bluuebunny/crossref_metadata_2025_split huggingface dataset:
The long-term clinical course of moderate tricuspid regurgitation
Authors: Margonato D , Ancona F , Melillo F , Ingallina G , Stella S , Biondi F , Manini C , Montorfano M , Maisano F , Topilsky Y , Agricola E 
Published: October 2022

Abstract

Background
Moderate TR is a frequent condition, worsening mid and long-term survival, particularly in patients &gt;75 years old, and in those suffering from left ventricular systolic dysfunction. As TR is often clinically unsuspected until an advanced stage of congestive heart failure (HF), there is a great need of early diagnosis and long-term appropriate follow-up. However, data focusing on the clinical and echocardiographic course of a cohort of patients with moderate TR is lacking, and the most appropriate type and time of management of these patients is still heavily debated.

Purpose
To evaluate the evolution and the long-term clinical outcome of a cohort of patients suffering from moderate and moderate to severe TR, regardless of its etiology.

Methods
Clinical outcome and echocardiographic follow-up were assessed in 212 patients diagnosed with moderate and moderate to severe TR in our centre between January 2014 and December 2019. TR progression at follow-up was defined as TR grade increase to at least severe. The primary endpoint was all-cause death; secondary endpoints were cardiovascular (CV) death and HF hospitalization.

Results
After a median follow-up of 4.2 years, TR progression occurred in 76 patients (36%): patients with TR progression presented with more history of coronary artery disease (p=0.042), atrial fibrillation (AF, p=0.007) and chronic kidney disease (CKD, p=0.007) and with baseline larger right ventricle end-diastolic diameter (RVEDD, p&lt;0.001) and worse left ventricular ejection fraction (LVEF, p=0.048). After univariate and multivariate analyses, a history of AF (HR 2.3, CI 1.2–4.5, p=0.011) and RVEDD (HR 2.4, CI 1.3–4.4, p=0.003) were independent predictors of TR progression. The primary endpoint occurred in 57 patients (27%) and was significantly more frequent (p=0.015) in the group of patients with TR progression compared to those without TR progression; multivariate analyses showed TR grade progression (HR 4.3, CI 2.1–9.1, p&lt;0.001), CKD (HR 3.2, CI 1.5–7.1, p=0.002) and LVEF (HR 0.9, CI 0.93–0.99, p=0.007) as being independently associated with the primary outcome. Moreover, both CV death (p=0.003) and HF hospitalization (p=0.0139) were significantly more frequent in patients with TR progression.

Conclusions
Our results showed that moderate TR, by progressing in a relevant proportion of patients over a long-term follow-up, significantly increases the risk of mortality and HF hospitalization. We identified specific risk factors associated with TR progression, which could help to identify patients at risk before an advanced stage of this disease. We believe that this cohort of patients should be appropriately managed and closely followed-up to avoid adverse clinical events related to the natural course of this valvulopathy.

Funding Acknowledgement
Type of funding sources: None.
Diabetes mellitus and cardiovascular mortality across the spectrum of aortic stenosis
Authors: Coisne A , Montaigne D , Ninni S , Lamblin N , Lemesle G , Delsart P , Butruille L , Decoin R , Woitrain E , Granada J , Staels B , Bauters C 
Published: October 2022

Abstract

Background
Current data regarding the impact of diabetes mellitus (DM) on cardiovascular mortality in patients with aortic stenosis (AS) are restricted to severe AS or aortic valve replacement (AVR) trials.

Purpose
To investigate cardiovascular mortality according to DM across the entire spectrum of AS outpatients.

Methods
Between May 2016 and December 2017, patients with mild (peak aortic velocity=2.5–2.9m/s), moderate (3–3.9m/s) and severe (≥4m/s) AS graded by echocardiography were included during outpatient cardiology visits in the Nord-Pas-de-Calais region in France and followed-up for modes of death.

Results
Among 2,703 patients, 820 (30.3%) had DM, mean age was 76±10.8 years with 46.6% of women and a relatively high prevalence of underlying cardiovascular diseases. There were 200 cardiovascular deaths prior to AVR during the 2.1 years (IQR 1.4–2.7) follow-up period. In adjusted analyses, DM was significantly associated with cardiovascular mortality (HR=1.40, 95% CI 1.04–1.89; P=0.029). In mild or moderate AS, the cardiovascular mortality of diabetic patients was similar to that of nondiabetic patients (Figuer 1). In severe AS, DM was associated with higher cardiovascular mortality (HR=2.65, 95% CI 1.50–4.68; P=0.001). This was almost exclusively related to a higher risk of death from heart failure (HR=2.61, 95% CI 1.15–5.92; P=0.022) and sudden death (HR=3.33, 95% CI 1.28–8.67; P=0.014) (Figure 2).

Conclusion
The effect of DM on cardiovascular mortality varied across AS severity. Despite no association between DM and outcomes in mild/moderate AS patients, DM was strongly associated with death from heart failure and sudden death in severe AS patients.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Fédération Française de Cardiologie
Diagnostic performance of coronary CTA and CT-FFR for the detection of coronary artery disease in routine TAVI work-up
Authors: Peper J , Becker L M , Van Den Berg H , Bor W L , Brouwer J , Nijenhuis V J , Van Ginkel D J , Rensing B M J W , Timmer L , Ten Berg J M , Leiner T , Swaans M J 
Published: October 2022

Abstract

Objectives
To assess the diagnostic performance of CT-FFR for the diagnosis of CAD in the work-up for TAVI.

Background
Work-up for transcatheter aortic valve implantation (TAVI) currently utilizes computed tomography (CT) to evaluate annulus diameter and peripheral vascular access, plus invasive coronary angiography (ICA) to assess significant coronary artery disease (CAD). ICA might partially be redundant with the use of Coronary CT Angiography (CCTA). Prior studies found improvement of the diagnostic accuracy of CCTA by use of CT derived fractional flow reserve (CT-FFR).

Methods
Consecutive patients with severe symptomatic aortic valve stenosis who underwent TAVI work-up between 2015–2019 were included in this cross-sectional study. All patients underwent CCTA and ICA within 3 months and diagnostic performance of both CCTA and CT-FFR were assessed using ICA as reference.

Results
Seventy-six of the 338 patients included in the analysis had ≥1 significant coronary stenosis at ICA. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy per-patient were 76.9%, 64.5%, 34.0%, 92.1% and 66.9% for CCTA and 84.6%, 88.3%, 63.2%, 96.0% and 87.6% for CT-FFR. The area under the receiver-operating characteristic-curve significantly differ between CCTA and CT-FFR (0.84 versus 0.90 p=0.02). A CT-FFR guided approach could avoid ICA in 57.1% versus 43.6% using CCTA.

Conclusions
CT-FFR significantly improves the diagnostic accuracy of CCTA without additional testing and increases the proportion of patients in whom ICA could have been safely avoided It has the potential to be integrated in the current clinical work-up for TAVI for diagnosing stable CAD requiring treatment.

Funding Acknowledgement
Type of funding sources: None.
Left ventricular reverse remodeling in post operative aortic stenosis patients: prevalence and predictor(s)
Authors: R Santos R , Abecasis J , Maltes S , Mendes G S , Oliveira L , Horta E , Guerreiro S , Freitas P , Ferreira A , Ribeiras R , Andrade M J , Cardim N , Gil V , Mendes M , Neves J P 
Published: October 2022

Abstract

Background
In patients with severe aortic stenosis (AS), left ventricular (LV) remodeling is believed to be a compensatory adaptive process which should reverse after aortic valve intervention. However, this is not always the rule and remodeling persistence may negatively impact post-procedural outcomes and survival.

Aim
To assess the prevalence and predictors of morphological LV reverse remodeling in severe symptomatic AS patients after surgical aortic valve replacement (AVR).

Methods
We prospectively studied 75 patients (72y [68–77y], 45% male) with severe symptomatic AS - mean gradient (AVM): 61±17mmHg; mean indexed aortic valve area (AVAi) 0.41±0.10 cm2/m2 with no previous history of ischemic cardiomyopathy, all with high gradient, 4 with low-flow, 81% with hypertension, 27% with type 2 diabetes mellitus and 35% patients with stage 3 chronic kidney disease: median MDR creat clearance: 70.4mL/min [40–102]. All patients performed pre-operative cardiac magnetic resonance (CMR) at a mean period of 3.4 months (0–17 months) before AVR and at the 3–6th months after AVR, for LV reverse remodeling assessment. It was defined as at least the occurrence of one of the following: &gt;15% reduction in LVEDVi; &gt;15% reduction in LVMi by CMR; &gt;10% reduction in geometric remodeling ratio. Clinical, AV severity data, preoperative functional LV and tissue characterization data were analyzed at multivariate regression to predict the occurrence of LV reverse remodeling.

Results
Overall, at pre-operative CMR: mean LV indexed mass (LVMi): 82±28.9 g/m2; mean end-diastolic LV indexed volume (LVEDVi): 87.4±26.6 mL/m2; mean geometric remodeling (LV mass/end-diastolic volume): 0.92±0.2 g/mL. After AVR, at echocardiographic evaluation, no patient had prosthetic obstruction or prosthetic patient mismatch: median LV-Ao gradient 12mmHg [9.1–14 mmHg]; 5 of them had mild paravalvular regurgitation. LV reverse remodeling occurred in 65 patients (88%) (Figure 1A) and these were younger, had significantly smaller preoperative AVAi and higher valvular gradients (Figure 1B). At multivariate analysis, only preoperative AVAi remained an independent predictor (odds ratio 0.85, 95% CI 0.735–0.984, p=0.029).

Conclusions
In this prospective cohort of patients LV reverse remodeling after surgical AVR was highly frequent, occurring in almost nine out of every ten patients.

Funding Acknowledgement
Type of funding sources: None.
Cardiac magnetic resonance patterns of left ventricular hypertrophy in aortic stenosis patients
Authors: R Santos R , Abecasis J , Maltes S , Mendes G S , Oliveira L , Horta E , Guerreiro S , Freitas P , Ferreira A , Ribeiras R , Andrade M J , Cardim N , Gil V , Mendes M , Neves J P 
Published: October 2022

Abstract

Background
Left ventricular (LV) hypertrophy is a known compensatory mechanism to pressure overload in aortic stenosis (AS) patients. However, by cardiac magnetic resonance (CMR) different patterns of LV adaptation are seen in this group of patients.

Aim
To describe the patterns of LV adaptation (by CMR) and to analyze its structure and function indexes in AS patients referred for surgical aortic valve replacement (AVR).

Methods
We prospectively studied 134 consecutive patients (age: 73y [IQR 68–77y], 49% men) with severe symptomatic AS - mean transaortic pressure gradient (AVmean): 61±1.5 mmHg; mean aortic valve area: AVA): 0.7±0.1 cm2, referred for surgical AVR with no previous history of ischemic cardiomyopathy or other. All patients underwent electrocardiogram, 2D transthoracic echocardiogram (TTE) and cardiac magnetic resonance (CMR) before surgery for LV assessment and tissue characterization. Five patterns of LV structure were considered: normal ventricular structure (normal LV mass/volume ratio [M/V], normal LVMi and normal indexed LV end-diastolic volume (LVEDVi); concentric remodeling: increased M/V, normal LVMi; concentric hypertrophy: increased M/V and LVMi; eccentric hypertrophy: increased LVMi and LVEDVi, normal M/V and ejection fraction; and adverse remodeling: dilated left ventricle, increased LVMi and normal M/V in the context of an impaired ejection fraction. Echocardiogram and CMR structural and functional indexes were compared between these groups.

Results
At baseline study, at CMR: mean LV indexed mass [LVMi]: 80.3±26.5 g/m2; mean end-diastolic LV indexed volume [LVEDVi]: 84.4±24.5 mL/m2 and median geometric remodeling ratio [M/V]: 0.95 g/mL [IQR 0. 81–1.08 g/mL]. Overall, 22% patients had normal LV structure, 30% concentric remodeling ventricular geometry, and two patients had an adverse remodeling pattern. LV hypertrophy was the most prevalent pattern and occurred in 48% of subjects (concentric 43%; eccentric 4%). In our cohort, the severity of AS (AVmean (p&lt;0.001), LV function (LV ejection fraction [p&lt;0.001] and Global longitudinal strain [p&lt;0.001]), LV loading conditions (indexed left atrial volume [p&lt;0.001] and E/e' ratio [p&lt;0.001]) and NT-proBNP (p&lt;0.001) were related to the pattern of LV structure (Table 1).

Conclusions
In our cohort, AS patients presented several distinct patterns of LV remodeling. Disease severity, functional repercussion and loading conditions are distinct between them.

Funding Acknowledgement
Type of funding sources: None.
Effects of guideline directed medical therapy on secondary mitral regurgitation
Authors: Spinka G , Bartko P E , Heitzinger G , Prausmueller S , Winter M P , Arfsten H , Strunk G , Rosenhek R , Kastl S , Hengstenberg C , Pavo N , Huelsmann M , Goliasch G 
Published: October 2022

Abstract

Background
Guideline directed medical therapy (GDMT) is the recommended initial treatment for secondary mitral regurgitation (SMR), however supported by only little comprehensive evidence. This study therefore sought to assess the effect of GDMT titration on SMR and to identify specific substance combinations able to reduce SMR severity.

Methods
We included 261 patients who completed two visits with an echocardiographic exam available within one month at each visit. After comprehensively defining GDMT titration as well as SMR reduction, logistic regression analysis was applied in order to assess the effects of overall GDMT titration and specific substance combinations on SMR severity.

Results
SMR severity improved by at least one degree in 39.3% of patients with subsequent titration of GDMT and was accompanied by reverse remodelling and clinical improvement. The effects of GDMT titration were significantly associated with SMR reduction (adj. OR 0.31, 95% CI 0.13–0.71, P=0.006). Moreover, ARNI as well as the combined dosage effects of (i) renin angiotensin system inhibitors (RASi) and mineralocorticoid-receptor antagonists (MRA), (ii) betablockers (BB) and MRA, as well as (iii) RASi, BB, and MRA were all significantly associated with SMR improvement (P&lt;0.001 for all).

Conclusions
The present study provides comprehensive evidence for the effectiveness of contemporary GDMT to specifically improve SMR. Our data indicates that GDMT titration conveys a threefold increased chance of reducing SMR severity. Moreover, the dosage effects of ARNI, as well as the combination of RASi and MRA, BB and MRA, and all three substances in aggregate are able to significantly improve SMR.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): FWF - Austrian Science Fund
Prognosis after aortic valve replacement in dialysis patients: results from the Swedish Renal Registry
Authors: Vavilis G , Back M , Barany P , Ruck A , Szummer K 
Published: October 2022

Abstract

Background
The choice of aortic valve prosthesis in aortic stenosis patients is based on patient preference, preoperative age, life expectancy, need for anticoagulant therapy and valve durability. Major uncertainties remain regarding optimal prosthetic valve choice in dialysis patients.

Objectives
The aim of the study was to compare the clinical outcomes after aortic valve replacement with mechanical (MAV) or bioprosthetic valves (BAV) in dialysis patients.

Methods
We used the observational, prospective, multicenter cohort from the Swedish Renal Registry, which includes all dialysis patients in Sweden. The study included 294 dialysis patients with aortic stenosis who underwent aortic valve replacement with MAV or BAV (obtained from surgical procedure codes) between 2005 and 2018, either before (n=155) or after dialysis start (n=139). Comorbidities and net adverse clinical events (bleeding events, stroke and reoperation) were obtained from national registries and defined by International Classification of Diseases codes (ICD-10). The incidence rate (IR) of primary endpoint comprised of all-cause death, bleeding events, stroke and aortic valve reoperation, as well as only all-cause death rates between recipients of MAV or BAV were estimated with Kaplan – Meier curves.

Results
The median age was 72 years (interquartile range [IQR]: 63.9, 77.3), 77% were males and 60% received mechanical valves. During a median follow-up of 1.49 years (IQR: 0.66–2.83), the primary endpoint occurred in 202 patients. Compared to BAV-recipients, those who received MAV had comparable IR of the primary end-point (40.1/100 person-years; [95% Confidence Interval (CI): 33.7–47.7], vs 36.2/100 person-years; [95% CI: 28.9–45.4], P=0.322) (Figure 1).
Mortality rate at 1-year of follow-up was 28.9% without difference between recipients of MAV or BAV (68.8% in MAV-group and 57.6% with BAV; mortality rate MAV 33.3/100 person-year; (95% CI: 27.9–39.8) vs BAV 27.3/100 person-year; (95% CI: 21.5–34.6), P=0. 183)), (Figure 2). Additional statistical analysis of the secondary endpoint based on the occurrence of aortic valve intervention before or after dialysis start, was consistent with the main results.

Conclusion
There is no difference in mortality and complication rates in dialysis patients who underwent aortic valve replacement with MAV or BAV.

Funding Acknowledgement
Type of funding sources: None.
Percutaneous valve commissurotomy in mitral stenosis patients: a 20 years follow-up
Authors: Alves Pinto R , Martins Carvalho M , Proenca T , Costa C , Amador A F , Calvao J , Marques C , Cabrita A , Santos L , Pinho A , Oliveira C , Paiva M , Silva J C , Macedo F 
Published: October 2022

Abstract

Background
Percutaneous valve commissurotomy (PMC) is a viable alternative to mitral valve surgery in the treatment of patients with clinically significant mitral stenosis (MS). Although rheumatic MS incidence has decreased in developed countries, it remains a prevalent healthcare problem in Cardiology clinics

Purpose
To evaluate the early and long-term results of PMC in patients with rheumatic MS and to compare long-term events between patients with and without pulmonary hypertension (PH).

Methods
We retrospectively analysed all consecutive patients between 1991 and 2008 with clinically significant rheumatic MS undergoing PMC. Clinical and echocardiographic data were collected at baseline and during long-term follow-up. MACE was a composite of adverse events defined as all-cause mortality, mitral valve re-intervention or hospitalization for a cardiovascular cause.

Results
A total of 124 patients were enrolled: 87% were female, with a mean age at the time of repair of 46±11 year-old and a mean follow-up of 20±6 years. Before the procedure, 34% were in NYHA class ≥ III and 81% had a Wilkins score ≤8; all patients had preserved biventricular systolic function, 83% presented PH, mean transvalvular gradient (TVG) and mitral valve area (MVA) were 12.8 mmHg and 1.0 cm2, respectively. Most of the procedures were successful (91%) and without complications (94%), with a mean MVA improvement of 0.9 cm2 and reduction of 8.5 mmHg in TVG and 9.7 mmHg in pulmonary artery systolic pressure (PASP) after PMC.
During long-term follow-up, 42% of patients were submitted to re-intervention (most of them surgically) and 24% died. In patients non-submitted to re-intervention, TVG and PASP remained similar with early post-procedure evaluation (p=0.109 and p=0.777, respectively), while MVA reduced over time, yet still statistically superior to baseline MVA (1.6 cm2 vs 1.0 cm2, p&lt;0.001). Concerning time-to-event analysis, approximately 80% of patients kept uneventful after 10 years; after 30 years, more than 20% continued MACE-free and approximately 50% were alive. Regarding PH presence at time of PMC, there was no significant difference in MACE events and all-cause mortality between the two groups (Log Rank, p=0,846 and p=0.661, respectively).

Conclusion
PMC was safe and effective in clinically significant rheumatic MS. After a long-term follow-up patients maintained the reduction in TVG and PASP and a smaller but significative improvement in MVA. Most of the patients were free from adverse events after 10 years and half were alive after 30 years. There was no difference in all-cause mortality and in a composite of all-cause death, mitral valve re-intervention or cardiovascular hospitalization concerning PH presence.

Funding Acknowledgement
Type of funding sources: None.
Prognostic impact of acute kidney injury following tricuspid transcatheter edge-to-edge repair
Authors: Tanaka T , Kavsur R , Sugiura A , Galka N , Oeztuerk C , Vogelhuber J , Becher M U , Weber M , Zimmer S , Nickenig G , Zachoval C 
Published: October 2022

Abstract

Background
A considerable risk of acute kidney injury (AKI) following transcatheter interventions without iodinated contrast agents has also been recognized; however, little is known about the incidence and clinical relevance of post-procedural AKI in patients undergoing transcatheter edge-to-edge repair (TEER) for tricuspid regurgitation (TR).

Purpose
This study aimed to investigate the prognostic impact and predictors of post-procedural AKI following TEER for TR.

Methods
We retrospectively analyzed 218 consecutive patients who underwent TEER for TR. Post-procedural AKI was defined as an increase in serum creatinine of ≥0.3 mg/dl within 48 hours or of ≥50% within seven days after the procedure, compared to baseline. Procedural success was defined as at least one grade reduction in TR severity upon discharge. We determined the association between post-procedural AKI and the composite outcome consisting of all-cause mortality and re-hospitalization due to heart failure within one year after the procedure.

Results
Overall, the mean age of the patients was 79±7 years, and 46.3% of the patients were male. Post-procedural AKI occurred in 32 patients (14.7%) (Figure 1). Among baseline characteristics, male sex and an estimated glomerular filtration rate of &lt;60 ml/min/m2 were associated with the occurrence of AKI. In addition, patients without procedural success had a higher incidence of post-procedural AKI (30.4% vs. 1.8%; p=0.024).
Patients with AKI had a higher incidence of in-hospital mortality compared to those without AKI (12.5% vs. 1.1%; p=0.005). Moreover, AKI was associated with the incidence of the composite outcome within one year after TEER for TR (adjusted hazard ratio: 2.06; 95% confidence interval: 1.11–3.84; p=0.023). In addition, our restricted cubic spline curve showed that a post-procedural increase in the creatinine level within seven days after the procedure was associated with a linear trend of the risk of the composite outcome after TEER (Figure 2).

Conclusions
Post-procedural AKI occurred in 14.7% of patients undergoing TEER for TR, despite the absence of iodinated contrast agents, which was associated with worse clinical outcomes. Male sex and CKD at baseline were related to the occurrence of AKI, and the procedural success of TEER was associated with a lower incidence of AKI. Our findings highlight the clinical impact of AKI following TEER for TR and should help with identifying patients at high risk of AKI.

Funding Acknowledgement
Type of funding sources: None.