bluuebunny/crossref_metadata_2025_split huggingface dataset:
Modeling aortic stenosis progression: impact on follow-up, treatment and survival
Authors: Teixeira R , Ribeiro D , Sousa Nunes F , Leite M , Neves A , Santos D , Silva M , Silva G , Diaz S , Saraiva F , Sampaio F , Fontes-Carvalho R 
Published: October 2022

Abstract

Background
Aortic stenosis (AS) is one of the main valvular heart diseases in developed countries. Degenerative fibrocalcific aortic stenosis is a progressive disease of the valve and ultimately of the myocardium, which can be fatal when symptomatic. There is no medical treatment that can halt or delay its progression. AS does not evolve linearly over time, and not every patient has the same progression rate.

Aims
The aim of this study is to 1) compare different mathematical models of aortic stenosis progression, 2) cluster patients into rapid and slow progressors and explore possible predictors, 4) evaluate the impact of different progression rates on cardiac structure and function, and 5) evaluate survival and optimal timing for follow-up and treatment.

Methods
We retrospectively studied consecutive patients with aortic peak velocities from 2012 to 2020. Follow-up echocardiograms, seriated biomarker assessment, and clinical records were consulted, providing a multiparametric data frame for longitudinal and dynamic modeling of aortic stenosis progression and its consequences.

Results
This study included 9583 studies from 752 patients with a median total follow-up of 4.26 years (interquartile range: 1.28 to 7.24 years). A logistic model was selected with the best accuracy to predict the rate of AS progression. Patients were categorized into slow and rapid progressors in a ratio of 5:1. Multiparametric analysis showed no association between these profiles and clinical variables. However, anti-hypertensive drugs before and after adjustment for blood pressure control (Calcium Channel Blockers, p=0.013, OR 0.50) were associated with slower progression. Meanwhile, elevated inflammatory markers (erythrocyte sedimentation rate, p=0.01) were associated with faster AS progression. Despite no survival difference between these groups, higher rates of valvular intervention were registered in rapid progressors (p&lt;0.001). Moreover, faster progressors were associated with earlier cardiac damage (as demonstrated by early onset of moderate mitral and tricuspid valve regurgitation, left auricle dilation, and left ventricle hypertrophy, p&lt;0.05).

Conclusions
These results can potentially modify follow-up times and deliver more personalized and individualized health care to different AS patients, thereby optimizing resources.

Funding Acknowledgement
Type of funding sources: None.
Effect of the cold pressor test on coronary flow reserve by cardiac magnetic resonance in patients with hereditary TTR+ amyloidosis
Authors: Chango D X , Hurtado A M , Sanchez M I , Vasquez Z Y , Gonzalez-Duarte A , Rosales S 
Published: October 2022

Abstract

Background
Cold pressor test (CPT) is a potent alpha-adrenergic vasoconstrictor stimulus and evaluates the sympathetic reactivity of the cardiovascular system during the immersion of a hand in cold water, its effect on coronary flow reserve (CFR) in patients with hereditary TTR+ amyloidosis is unknown.

Purpose
To evaluate CFR by CPT in hereditary TTR+ amyloidosis patients with different cardiac involvement regarding the distribution of late gadolinium enhancement (LGE) by cardiac magnetic resonance imaging (CMRI) and compare with healthy volunteers

Methods
It was a cross-sectional study of 22 hereditary TTR+ amyloidosis patients with different patterns of LGE (absence/minimum or extensive involvement), and 4 healthy controls without LGE. CPT was performed with immersion of one hand in four Celsius degrees temperated water. Phase-contrast images were acquired on rest and during stress (after four minutes of a hand immersion). Volume quantification was made in posterior analysis to determine flow differences.

Results
No statistically significant differences were found regarding left ventricular (LV) volumes, LV mass, LV ejection fraction, and atrial volumes comparing the three groups of patients. CFR was abnormal in both groups of TTR+ amyloidosis patients compared with higher values in healthy subjects. Nevertheless, no statistically significant differences were determined.

Conclusions
Hereditary TTR+ amyloidosis subjects presented with abnormal values of CFR even with minimal or non-LGE by CMRI in the setting of infiltration. This response hypothesized small vessel involvement due to early infiltration by amyloid deposits before LGE development.

Funding Acknowledgement
Type of funding sources: None.
Oral anticoagulant treatment in patients with atrial fibrillation early after valvular intervention: a nationwide cohort study
Authors: Christersson C , Skogseid E L , Westerbergh J , Held C , Batra G 
Published: October 2022

Abstract

Background
Treatment with non-vitamin K oral anticoagulants (NOAC) is the first option for primary prevention of ischaemic stroke in patients with atrial fibrillation (AF). However, there is still an evidence gap regarding efficacy and safety of NOAC in patients with AF and severe valvular heart disease undergoing valvular intervention.

Purpose
The aim was to evaluate the efficacy and safety of NOAC or no oral anticoagulant (OAC) treatment versus warfarin during the first 3 months after valvular intervention.

Methods
We used data from the National Quality Register SWEDEHEART and included all patients with AF discharged after surgical valvular intervention with bioprosthesis or valvuloplasty, or transcatheter aortic valve implantation (TAVI) between 2010 and 2016. Outcomes, including the composite of cardiovascular (CV) events (CV death, ischaemic stroke or systemic embolism), major bleeding, and relevant comorbidities and OAC treatment at discharge were collected from the National Patient Register, the Swedish Prescribed Drug Register, and the National Cause of Death Register. The association between exposure (warfarin, NOAC or no OAC) and occurrence of composite CV events and major bleeding was explored using a time-dependent adjusted Cox regression analysis.

Results
In total, 4730 patients with AF and valvular intervention were included. The cohort had a mean age of 75 years, 35.9% were women and mean CHA2DS2-VASc score was 3.3 (Table 1). The proportion of patients treated with warfarin was higher in patients undergoing surgical valve intervention whereas NOAC was more commonly prescribed to patients treated with TAVI. Rates of composite CV events and major bleeding was similar between patients treated with NOAC versus warfarin. No OAC treatment versus warfarin was associated with higher rate of composite CV event, but with no difference with regard to major bleeding (Table 1).

Conclusion
A large proportion of patients with AF undergoing valvular intervention was not treated with OAC despite having a high CHA2DS2-VASc score. Also, patients on no OAC versus warfarin had a higher risk of i CV events in the early phase after valvular intervention. The efficacy and safety of NOAC was similar compared to warfarin during the first 3 months after intervention. Treatment with OAC in patients with AF, irrespective of NOAC or warfarin, was associated with improved clinical outcome early after valve intervention.

Funding Acknowledgement
Type of funding sources: None.
Risk factors and clinical effects of late leaflet thrombosis after transcatheter aortic valve replacement
Authors: Bak M , Choi K H , Kim J H , Park T K , Kim E K , Kim S M , Choi S H , Park S J 
Published: October 2022

Abstract

Background
As the indications for trans-catheter aortic valve replacement (TAVR) expand, it is expected that the number of TAVR patients would increase and the follow-up duration would be longer. It is known that the incidence of leaflet thrombosis is higher in TAVR than in surgical aortic valve replacement (SAVR), but not much is known about the risk factors of late leaflet thrombosis in TAVR.

Aim
Therefore, in this study, the incidence and risk factors of late leaflet thrombosis at late term after TAVR and the effect on clinical course of late leaflet thrombosis would be investigated.

Method
There were 176 patients undergone TAVR from January 2015 to October 2020 in one tertiary hospital of south korea. 94 patients had follow-up cardiovascular computed tomography (CT) between 3 months and 2 years after TAVR. Among 94 patients, late leaflet thrombosis was discovered at 20 patients, and risk factors were analyzed by comparing clinical factors, echocardiographic and cardiovascular CT information, and angiographic data between the group with and without late leaflet thrombosis. And the difference in aortic valve hemodynamics between the group with and without leaflet thrombosis was examined and clinical outcomes were compared. Clinical outcome was defined as the composite of all-cause death, stroke, heart failure (HF) admission, redo-aortic valve (AV) replacement and major bleeding after detection of late leaflet thrombosis.

Results
Indexed mean sinus of Valsalva diameter, AV calcium score and post procedure estimated orifice area (EOA) had predictability of late leaflet thrombosis with AUC value of 0.670 (95% CI [0.546–0.795], p value = 0.020), AUC value of 0.698 (95% CI [0.544–0.851], p value = 0.012) and AUC value of 0.665 (95 percent CI [0.548–0.782], p value = 0.031), respectively (Figure 1).
In echocardiography performed at the time of follow-up CT, AV max velocity and AV mean pressure gradient were higher in thrombosis group and EOA and Doppler velocity index were lower in thrombosis group than in no thrombosis group within normal range (Figure 2). Clinical outcome was not significant different between the two groups (log rank p value = 0.560).

Conclusion
Larger indexed sinus of Valsalva diameter, higher AV calcium score and smaller post procedure AV EOA were risk factors for late leaflet thrombosis after TAVR. Subclinical late leaflet thrombosis have a benign course when properly managed.

Funding Acknowledgement
Type of funding sources: None.
Long-term success in percutaneous valve commissurotomy – is Wilkins score over 9 a definitive limit?
Authors: Martins De Carvalho M , Alves Pinto R , Proenca T , Calvao J , Martins Da Costa C , Amador A F , Amaral Marques C , Cabrita A , Santos L , Oliveira C , Pinho A , Sousa C , Paiva M , Silva J C , Macedo F 
Published: October 2022

Abstract

Background
Percutaneous valve commissurotomy (PMC) is an established treatment in patients with significative mitral stenosis (MS). Although rheumatic MS incidence has decreased in the last century, it remains a prevalent pathology worldwide. The Wilkins score (WS) is a reference in echocardiographic assessment of MS; a score ≤8 is considered a predictor of treatment success and score between 9 and 11 is a “grey zone” (WGZ) in which doubts persists regarding PMC success.

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 WS ≤8 and patients in WGZ.

Methods
We retrospectively analysed all patients between 1991 and 2008 with significative rheumatic MS undergoing PMC. Data were collected at baseline and during long-term follow-up. M ACE was defined as a composite of all-cause mortality, mitral valve re-intervention or cardiovascular hospitalization.

Results
In our cohort, 124 patients were included. Most were female (87%), mean age at the time of repair was 46±11 year-old and mean follow-up was 20±6 years. Before the procedure, 81% had WS ≤8 and 19% were in WGZ. Both groups had similar baseline characteristics, namely age at first intervention, NYHA class and follow-up time. 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%). Mean MVA improvement was similar in both groups [0.9 cm2 in WS ≤8 and 0.8 cm2 in WGZ, t(102)=0.173, p=0.863]; there was also no significative difference in TVG and PASP reduction after PMC. During long-term follow-up, re-intervention and mortality occurred in 40% and 23% in WS ≤8 and in 50% and 29% in WGZ, respectively, and none of these differences was statistically significant (p=0.389 and p=0.544, respectively). Concerning time-to-event analysis, approximately 80% of patients kept uneventful and &gt;90% alive after 10 years in both groups and no significant difference in M ACE events and all-cause mortality between WS ≤8 and WGZ was observed (Log Rank, p=0,419 and p=0.950, respectively).

Conclusion
PMC was safe and effective in clinically significant rheumatic MS in both WS ≤8 and WS 9–11, with similar MVA improvement. After 10 years, approximately 80% of patients were MACE-free and &gt;90% alive in both groups. There was no difference in all-cause mortality and in a composite of all-cause death, mitral valve re-intervention or cardiovascular hospitalization concerning WS groups.

Funding Acknowledgement
Type of funding sources: None.
Predictive Role of Aortic Valve Calcium score on post-procedural outcomes and mortality after Transcatheter aortic valve replacement
Authors: Taskesen T , Ahsan M , Putz J , Park A , De Santis T , Latif A , Ugwu J , Ellerman M , Shivapour D , Chawla A , McAllister D , Sigurdsson G , Martin E 
Published: October 2022

Abstract

Introduction
Extent of aortic valve (AV) calcium increases as degenerative aortic valve stenosis progresses. Initial studies postulated AV calcium (AVC) score to be a predictor of complications such as need for pacemaker implantation, paravalvular regurgitation and mortality after Trans-catheter Aortic valve Replacement (TAVR). However, evidence regarding the impact of AVC score as a predictor of post-procedural complications and mortality has been conflicting.

Objective
This study aimed to determine the prognostic impact of AVC as predictor of post-procedural outcomes and mortality in patients with severe aortic stenosis (AS) who underwent TAVR.

Methods
We retrospectively abstracted the records of 497 patients with severe AS who underwent TAVR between January 2016 and July 2019 at our institution. All patients underwent a non-contrast cardiac CT scan on a Siemens Somatom Definition Flash 128 slice scanner. AVC score using the Agatston method was obtained retrospectively. Patients were divided into two groups: 1) Non-severe AVC score group [women &lt;1200 Agatston unit (AU) and men &lt;2000 AU]; 2) Severe AV Calcium Score group [women &gt;1200 AU and men &gt;2000 AU]. Primary outcome was 1-year mortality.

Results
Among 466 patients included in the analysis, 352 patients were included severe AVC group while 114 patients were in the non-severe AVC group. Patients in the severe AVC group were older (81±8 vs 79±8 years), were predominantly males (79% vs 71%), and had less diabetes mellitus (31% vs 42%, p=0.02). Post-TAVR AV dimensionless index (0.58±0.13 vs 0.58±0.12, p=0.8) and AV mean gradient (9.5±4.9 vs 9.2±5.4 mmHg) were not statistically different between both groups. There was no statistical difference in the need for PPM (12% vs 7%, p=0.16), post-TAVR stroke (1.5% vs 0%), post-TAVR major complications (17.4% vs 10%, p=0.07), 30 day (3.7% vs 4.4%), and 1-year mortality (13.6 vs 11.4, p=0.6) between both groups.

Conclusion
Our study report that the severity of AVC score does not have a prognostic impact on major post-procedural outcomes and mortality after TAVR.

Funding Acknowledgement
Type of funding sources: None.
Same-day discharge following transcatheter aortic valve replacement: a propensity-matched analysis from national readmission database
Authors: Goel A , Malik A , Bandyopadhyay D , Chakraborty S , Gupta R , Hajra A , Abbott J D , Ahmad H 
Published: October 2022

Abstract

Background
The length of hospital stay following transcatheter aortic valve replacement (TAVR) has decreased in recent years, and next-day discharge strategy is being increasingly adopted in some centers. Whether it is safe to further expedite discharge post-TAVR in selected patients by allowing discharge on the same day as the procedure remains unknown. In addition to potentially decreasing hospitalization costs, it could also limit the inpatient footprint and strain on healthcare resources.

Purpose
The purpose of our study was to compare the 30-day readmission rate in patients receiving TAVR who were discharged the same day (same-day discharge or SDD group) with those who were discharged on a different day (different-day discharge or DDD group). Additionally, we aimed to identify risk factors for readmission after TAVR.

Methods
We used the United States Nationwide Readmission Database to identify all adults who underwent elective TAVR in the years 2015–2019. The primary outcome of this study was all-cause 30-day readmission rate. The secondary outcomes were total hospital costs for the index admission, and risk factors for 30-day readmission. Propensity score matching was conducted to compare the SDD and DDD groups. Independent risk factors of 30-day readmission were identified using multivariate Cox proportional hazards regression analysis of the unmatched cohort.

Results
Of the 196,618 patients who received TAVR (mean age 79.5±8.4 years, 45.0% females), 245 (0.12%) patients were discharged on the same day they received TAVR (SDD group), and the remaining 196,373 were discharged on a different day (DDD group). In the DDD group, the median length of hospital stay was 2 days (interquartile range 1–4 days). A 1:3 propensity score analysis generated a matched cohort including 245 and 889 patients in the SDD and DDD groups, respectively. The 30-day readmission rate was similar between the SDD and DDD groups (11.0% versus 10.8%, hazard ratio [HR] 1.01, 95% confidence interval [CI] 0.59–1.71, p=0.989). Hospitalization costs were significantly lower in the SDD group than the DDD group ($37,811±18,029 versus $49,130±27,007, p&lt;0.001) (see Picture 1). Age, female gender, history of diabetes, chronic kidney disease, chronic pulmonary disease, oxygen use, prior stroke, peripheral vascular disease, anemia, liver disease, and cancer were found to be independent risk factors for 30-day readmission after TAVR (see Picture 2).

Conclusion
In this large nationwide database analysis, patients receiving uncomplicated TAVR who were discharged on the same day as the procedure had a similar all-cause 30-day readmission rate and significantly lower hospital costs compared to those discharged on a different day. These results indicate that same-day discharge after TAVR may be a safe and feasible option in carefully selected patients.

Funding Acknowledgement
Type of funding sources: None.
Severe rheumatic mitral stenosis – analysis of clinical and echocardiographic very long-term outcomes after percutaneous mitral balloon valvuloplasty
Authors: Presume J , Paiva M , Gomes D , Albuquerque F , Guerreiro S , Marta L , Freitas P , Trabulo M , Abecasis J , Andrade M J , Ribeiras R 
Published: October 2022

Abstract

Introduction
Mitral balloon valvuloplasty (MBV) is the guideline recommended treatment for symptomatic severe mitral stenosis (MS) with suitable anatomy, but is often deemed transitory. However, data on very-long term echocardiographic follow-up is scarce. The aim of our study was to describe clinical and echocardiographic outcomes in patients previously submitted to MBV for rheumatic MS.

Methods
We conducted a single-centre retrospective study enrolling patients previously submitted to MBV for rheumatic MS from 1990 until 2021. Follow-up was considered until last registered echocardiographic re-evaluation. Patients without electronic health records available were excluded. The primary endpoint was a composite of all-cause death or need of surgery.

Results
A total of 193 patients were included (15.5% male, with a mean age of 52±15 years at the time of MBV, 60.6% with permanent atrial fibrillation). During a mean follow-up of 11±8 years, 87 (45.1%) patients implanted a mitral valve prosthesis, 4 (2.1%) were submitted to surgical mitral valvuloplasty and 30 (15.5%) died without being reinterventioned. Moreover, a total of 23 (11.9%) embolic events were registered – 21 strokes, 1 pulmonary embolism and 1 acute lower limb embolism.
Overall, 133 patients (68.9%) survived more than 5 years, 95 (49.2%) more than 10 years and 56 (26.9%) more than 15 years since MBV without meeting the primary endpoint. The maximum follow-up without intervention was 32 years. Concerning patients submitted to surgery, the mean time from MBV until operation was 9.4±7.3 years (minimum 8 days; maximum 29.3 years).
In regard to echocardiographic long-term outcomes on alive non-operated patients (mean follow-up of 12±9 years), 52.8% remain with mild MS, 91.6% with mild or no mitral regurgitation and 77.6% with mild or no tricuspid regurgitation. Furthermore, only 20.4% have right ventricle dysfunction (defined as a TAPSE &lt;17 mm), 18.3% have pulmonary hypertension (pulmonary artery systolic pressure &gt;45 mmHg), and 6.8% have residual interatrial communication.

Conclusion
MBV is a minimally invasive procedure that has an important benefit in a very significant proportion of patients with rheumatic mitral stenosis, with potential benefit that may last more than three decades without need for another invasive intervention.

Funding Acknowledgement
Type of funding sources: None.
Assessment of paravalvular regurgitation after transcatheter aortic valve replacement by hemodynamic measurements and cardiac magnetic resonance (APPOSE trial)
Authors: Rooijakkers M J P , Stens N A , Van Wely M H , Van Der Wulp K , Rodwell L , Gehlmann H , Van Garsse L A F M , Geuzebroek G S C , Verkroost M W A , Habets J , El Messaoudi S , Thijssen D H J , Nijveldt R , Van Royen N 
Published: October 2022

Abstract

Background
Paravalvular regurgitation (PVR) is a common complication after transcatheter aortic valve replacement (TAVR) which poses an increased risk of rehospitalization for heart failure and mortality.

Purpose
To assess the accuracy of hemodynamic indices to detect relevant PVR as compared to gold-standard cardiac magnetic resonance (CMR) quantitative flow assessment.

Methods
In this prospective single-centre clinical trial, four hemodynamic indices of PVR measured directly after TAVR were assessed for their correlation with CMR regurgitant fraction (CMR-RF) at one month follow-up: diastolic delta (DD), heart rate adjusted diastolic delta (HR-DD), aortic regurgitation index (ARI) and aortic regurgitation index ratio (ARI ratio). The hemodynamic indices were analyzed for their ability to detect relevant PVR (defined as more than mild PVR, CMR-RF &gt;20%) using receiver operating characteristic (ROC) curves.

Results
We examined 77 patients in whom CMR was performed one month after TAVR. Mean age was 80.4±5.1 years and 46.8% of patients were men. Mean CMR-RF was 12.4±9.3%. Sixty-two (80.5%) patients had ≤ mild PVR (CMR-RF ≤20%), 14 (18.2%) patients had moderate PVR (CMR-RF 21–39%) and one (1.3%) patient had severe PVR (CMR-RF ≥40%). DD was the best hemodynamic index to discriminate between relevant and non-relevant PVR (area under the curve (AUC) 0.82; 95% CI, 0.72–0.92), followed by HR-DD (AUC 0.78; 95% CI 0.67–0.89), ARI (AUC 0.78, 95% CI 0.66–0.89) and ARI ratio (AUC 0.65; 95% CI 0.49–0.81).

Conclusions
Diastolic delta measured directly after TAVR has a high accuracy to predict relevant PVR at one month follow-up as assessed by CMR. Correction for heart rate (HR-DD) or systolic blood pressure (ARI, ARI ratio) does not improve this accuracy.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Abbott Medical