bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term outcomes following transcatheter pulmonary valve implantation with the sapien 3 valve: an international multicentre registry
Authors: Hascoet S , Bentham J R , Betrian-Belasco P , Houeijeh A , Jones M , Biernacka E K , Karsenty C , Malekzadeh-Milani S G , Dohlen G , Kantzis M , Valdeolmillos E , Georgiev S , Guerin P , Tengler A , Fraisse A 
Published: October 2022

Abstract

Background
Transcatheter pulmonary valve implantation (TPVI) is indicated to treat right-ventricular outflow tract dysfunction related to congenital heart disease. Long-term outcomes following TPVI with the new-generation SAPIEN 3 valve are not well documented.

Purpose
We investigated mid-term outcomes in a large cohort of patients who underwent TPVI using the SAPIEN 3 valve.

Methods
We retrospectively analysed data from a multicentre observational registry of patients who underwent TPVI with SAPIEN 3 in 30 centres in 12 countries from Europe, the Middle East, and Canada. Patient-related, procedural, and mid-term-outcome data were assessed.

Results
We obtained data for 713 patients treated in 2014–2021. Number of procedures performed among centres varied from 1 to 190 with a median of 15. Median age was 29.4-year-old [19.0–42.8]. The most common underlying diagnosis was cono-truncal defect (68.9%), with a native or patched right-ventricular outflow tract, a bioprosthetic valve, a homograft and a conduit, in 50.8%, 19.6%, 16.5% and 13.2% patients, respectively. Pre-stenting was performed in 74.8% patients. The 20-mm, 23-mm, 26-mm, and 29-mm valves were used in 0.4%, 28.2%, 31.2%, and 40.2% of patients, respectively. Valve implantation was successful in 98.6% patients. Life-threatening peri-procedural adverse events occurred in 3.7% patients, including 0.6% peri-procedural death. Median follow-up was 1.4 years (maximum, 5.9 years; 1160 patient-years), At last follow-up, pulmonary regurgitation grade 2, 3 and 4 was noted in 6.9%, 0.9% and 0.0% patients, respectively. Median maximal gradient at last follow-up was 18 mmHg.
Six patients experienced infective endocarditis (0.5 per 100 patient-years) of whom 1 died and 2 required pulmonary valve replacement. Nine patients (0.8 per 100 patient-years) had secondary pulmonary valve replacement (including 2 by valve-in-valve TPVI; 7 patients had 23-mm and 2 had 26-mm valves). Four patients experienced pulmonary valve thrombosis (0.6 per 100 patient-year) of whom one died and 3 resolved under anticoagulation therapy.
Cumulative incidences of infective endocarditis, secondary pulmonary valve replacement and valve thrombosis were 0.7%, 1.3% and 1.3%; 0.4%, 1.3% and 4.6%; 0.5%, 0.5% and 0.8% at 1, 3 and 5 years after TPVI respectively.

Conclusion
TPVI with the SAPIEN 3 valve was feasible and safe in a wide range of patients with congenital heart defects, most of whom had large native right-ventricular outflow tracts. Mid-term outcomes were favourable.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): The study is promoted and financially supported by a Research grant of the Groupe Hospitalier Paris Saint Joseph
Prognostic impact of cerebral embolism in patients with active infective endocarditis and therapeutic strategies. A retrospective real world study in a surgical centre
Authors: Scheggi V , Menale S , Tonietti B , Giovacchini J , Bigiarini C , Del Pace S , Zoppetti N , Alterini B , Stefano P L , Marchionni N 
Published: October 2022

Abstract

Purpose
Infective endocarditis still has high mortality and invalidating complications, such as cerebral embolism. The best strategies to prevent and to manage neurologic complications remain uncertain. This study aimed to identify predictors of septic cerebral embolism and to evaluate the role of surgery in these patients, in a real-world surgical center.

Methods
We retrospectively analyzed 551 consecutive patients admitted to our department with a definite diagnosis of non-device-related infective endocarditis; of these, 126 (23%) presented a neurologic complication.

Results
Cerebral embolism was significantly more frequent in patients with large vegetations (p=0.001), mitral valve infection (p=0.001), and Staphylococcus aureus infection (p=0.025). At multivariable analysis, only vegetation length was an independent predictor of cerebral embolism (HR 1.057, 95% CI 1.025–1.091, p 0.001), with a best predictive threshold of 10 mm at ROC curve analysis (AUC 0.54, p=0.001). Patients with neurologic complications were more often excluded from surgery despite an indication to it (16% vs 8%, p=0.001). If eligible, they were treated within two weeks from diagnosis in similar proportion as patients without cerebral embolism with similar survival rate. Predictors of mortality were hemorrhagic lesions (p=0.018), a GCS&lt;14 (p=0.001) or a severe degree of disability (p=0.001) at presentation. The latter was the only independent predictor of mortality at multivariable analysis (HR 2.3, 95% CI 1.43–3.80, p=0.001).

Conclusions
The present study highlights the prognostic value of clinical functional presentation and the safety of cardiac surgery, when feasible, in patients with septic cerebral embolism.

Funding Acknowledgement
Type of funding sources: None.
Endocarditis-TR: diagnosis, treatment and prognosis of the infective endocarditis patients admitting tertiary centers of Turkey
Authors: Calik A N , Ozluk O A , Karatas M B , Canga Y , Eren S , Ayhan G , Akdeniz A , Palice A , Candemir A , Akyuz S , Zoghi M , Kozan O 
Published: October 2022

Abstract

Background/Aim
Infective endocarditis (IE) is still a significant cause of morbidity and mortality among cardiovascular diseases. ENDOCARDITIS-TR study aims to evaluate the compliance of the diagnostic and therapeutic methods being used in Turkey with current guidelines.

Material and methods
The ENDOCARDITIS-TR trial is a multi-centre, prospective, observational study consisting of patients admitted to tertiary centres with a definite diagnose of IE. In addition to the demographic, clinical, microbiological and echocardiographic findings of the patients, adverse events, indications for surgery, and in-hospital mortality were recorded during a 2-year time interval.

Results
A total of 208 IE patients from 7 tertiary centres in Turkey were enrolled in the study. The study population included 125 (60.1%) native valve IE (NVE), 65 (31.3%) prosthetic IE (PVIE), and 18 (8.7%) intracardiac device-related IE (CDRIE). One hundred thirty-five patients (64.9%) were culture positive, and the most frequent pathogenic agent was methicillin-susceptible Staphylococcus aureus (MSSA) (18.3%). Among 155 (74.5%) patients with an indication for surgery, only 87 (56.1%) patients underwent surgery. The all-cause mortality rate was 29.3% in-hospital follow-up. Multivariable Cox regression analysis revealed that absence of surgery when indicated (HR: 3.29, 95% CI: 0.93–11.64, p=0.05), albumin level at admission (HR: 0.46 95%, CI: 0.29–0.73, p&lt;0.01), abscess formation (HR: 2.11, 95% CI: 1.01–4.38, p=0.04) and systemic embolism (HR: 1.78, 95% CI: 1.05–3.02, p=0.03) were ascertained as independent predictors of in-hospital all-cause mortality.

Conclusion
The short term results of the ENDOCARDITIS-TR trial showed the high frequency of staphylococcal IE, relatively high in-hospital mortality rates, shortage of surgical treatment despite guideline-based surgical indications and low usage of novel imaging techniques. The results of this study will provide a better insight to physicians in respect to their adherence to clinical practice guidelines.

Funding Acknowledgement
Type of funding sources: None.
Outcomes of infective endocarditis in patients with and without pericardial effusion: a National Inpatient Sample study
Authors: Cruz Torres R , Bansal R , Palicherla A , Thandra A , Sharma A , Narmi A , Smer A 
Published: October 2022

Abstract

Introduction
Pericardial effusion (PE) in patients with infective endocarditis (IE) has been shown to be an independent risk factor for severe complications, however no significant association with mortality has been established. Our study aims to study the significance of pericardial effusion in patients with IE.

Methods
We performed a retrospective analysis using the United States National Inpatient Sample (NIS) database to identify all the hospital admissions with IE using ICD 10 codes and divided them into two groups based on the presence of PE. The outcomes of interest were in-hospital mortality, in-hospital complications, need for cardiac surgery, and length of stay (LOS).

Results
A total of 381,300 patients were hospitalized from 2016 to 2019 with IE, of whom 10,370 developed PE. Mean age of patients in the PE group was 51 years and in non-PE group was 61 years with males and Caucasian race being predominant in both groups. PE group had higher rates of in-hospital death (12.7% vs 9%, P≤0.001) and longer in-hospital stay (12 days vs 7 days, P≤0.001) compared to non-PE group. The rates of cardiac surgery were higher in PE group (26.1% vs 8.4%, P≤0.001). The rates of heart failure, heart block, renal failure, cardiogenic shock, and embolic stroke were higher in PE group [Table 1].

Conclusion
Our study shows that presence of PE in patients with IE is a predictor for in-hospital mortality, length of stay, and need for cardiac surgery. Also, these patients are at higher risk for heart failure, heart block, cardiogenic shock and embolic stroke.

Funding Acknowledgement
Type of funding sources: None.
TAVI-prosthetic valve endocarditis can often be cured without surgery
Authors: Ried I , Omran H , Rudolph T K , Scholtz S , Bleiziffer S , Piper C 
Published: October 2022

Abstract

Introduction
Prosthetic valve endocarditis (PVE) is the most unfavourable complication after any aortic valve replacement.

Purpose
The aim of this study was to analyse the impact of antibiotic-only and additional surgical therapy in patients with TAVI-PVE and to compare it with the results of patients with PVE after surgical aortic valve replacement (SAVR) regarding survival.

Methods
All patients who underwent primary isolated aortic valve replacement via SAVR (n=3.447) or TAVI (n=2.269) in our heart center between 01/2012–12/2018 were analysed. The diagnosis of PVE was made using the 2015 modified Duke criteria. Follow-up was performed until 06/2019 (max. 89, mean 34 months) with a follow-up rate of 98% regarding mortality.

Results
PVE incidence did not differ significantly between SAVR with 4.9 cases per 100 patient-years and TAVI with 2.4 cases per 100 patient-years (p=0.49), although TAVI patients were significantly older (mean 80 vs. 67 years) and had more multimorbidities (STS score mean 5.9 vs. 1.6) (p&lt;0.001). TAVI prostheses with polymer showed a 4.3-fold higher risk to develop PVE than TAVI prostheses without polymer (p=0.004). Most common pathogens were staphylococci and enterococci in all PVEs. Antibiotic-only therapy in TAVI-PVE patients resulted in a significantly better 1-year survival compared with additional surgical therapy (90.9% vs. 33.3%; p=0.005) even in 4 patients with an indication for surgery according to ESC guidelines. In SAVR-PVE patients both therapies led to comparable survival (p=0.861). However, SAVR-PVE who were not operated although indication for surgery was given by the guidelines resulted in a significantly worse survival after 1 year (p=0.004).

Conclusion
TAVI patients did not have a significantly higher risk to develop PVE than SAVR patients despite their older age and greater comorbidities. The 1-year survival of TAVI-PVE patients was significantly higher after antibiotic-only therapy than after additional surgery, even if surgery had been indicated according to guidelines. This new finding is presumably due to the fact that TAVI prostheses do not have a polymeric suture ring. Our results show for the first time that indication for surgery in TAVI-PVE patients should be made carefully. SAVR-PVE patients however benefit from guideline-compliant surgery as in this respect antibiotics-only led to a significantly worse prognosis. This is probably related to the ability of gram-positive cocci to migrate into the polymeric ring and to protect themselves from antibiotic therapy by forming a biofilm. Some of the newer TAVI prostheses contain plastic components which can also be cured often with antibiotic-only but are associated with an increased risk to develop PVE.

Funding Acknowledgement
Type of funding sources: None.
Factors associated with outcome five years after infectious endocarditis – the POET trial
Authors: Pries-Heje M 
Published: October 2022

Abstract

Introduction
In stabilized patients with left-sided infectious endocarditis (IE) a shift to oral antibiotic treatment was non-inferior compared to conventional intravenous antibiotic treatment as assessed six months after randomization (1). After 5 years the primary outcome was superior in the orally treated group (2). Factors associated with primary outcome in the POET trial have not previously been reported.

Purpose
To identify factors associated with the occurrence of the primary outcome in the POET trial (Partial Oral Antibiotic Endocarditis Treatment) after 5-years of follow-up.

Method
The POET trial was a Danish national randomized clinical trial with inclusion from 2011–2017. Patients were randomized 1:1 to shift to partial oral versus continued intravenous antibiotic treatment after fulfilling stabilization criteria. Patients were followed from randomization until July 2020. The primary outcome was a composite outcome including the occurrence of 1) all-cause mortality, 2) non-intended heart valve surgery, 3) embolization or 4) relapse of positive blood culture with the primary IE causing bacteria. Associations between baseline characteristics and IE-specific factors and the occurrence of the primary outcome were examined using univariate cox-regression analysis and a multivariate model was constructed using backwards elimination at p&gt;0.05. The proportional hazard assumption was assessed with Schoenfeld residuals.

Results
A total of 400 patients with left-sided endocarditis were randomized. After a median follow-up of 5.4 years (IQR 4.0–6.9), one or more of the components of the primary outcome had occurred in 156 patients (Table 1) (mean age 71.5 years (SD 10.0), 119 males (76.3%)). Patients who reached a primary outcome were older, more comorbid, more often had an existing prosthetic valve at time of IE admission, had IE localized to the aortic valve, had vegetations &gt;9 mm or valvular incompetence at time of admission. In multivariable regression analysis older age (HR 1.03; 95% CI 1.02–1.05, p&lt;0.001), diabetes (HR 1.56; 95% CI 1.06–2.30, p=0.025), renal failure (HR 2.13; 95% CI 1.40–3.24, p&lt;0.001), and prosthetic aortic valve (HR 1.52; 95% CI 1.08–2.14, p=0.016) were associated with a risk of reaching a primary outcome, while heart valve surgery during primary admission for endocarditis (HR 0.41; 95% CI 0.27–0.62, p&lt;0.001) and shift to oral antibiotic treatment (HR 0.69; 95% CI 0.50–0.95, p=0.022) were associated with a lower risk (Table 2).

Conclusion
In the POET-trial older age, diabetes, renal failure and prosthetic aortic valve at baseline were independently associated with a higher risk of reaching a primary outcome, while heart valve surgery and shift to oral antibiotic treatment were associated with a lower risk. These findings may inform future guidelines for treatment of endocarditis.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Danish Heart FoundationNovo Nordisk Foundation
Clinical findings of triglyceride deposit cardiomyovasculopathy
Authors: Ono R , Miyauchi H , Iimori T , Hoshi K , Ohyama M , Hirano K , Kobayashi Y 
Published: October 2022

Abstract

Background
Triglyceride (TG) deposit cardiomyovasculopathy (TGCV) is a novel cardiovascular disorder and was recently encoded as an orphan disease in Europe (ORPHA code: 565612). Defective intracellular lipolysis results in TG accumulation in the myocardium and coronary arteries in TGCV. The myocardial washout rate (WR) of iodine-123-β-methyl-p-iodophenylpentadecanoic acid (BMIPP) is an essential indicator to evaluate myocardial lipolysis in vivo, and decreased WR (&lt;10%) of BMIPP is one of the essential items of diagnostic criteria for TGCV.

Purpose
To clarify clinical findings of TGCV including comorbid conditions and laboratory findings.

Methods
We enrolled 234 patients who underwent BMIPP scintigraphy between September 2015 and July 2019. The distributions of TGCV in each comorbidity, cardiac functions and laboratory findings were investigated.

Results
In total, 104 patients were diagnosed with definitive TGCV. The BMIPP WR of TGCV patients was −1.37±10.6%. TGCV patients had various comorbid conditions, including coronary artery disease (75%), diabetes mellitus (56%), and heart failure (21%). Left ventricular ejection fraction (LVEF) of TGCV patients was significantly lower than that of non-TGCV patients (38.1±18.0% vs. 43.6±18.9%, p-value=0.026). Moreover, among those who did not take lipid-lowering drugs, there was no difference in the serum TG level between TGCV and non-TGCV patients (TGCV: n=44, 127±84.6 mg/dL, non-TGCV: n=66, 133±70.7 mg/dL, p-value=0.73).

Conclusions
TGCV patients showed multiple coexistence of coronary artery disease, diabetes mellitus, or heart failure with lower LVEF. Serum TG level was not significantly different between TGCV and non-TGCV patients. Serum TG did not affect the intracellular TG accumulation in TGCV patients directly, and this result was consistent with the pathophysiological hypothesis that the TG accumulation in the myocardial cytoplasm is due to intracellular lipase dysfunction.

Funding Acknowledgement
Type of funding sources: None.
Acute myocarditis associated with desmosomal gene variants
Authors: Ammirati E , Raimondi F , Piriou N , Mohiddin S A , Imazio M , Aquaro G , Olivotto I , Van De Heyning C M , Peretto G , Merlo M , Klaassen S , Poller W , Adler E D , Camici P G , Cooper L T 
Published: October 2022

Abstract

Background
The risk of adverse cardiovascular events in patients with acute myocarditis (AM) and desmosomal gene variants (DGV) remains unknown.

Purpose
To ascertain the risk of death, ventricular arrhythmias, recurrent myocarditis, and heart failure (main endpoint) in patients with AM and pathogenic or likely pathogenetic DGV.

Methods
In a retrospective international study from 23 hospitals, 97 patients were included: 36 with AM and DGV (DGV(+)), 25 with AM and negative gene testing (DGV(−)), and 36 AM patients without genetics (w/o genetics). All patients had troponin elevation plus findings consistent with AM on histology or at cardiac magnetic resonance imaging (CMRI). In 86 patients CMRI changes in function and structure were re-assessed at follow-up.

Results
In the DGV(+) AM group (88.9% DSP variants), median age was 24 years, 91.7% presented with chest pain, and median left ventricular (LV) ejection fraction was 56% on CMRI (p=NS vs. the other 2 groups). Kaplan-Meier curves demonstrated a higher risk of the main endpoint in DGV(+) AM compared to DGV(−) and w/o genetics patients (62.3% vs. 17.5% vs. 5.3% at 5 years respectively; p&lt;0.0001), driven by myocarditis recurrence and ventricular arrhythmias (Figure 1A, B). At follow-up CMRI, a higher number of late-gadolinium enhanced segments was found in DGV(+) AM.

Conclusions
Patients with AM and evidence of DGV have a higher incidence of adverse cardiovascular events compared with AM patients without DGV. Further prospective studies are needed to ascertain if genetic testing might improve risk stratification of patients with AM who are considered at low risk.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Italian Ministry of Health
Does my TAVR patient have cardiac amyloidosis?
Authors: De Almeida J P L , Martinho S , Rosa J , Campos G , Cunha M , Ferreira M , Costa C , Marinho V , Goncalves L 
Published: October 2022

Abstract

Introduction
Aortic stenosis (AS) is highly age-related, and its prevalence is increasing rapidly in high-income countries. There are 2 major types of amyloid protein responsible for cardiac amyloidosis (CA) - transthyretin (TTR) and immunoglobulin lightchain (AL). Previous cohorts report an incidence ranging from 9 to 16% for the presence of CA in patients with AS referred for TAVR. These patients appear to have a similar prognosis to those with lone AS when undergoing TAVR, but a trend toward worse prognosis if left treated. We aimed to investigate the prevalence of CA in patients with severe AS referred for TAVR in the Portuguese population.

Methods
We prospectively recruited 60 consecutive patients referred for TAVR at our tertiary center between November 2020 and May 2021. 59 patients agreed to participate and signed an informed consent, approved by the local Ethics Commission. All patients performed coronary angiogram, echocardiogram, thoracic abdominal pelvic CT scan, ECG, bone scintigraphy (99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid [DPD]) and blood and urine monoclonal immunoglobulin testing. (Figure 1).

Results
About half (54.2%) of patients were male, average age was 82 years and the prevalence of ischemic heart disease and cardiovascular risk factors was high. About one third of patients had atrial fibrillation and 27.1% were pacemaker carriers. Echocardiographic baseline findings were: maximum aortic valve gradient 72.77±18.18 mmHg; mean aortic valve gradient 43.49±11.60; aortic valve area 0.65±0.15 cm2; interventricular septum thickness 1.30±0.23 cm; left ventricular ejection fraction (LVEF) 52.06±11.35%; E/E' 14.63±7.5; tricuspid annular plane systolic excursion 19.2±4mm; right ventricle/ right atrial gradient 38.1±14.32mmHg.
CA was diagnosed in 6 (10.2%) patients. Perugini grade was 1 (n=3) and 3 (n=3). One patient (Perugini grade = 3) was found to have plasma cell dyscrasia, producing monoclonal IgG Kappa protein. CA patients were all male, older (86.5 vs 81.30 years, p=0.049), more frequently pacemaker carriers (66.7 vs 22.6%, p=0.041) and had a tendency to have a thicker interventricular septum (1.48 vs 1.28 cm, p=0.065).

Conclusions
We show that in the Portuguese population, the prevalence of CA in severe AS patients referred for TAVI is in line with what is observed in other countries. This has important consequences regarding the diagnosis and management of these patients.

Funding Acknowledgement
Type of funding sources: None.
Validation of an electrocardiographic algorithm for the detection of cardiac amyloidosis
Authors: Schrutka L , Seirer B , Dusik F , Rettl R , Duca F , Dalos D , Dachs T M , Binder C , Badr-Eslam R , Kastner J , Hengstenberg C , Stix G , Bonderman D 
Published: October 2022

Abstract

Background
Despite new therapies, diagnosis of cardiac amyloidosis (CA) is often delayed. We recently developed a simple electrocardiographic (ECG) algorithm to suspect CA without the aid of advanced imaging modalities (Figure).

Methods
The aim of this study was to validate the algorithms' usefulness in clinical practice. ECG readings from patients with CA, heart failure with preserved ejection fraction (HFpEF), and hypertrophic cardiomyopathy (HCMP) were analyzed in a blinded fashion.

Results
884 patients were included. Patients with pacemakers were excluded, leaving 827 ECGs (237 CA, 407 HFpEF, 183 HCMP) for final analysis. A characteristic pattern defined by the algorithm was visually perceptible in 165 ECGs (69.6%) of the amyloidosis patients vs. 114 (28%) of HFpEF vs. 22 (12.0%) of HCMP patients (p&lt;0.001). The area under the curve (AUC) for the detection CA was 0.75 with a sensitivity of 69.6% and a specificity of 76.9% (Figure). Binary logistic regression analysis revealed that the presence of a distinctive pattern increased the probability of CA with an odds ratio of 7.66 (CI: 5.47–10.72; p&lt;0.001).

Conclusion
This easy-to-use ECG algorithm has proven helpful to suspect CA. Our tool may significantly improve the treatment of heart failure patients by identifying those with amyloidosis-related disease.

Funding Acknowledgement
Type of funding sources: None.