entry point in 10 patients (43.5%), 6 patients were COVID-19 positive and PCT was performed as the first treatment. While PBP was chosen as the first therapeutic option in 13 patients (56.5%) (2 Re-PBP). The initial efficacy of the procedure was 93.1% and 92.2% respectively (p=0.88), with 1 complication occurring in the PBP group but not requiring scheduled SPW. In the former group, the percentage of recurrences was higher (34.7%; 8 recurrences in 10 patients) compared to patients treated with upfront PBP (8.6%; 2 recurrences in 13 patients), p=0.09. In addition, only one patient had to resort to surgery. When analyses according to the BP. used, the recurrence rate was 4.0 times higher for PCT (34.7 vs. 8.6% recurrences), although without reaching statistical significance (p=0.16).

Conclusions
The PBP is a simple, safe and effective technique for the treatment of NPE during the COVID-19 pandemic, in our series it was associated with a lower recurrence rate. Therefore, it could replace PCT in these patients during the COVID-19 pandemic as optimal first line treatment, providing better quality of life and reducing the need for re-interventions.

Funding Acknowledgement
Type of funding sources: None.
Exploring variations in current clinical practice regarding postoperative pericardial effusion: a questionnaire study
Authors: Van Dinter S R , Li W W , Wollersheim L W , Morshuis W J , Van Royen N , Dieker H , Verhagen A F T M 
Published: October 2022

Abstract

Background
Postoperative pericardial effusion (PPE) is a frequently occurring event after cardiac surgery, potentially leading to life-threatening cardiac tamponade. Unfortunately, no guidelines are currently available on this subject, possibly leading to unwarranted variations in care in clinical practice.

Purpose
The goal of our study was to determine the diagnostic and therapeutic preferences of cardiologists and cardiothoracic surgeons in the Netherlands regarding PPE, and to evaluate possible variations in this matter between specialties and centers.

Methods
A web-based questionnaire was sent to all interventional cardiologists and cardiothoracic surgeons in the Netherlands. Diagnostic preferences for the evaluation of PPE were examined. Additionally, clinical preferences were explored in response to 4 patient scenarios with each illustrating a combination of either high or low clinical suspicion of cardiac tamponade and either high or low echocardiographic suspicion. Each scenario was also stratified by 3 different amounts of PPE (&lt;1cm, 1–2cm, &gt;2cm), leading to a total of 12 fictional patient cases (Figure 1).

Results
From 27 of the 31 contacted centers, a total of 94 clinicians responded to the survey, of whom 46 interventional cardiologists and 48 cardiothoracic surgeons. Cardiologists were more in favor of routine postoperative echocardiography in all patients (44%), whereas cardiothoracic surgeons preferred routine imaging after specific procedures, especially after mitral (85%) and tricuspid (79%) valve surgery. Overall, drainage of PPE (&gt;48 hours postoperatively) was preferred through pericardiocentesis (83%) instead of surgical evacuation (17%). Regarding the patient scenarios, cardiothoracic surgeons were significantly more inclined to evacuate PPE compared to cardiologists for all scenarios combined (51% vs 37%, p&lt;0.001) (Figure 1). In addition, evacuation was overall significantly more preferred by cardiologists employed in surgical centers when compared to those working in non-surgical centers (43% vs 31%, p=0.02). Results from the interrater agreement analysis of groups of clinicians working in the same center varied from very poor up to very good (kappa value of 0.22–0.67), suggesting existing variation of PPE treatment preferences even within one center.

Conclusions
Our study highlights the significant variation of preferences in contemporary PPE management between cardiothoracic surgeons and interventional cardiologists in the Netherlands, sometimes even within the same center. These findings are the possible consequences of a current lack of general recommendations or guidelines. This could lead to unwarranted variation in care and additional research is necessary to provide general recommendations.

Funding Acknowledgement
Type of funding sources: None.
The risk spectrum of infective endocarditis among patients with congenital heart diseases
Authors: Havers-Borgersen E H B , Butt J H B , Oestergaard L O , Petersen J K P , Torp-Pedersen C T P , Koeber L K , Fosboel E L F 
Published: October 2022

Abstract

Background
Patients with congenital heart disease (CHD) are considered at lifelong high risk of infective endocarditis (IE). The risk of IE presumably differs among different types of CHD, but little knowledge exists on the area.

Purpose
This study set out to investigate the long-term incidence of IE among CHD-patients and associated risk factors.

Methods
In this observational cohort study, all patients with CHD born in 1977–2018 were identified using Danish nationwide registries and followed from date of birth until occurrence of first-time IE, emigration, death, or end of study (December 31, 2018). The comparative risk of IE among patients with CHD versus age- and sex-matched controls from the background population was assessed. Moreover, the risk of IE was stratified according to type of CHD and risk factors associated with IE among patients with CHD were examined using Cox regression analysis including sex and relevant time-varying coefficients (i.e., cyanotic yet surgically untreated CHD, CHD repaired with prostheses, diabetes mellitus, chronic kidney disease, and presence of cardiac implantable devices).

Results
A total of 23,464 patients with CHD (50.0% men) were identified and matched with 93,856 controls from the background population. During a median follow-up of 17.7 years, 217 (0.9%) patients with CHD and 4 (0.0%) controls developed IE, corresponding to incidence rates of 5.2 (95% CI: 4.6–6.0) and 0.02 (95% CI: 0.01–0.1) per 10,000 person-years, respectively. The associated incidence of IE was greatest among patients with tetralogy of Fallot, malformations of the heart chambers (including transposition of the great arteries and truncus arteriosus), atrioventricular septal defects, and heart valve defects (Figure 1). Factors associated with IE among patients with CHD included male sex (HR 1.7 [95% CI, 1.3–2.2]), cyanotic yet surgically untreated CHD (HR 5.2 [95% CI, 3.5–7.7]), cardiac prostheses (HR 5.2 [95% CI, 3.6–7.5]), chronic kidney disease (HR 3.1 [95% CI, 1.3–7.6]), and presence of cardiac implantable electronic devices (HR 3.1 [95% CI, 1.5–6.2]).

Conclusions
Patients with CHD, especially those with tetralogy of Fallot and malformations of the heart chambers, have a substantially higher incidence of IE than the background population. With an increasing longevity of these patients, relevant guidelines concerning preventive measures are decisive to improve morbidity, mortality, and the quality of life among this growing group of patients.

Funding Acknowledgement
Type of funding sources: None.
Long-term survival in adults with congenital heart disease: a nationwide, register-based cohort study
Authors: Dellborg M D , Giang W G K , Eriksson P E , Liden H L , Fedchenko M F , Ahnfelt A A , Rosengren A R , Mandalenakis Z 
Published: October 2022

Abstract

Background
The survival of children with congenital heart disease has increased exponentially over the last decades, with 97% currently reaching adulthood. However, the total impact of advanced treatment on mortality and morbidity in adult survivors in relation to the general population is less well described.

Purpose
We aimed to investigate long term outcomes of adults with congenital heart disease (ACHD) in Sweden, from the age of 18 years through middle-age.

Methods
Data from the Swedish National Patient Register and Cause of Death Register were linked to identify all ACHD patients born from 1950 to 1999 and alive at the age of 18 years. Each ACHD patient was matched by birth year and sex with more than ten controls without congenital heart malformations from the Total Population Register in Sweden, with follow-up time for cases and controls until December 2017.

Results
Altogether 37,278 ACHD patients and 412,799 matched controls were included in the study. The mean follow-up was 19.2 (± 13.6 years). The risk of death after the age of 18 years was 3.2 times higher (95%, confidence interval (CI) 3.04–3.37) among ACHD patients compared to controls. At the age of 68 years, more than 75% of ACHD patients were still alive. The risk of death was significantly higher also for the more benign lesions i.e. atrial septal defects, ventricular septal defects and coarctation of the aorta. Starting in the mid 1970ies, the risk of death declined over time and for those born after 1975 the risk decreased steadily with each successive birth year.
More patients with ACHD developed atrial fibrillation, heart failure, non-fatal myocardial infarction, non-fatal stroke or died in comparison to controls, adjusted hazard ratio for any of these ranged between 20.58 (95%, CI 18.74–22.60) for patients with complex disease and 9.89 (95%, CI 9.53–10.27) for patients with mild or moderate disease.

Conclusions
In this large, nationwide, register-based cohort study of patients with ACHD surviving until the age of 18 years, the risk of mortality up to the age of 68 years was more than three times higher compared to matched controls. A notable decline in the risk of death was found in patients with ACHD born after 1970. Despite this substantially high relative mortality risk during adulthood, at least 75% of ACHD patients will become sexagenerians.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish state under an agreement between the Swedish Government nad county Councils (ALF)
Survival in patients with congenital heart disease and down syndrome
Authors: Engsner S , Giang K W , Dellborg M , Fedchenko M , Eriksson P , Mandalenakis Z 
Published: October 2022

Abstract

Background
Increasing survivorship among patients with congenital heart disease (CHD) has been reported during the past decades. However, a number of patients with CHD have an associated Down syndrome diagnosis and the long-term prognosis is still debated.

Purpose
The aim of the present study was to estimate the mortality risk in CHD patients with Down syndrome compared to a matched control population without CHD.

Methods
We linked data from the Swedish National Patient Register and Cause of Death Register to identify all CHD patients born between January 1970 and December 2017. Then we identified all CHD patients with Down syndrome. Each CHD patient with Down syndrome was matched for sex and birth year with eight controls without CHD or Down syndrome from the Total Population Register. A Cox proportional regression model was used to estimate the mortality risk and Kaplan Meier for survival analysis.

Results
In total, 3,285 patients with CHD and Down syndrome and 26,128 matched controls were identified. During a mean follow-up of 16.0 (±12.6) years, 558 CHD patients (17%) with Down syndrome, and 198 controls (0.76%) died. CHD patients with Down syndrome had 25.1 times higher risk of mortality (Hazard ratio 25.1, 95%, confidence interval (CI) 21.3–29.5) compared with controls. Patients with the most complex CHD were found to have the highest mortality risk (Hazard ratio 32.3, 95% CI 26.1–39.9). A decrease in risk of mortality during the first year of life was found between the two birth periods, risk of mortality was 46.8 (CI 29.5–74.0) in 1970–1989 and 17.7 (CI 12.8–24.42) 1990–2017. In addition, the mortality risk was two times (95% CI 1.94–2.31) higher for CHD patients with Down syndrome when compared to CHD patients without Down syndrome.

Conclusion
The risk of mortality among CHD patients with Down syndrome was 25 times higher compared to controls without CHD or Down syndrome. The highest risk of mortality was found in patients with complex CHD. The survivorship rate was exponentially increased in CHD patients with Down syndrome that were born after 1990, determining the modern era of congenital heart care.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swedish state under an agreement between the Swedish Government and county Councils (ALF)
Conservative vs surgical management in ebstein's anomaly: long-term follow-up in a real-life cohort
Authors: Merino Argos C , Meras Colunga P , Ruiz Cantador J , Jimenez Valero S , Gonzalez Fernandez O , Valbuena Lopez S C , Ponz De Antonio I , Rosillo Rodriguez S O , Caro Codon J , Iniesta Manjavacas A M , Abelleira Pardeiro C , Balbacid Domingo E J , Perez David E , Lope De Sa Areses E , Gonzalez Garcia A E 
Published: October 2022

Abstract

Background
Ebstein's anomaly (EA) is a rare congenital heart disease that involves the tricuspid valve and the right ventricle, often associating atrial septal defects and atrial arrhythmias. Oligosymptomatic adults affected by this disease usually have good prognosis, while its evolution in symptomatic children is more aggressive. Clinical guidelines provide some recommendations for the former patients regarding surgical indication, but its evidence is scarce and benefit remains unclear.

Purpose
To compare functional capacity, ventricular function parameters and outcomes between medically and surgically treated patients with EA.

Methods
Retrospective cohort study of patients with EA followed-up in an adult congenital heart disease reference unit of a tertiary university hospital. Functional status and ventricular size and function parameters at baseline and follow-up, as well as clinical events, were compared between conservative and surgical groups.

Results
We included 72 patients; mean age was 45.2±15.2 years and 27 (37.5%) were men. Median follow-up was 6.6 (range 0.3–20.3) years. Finally, 18 (25%) patients were operated (12 tricuspid repairs, 5 tricuspid bioprostheses and 1 mechanical tricuspid prostheses). Characteristics and outcomes of conservative and surgical group are shown in Table 1. Comparison of follow-up data for each group are shown in Table 2. Of note, Glenn procedure was done in 6 (33.3%) patients of the surgical group and prosthetic thrombosis was observed in 3 (50%) patients during follow-up.

Conclusions
Only one fourth of patients with EA in our cohort were managed surgically. Operated patients had worse functional status and larger right ventricles at baseline. At follow-up, surgical patients had more clinical events and worse ventricular function. Exercise test parameters did not change significantly after surgery, whereas there was worsening functional capacity during follow-up in medically-managed patients.

Funding Acknowledgement
Type of funding sources: None.
Cardiopulmonary exercise testing in Fontan patients: unmasking the secret of Super-Fontans
Authors: Paiva M , Rato J , Santos R , Cunha G , Gomes D , Cordeiro S , Madeira S , Guerreiro S , Moreno L , Durazzo A , Mendes M 
Published: October 2022

Abstract

Background
Exercise capacity is usually reduced in Fontan patients, however there is a subset of patients who have normal exercise capacity and better outcomes, the “Super-Fontans”. The aim of this study was to characterize a cohort of Fontan patients undergoing cardiopulmonary exercise testing (CPET) and identify predictors of better functional capacity.

Methods
Single center retrospective analysis of consecutive Fontan patients aged &gt;10 years old who underwent CPET, between March 2018 and May 2021.
Peak respiratory exchange ratio1.05 defined maximal CPET. Peak VO2 (pVO2) as a percentage of its predicted value was used as reference value to stratify patients in tertiles.
Patients in 3rd tertile, with a percentage predicted pVO2 superior to 75%, were considered good-performers.
Blood tests and transthoracic echocardiogram (TTE) were performed on the same day. Additional data were collected from electronic charts.

Results
In total, 49 patients were included (mean age 19±7 years old, 67% male) with intra or extracardiac conduit implanted in mean 12±7 years prior to the CPET.
The most common primary diagnoses were tricuspid/pulmonary atresia (43%), followed by unbalanced complete AV septal defect (14%) and double inlet left ventricle (14%). 12 patients had a systemic right ventricle. All, except 5 patients, had preserved systolic ventricular function and 37% had moderate to severe AV regurgitation.
The majority had normal hemoglobin levels (median 15.6 g/dL), hepatic enzymes (median total bilirubin 0.8 mg/dL), renal function (median creatinine 0.8 mg/dL) and low NT-proBNP (median 122 pg/mL).
All patients had maximal CPET, median %VO2 at VT1 was 57% of peak and mean pVO2 was 66±14% of the predicted. Most patients (69%) showed exercise limitation due to cardiovascular cause, followed by O2 desaturation, present in 22% of CPETs. The age of Fontan completion was not associated with functional capacity (p=0.6).
The good-performer group comprised 13 patients (27%), all in sinus rhythm, of which 10 were physically active. Compared with the remainder, this group had higher VO2 at VT1 (18.7 vs. 14.6, p=0.01) and VO2 at VT2 (25.9 vs. 22.1, p=0.02), both in mL/kg/min. Also, peak heart rate (% predicted) (90 vs. 81, p=0.03) was higher in this subgroup – fig.1. Conversely, differences on TTE parameters (GLS and AV valve regurgitation) and blood biomarkers were not statistically significant. On multivariable analysis, no single variable predicted better functional capacity.

Conclusion
In our Fontan cohort, most patients had reduced exercise capacity, largely due to cardiovascular dysfunction. However, “Super-Fontans” stood out as they had a higher anaerobic threshold illustrating their better physical condition. These findings highlight the role of regular physical activity in Fontan patients as a cornerstone for better functional capacity.

Funding Acknowledgement
Type of funding sources: None.