bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term survival and ourtomes a large cohort of patients underwent with Transcatheter Aortic Valve Replacement: an 10-year single center TAVR experience
Authors: Munoz-Garcia M , Munoz-Garcia E , Munoz Garcia A J , Dominguez-Franco A J , Jimenez-Navarro M F , Alonso-Briales J H , Hernandez-Garcia J M , Gomez-Doblas J J 
Published: October 2022

Abstract

The use of transcatheter aortic valve replacement (TAVR) has expanded as an alternative to surgical aortic valve replacement and has become a widely accepted treatment option for patients with severe aortic stenosis who are considered intermediate- and high-risk surgical candidates. The information concerning the long-term durability of TAV devices is currently limited. The interplay between estimated life expectancy and prosthetic heart valve durability is a key consideration in these discussions. The aim of this study was to determine the clinical outcomes, survival and the factors predicting mortality after TAVR

Methods
From April 2008 to December 2020, the auto-expandible and baloom-expandable prostheses were implanted in 991 patients with symptomatic severe aortic stenosis with intermediate, high and deemed risk.

Results
The mean age was 79.43±6.7 years. The logistic EuroSCORE II and STS score were 5.92±5% and 5.22±3.7%, respectively. The implantation success rate was 98.7%. In-hospital mortality was 3.3%, and the combined endpoint of death, vascular complications, myocardial infarction or stroke had a rate of 17.2%.
The late mortality (beyond 30 days) was 43.2%. Survival at 1, 3, 5, 7, 9 and ten years were 88.2%, 68.2%, 50,1%, 38.1%, 26.3% and 16.4% respectively, after a mean follow-up of 44.8±31 months.
The NYHA functional class improved from 3.3±0.7 to 1.76±0.5 in the follow-up.
At 7 years, 9 patients had severe prosthetic valve dysfunction (severe stenosis and moderate transvalvular regurgitationI. In 7 patients were treated again with TAVR.
The predictors of cumulative mortality were: Charlson index [HR 1.167 (95% CI 1.078–1.264), p=0.001], Readmision Heart Failure [HR 2.793 (95% CI 1.948–4.005), p=0.001], stroke post-TAVR [HR 2.919 (95% CI 1.965–4.336), p=0.001], Left ventricular ejection fraction [HR −1.012 (95% CI 1.002–1.022) p=0.021] and Karnosfky index [HR −0.984 (95% CI 0.975–0.993), p=0,001] but the requirement of pacemaker or residual aortic regurgitation after TAVR were not predictors [HR 0,979 (CI 95% 0.678–1.415), p 0.911] and [HR 1.087 (CI 95% 0.913–1.294), p=0.349].

Conclusions
TAVR is associated with excellent clinical results at follow-up. Long-term survival depends particularly on comorbidities and the left ventricular ejection fraction

Funding Acknowledgement
Type of funding sources: None.
Pattern of cardiovascular risk factors and outcomes of patients older than 80 years and presenting with acute coronary syndromes
Authors: El Amrawy A , Almaghraby A , Abd Elnabi M , Wagdy S 
Published: October 2022

Abstract

Background
Elderly patients presenting with acute coronary syndrome (ACS) are at a higher risk for morbidity, complications and early mortality than younger patients. Elderly are frequently underrepresented in clinical trials.

Methods
A descriptive multi-center study including 760 patients admitted with ACS in order to determine the most frequently encountered cardiovascular risk factors, as well as the in-hospital complications among this age group.

Results
Of the 760 patients, 42.1% were males with a mean age of 85 years. Non-ST-elevation ACS was encountered in 496 patients (65.3%; NSTEMI 50% and unstable angina 15.3%) while STEMI was encountered in 264 patients (34.7%).
Regarding risk factors, 61.1% of patients were hypertensive, 60% were diabetics, 44.7% were smokers, 28.9% had dyslipidemia, 16.8% had a family history of coronary artery disease, and 20% had chronic renal impairment at presentation.
252 patients (33.2%) underwent primary PCI, 440 patients (57.9%) underwent elective PCI, 36 patients (4.7%) underwent coronary artery bypass graft (CABG) surgery while 32 patients (4.2%) were maintained on conservative medical therapy and no patients received fibrinolytic therapy.
In-hospital mortality was only 3.7% (28 patients), cerebrovascular stroke occurred in 16 patients (2.1%) and recurrent infarction occurred only in 8 patients (1.1%).

Conclusions
In patients over 80 years presenting with ACS, female sex, hypertension and diabetes were the most frequently encountered cardiovascular risk factors, with more frequent presentation of NSTEMI than STEMI and in-hospital mortality of 3.7%.

Funding Acknowledgement
Type of funding sources: None.
Complex high-risk indicated percutaneous coronary interventions (CHIP-PCI) in elderly patients
Authors: Marschall A , Marti Sanchez D , Ferreiro J L , Lopez Palop R , Ojeda S , Avanzas P , Jimenez Mazuecos J M , Carrillo Saez P , Gutierez-Barrios A , Pinar E , Linares J A , Diego A , Amat I J , Telleria M J , De La Torre Hernandez J M 
Published: October 2022

Abstract

Introduction
Complex high-risk indicated percutaneous coronary intervention (CHIP-PCI) is a poorly defined concept. A recent large-scale study identified various patient- and procedure-related factors that were associated with in-hospital major adverse cardiac or cerebrovascular events (MACCE), which were used to construct a CHIP-score [1].

Purpose
To investigate the predictive value of patient- and procedure related risk factors, based on the CHIP-score, in a large cohort of elderly patients.

Methods
This is a retrospective multicenter study of 20 centers, including patients of ≥75 years of age, that underwent PCI in the period of 2012–2019. The primary endpoint of MACCE was defined as cardiovascular death, myocardial infarction, revascularization or stroke. The follow-up time was 1 year. We created univariate and multivariate Cox regression models in order to investigate the predictive value of the CHIP-score variables (other than age, Table 2).

Results
A total of 2724 patients with a mean age of 81 (± 4.3) years were included in the study. Baseline characteristics are depicted in Table 1. The mean CHIP score was 1.74 (± 1.2) and 2262 (83%) had at least one CHIP criteria. At 1-year follow-up, 267 (9.8%) met the primary endpoint. Out of 11 investigated CHIP-score variables, only 5 were independent predictors of 1-year MACCE in adjusted regression models: Prior myocardial infarction (HR 1.56 (95% CI: 1.10–1.90), p=0.009), left ventricular ejection fraction &lt;30% (HR: 2.02 (95% CI: 1.34–3.0, p&lt;0.001), chronic kidney disease (HR 1.55 (95% CI: 1.21–2.02, p&lt;0.001), left main coronary PCI (HR: 2.35 (95% CI: 1.29–4.89, p&lt;0.001) and non-radial access (HR: 1.57 (95% CI: 1.19–1.85, p=0.002). See Table 2 for details. Overall MACCE was 4.5% when CHIP was 0, as compared to 10.7% with any CHIP factor present (p&lt;0.001) (Figure 1). A CHIP of 4+ or higher was present in 246 (9%) patients and was associated with a three-fold increase in 1-year MACCE (HR: 2.9 (95% CI: 2.1–3.9), p&lt;0.001).

Conclusions
The CHIP-score retains significant prognostic value in the elderly population. The implication of a CHIP-score might be a future tool for risk stratification in clinical practice, not only for in-hospital MACCE but also on long-term follow-up. In the special population of elderly patients, 3 patient related and 2 procedure related factors showed to be especially helpful for risk assessment.

Funding Acknowledgement
Type of funding sources: None.
Phenotyping patient-reported health profiles in octogenarians with coronary artery disease – a latent profile analysis
Authors: Instenes I , Breivik K , Allore H , Borregaard B , Deaton C , Larsen A I , Wentzel-Larsen T , Norekval T M 
Published: October 2022

Abstract

Background
Percutaneous coronary intervention (PCI) has demonstrated to be an effective treatment strategy also in octogenarian patients (≥80 years). However, limited studies describe patient-reported outcomes in older adults two months after the PCI procedure.

Purpose
To identify latent health profiles concerning fatigue, generic and disease-specific physical and mental health, anxiety and depression, insecurity, dependency and angina frequency. Further, to investigate if these profiles were associated with sex or cohabitation status.

Method
A prospective cohort multicenter study including 3417 patients was conducted. The following patient-reported outcome measures were used: Level of fatigue was assessed using de novo created questions. Generic physical and mental health was assessed using RAND-12. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Disease-specific physical and mental health status, insecurity and dependency were assessed with Myocardial Infarction Dimensional Assessment Scale, and disease-specific physical limitation, quality of life and angina frequency was assessed with Seattle Angina Questionnaire (SAQ-7). All scales were converted to a 0–100 scale (worst to best). Latent profile analysis was used for phenotyping health profiles and multinomial logistic regression analysis for investigating the association of sex and cohabitation status across health profiles.

Result
A total of 318 octogenarians were included. The mean age was 83.6 years, and 69% were males. Three health profiles differing in the level of fatigue, health status, insecurity and dependency and angina frequency were identified (Figure 1). Health profile 1 (26.1%) represents “Low-level of life satisfaction, high level of insecurity and dependency and monthly frequency of angina”. Health profile 2 (38.1%) represents “Medium-level of life satisfaction, medium-level of insecurity and dependency and monthly frequency of angina”. Health profile 3 (35.8%) represents “High-level of life satisfaction, low level of insecurity and dependency and angina free”. Importantly, female sex was strongly associated with being classified into Health profile 1 compared to Health profile 3 [OR 3.6, 95% CI 1.3–7.9]. Living alone however, did not predict a likelihood of being classified into any particular health profile.

Conclusion
We identified three unique health profiles of octogenarians with coronary artery disease. A quarter of the participants were classified into the “Low-level of life satisfaction” profile. In addition, female sex was strongly associated with being identified into the “Low-level of life satisfaction” profile. These result suggest a need for a more tailored and patient-centered aftercare in octogenarians undergoing PCI.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): MTG Holding AS
Prevalence of RV dysfunction in patients under cardiotoxic chemoterapy: a preliminary analysis
Authors: Maltes S , Rocha B M L , Cunha G J L , Paiva M S , Vasques A C , Freitas P , Guerreiro S , Marta L , Abecasis J , Regina R , Andrade M J , Aguiar C T , Martins A , Mendes M 
Published: October 2022

Abstract

Background
Chemotherapy-induced cardiotoxicity is a serious complication often leading to heart failure. While the left ventricle (LV) has been thoroughly implicated in this process, data is scarce on right ventricular (RV) function following cardiotoxic chemotherapies. Our goal was to determine the prevalence and clinical significance of RV dysfunction in a cohort of patients who had received these drugs.

Methodology
Single-center retrospective study of cancer patients performing 2D transthoracic echocardiogram between January 2020 and December 2021. Those previously exposed to anthracyclines and/or anti-HER2 agents (≥6 months prior to echocardiogram) were included. Patients with known coronary artery disease or cardiomyopathy were excluded. LV function was assessed through LV ejection fraction (LVEF) and global longitudinal strain (GLS). LV cardiotoxicity was defined as per 2020 ESMO guidelines. RV function was considered abnormal if the following criteria were met: tricuspid annular plane systolic excursion (TAPSE) &lt;17 mm, peak systolic velocity of the tricuspid annulus by pulsed wave TDI (S'VD) &lt;12 cm/s, fraction area change (FAC) &lt;35% and mean free wall longitudinal strain (FWLS) &gt;−20%.

Results
Forty patients were included (58±13 years; 95% female; 93% with breast cancer; 30%, 20% and 50% previously treated with anthracyclines, anti-HER2 or both, respectively). Mean LVEF and GLS were 56±7% and −17±3%. Overall, 13 patients had current LV cardiotoxicity. RV dysfunction was documented in 15 (38%) patients (7 [18%] with isolated RV dysfunction), most often detected through FWLS (14 [35%], 7 [18%], 6 [15%] and 5 [13%] patients with abnormal FWLS, TAPSE, FAC and S'VD, respectively) – Figure 1. Seven patients (18%) and one patient (3%) had ≥2 and ≥3 abnormal RV parameters. Those with RV dysfunction were more often symptomatic (NYHA class ≥2: 53% vs. 16%; p=0.013), had higher NT-proBNP levels (516 [204–2400] vs. 66 [46–191] pg/mL; p=0.003) and most often had LV cardiotoxicity (62% vs. 26%, p=0.029); pulmonary artery systolic pressures were similar between both groups.

Conclusion
In our cohort of patients treated with cardiotoxic anti-neoplastic drugs, RV dysfunction was observed in two out of every five patients, most often detected by RV 2D strain and associated with worse symptoms and higher NT-proBNP levels. This data suggests that RV cardiotoxicity may be common and clinically impactful in those under cardiotoxic chemotherapies.

Funding Acknowledgement
Type of funding sources: None.
The effect of ACE-I/ARBs and beta blockers on the development of cardiotoxicity in patients with breast cancer
Authors: Umadat G , Gharacholou S M 
Published: October 2022

Abstract

Introduction
Cardiovascular disease has become the leading cause of mortality among breast cancer survivors. Patients with breast cancer who receive treatment with anthracycline and trastuzumab therapies are at risk for the development of non-ischemic cardiomyopathy. The development of heart failure during chemotherapy administration often results in interruption of these life saving therapies.

Purpose
We aim to investigate whether ACE Inhibitors/angiotensin receptor blockers (ACE-I/ARBs) and beta-blockers can be used as primary prophylaxis to prevent the development of chemotherapy induced cardiomyopathy.

Methods
This was a retrospective cohort study investigating women who were diagnosed with breast cancer at our medical center from January 2000 to December 2021. The primary endpoint was the development of cardiotoxicity after treatment with chemotherapy. Cardiotoxicity was defined as a decrease of LVEF by 5% or more to less than 55% in the presence of symptoms of heart failure or an asymptomatic decrease in LVEF by 10% or more to less than 55%. Cox-proportional hazard ratios were conducted to determine the impact of prophylactic ACE/ARBs and beta-blockers on the development of cardiotoxicity. Other baseline characteristics were also investigated for their potential impact on the primary endpoint.

Results
There were 459 patients included in the study of which 70 met criteria for chemotherapy induced cardiomyopathy. Median follow up time of included patients was 12 months and average age was 55 years. Among the included patients, 52% were treated with only trastuzumab, 34% were treated with only anthracycline, and 14% were treated with both therapies. Before chemotherapy was initiated, 15% of patients were taking only ACE-I/ARBs, 7% were taking only beta-blockers, and 5% of patients were taking a combination of ACE-I/ARBS and beta-blockers. There were no significant protective benefits noted for patients who were taking ACE-I/ARBs [HR: 0.49, 95% CI (0.17–1.4)], beta-blockers [HR: 0.50, 95% CI (0.16–1.6)], or both [HR: 1.30, 95% CI (0.44–3.9)]. Notably, there was an increased risk of cardiotoxicity noted for patients who were older [HR: 1.04, 95% CI (1.01–1.1)], smokers within the past 10 years [HR: 2.54, 95% CI (1.41–4.6)], or received a combination of both trastuzumab and anthracycline therapy [HR: 2.52, 95% CI (1.01–6.3)].

Conclusion
Prophylactic use of ACE-I/ARBs and beta-blockers separately or in combination was not associated with beneficial reduction in the development of non-ischemic cardiomyopathy in patients receiving anthracycline or trastuzumab therapies. Older age, smoking within the past 10 years, and combination therapy with both anthracycline and trastuzumab were found to be associated with an increased risk. Further studies are needed to investigate the etiology of how smoking may augment the potential cardiotoxic effects in this population.

Funding Acknowledgement
Type of funding sources: None.
Manganese enhanced magnetic resonance imaging in type 1 and type 2 diabetes mellitus
Authors: Joshi S , Singh T , Kershaw L E , Spath N , Dattani A , Gulsin G S , Semple S I , Williams M W , Gibb F , Forbes S , Reynolds R P , McCann G P , Dweck M R , Newby D E 
Published: October 2022

Abstract

Background
The pathophysiology of diabetic cardiomyopathy has yet to be established although pre-clinical studies suggest a role for altered myocardial calcium handling. Manganese-enhanced magnetic resonance imaging (MEMRI) is a novel non-invasive method of assessing in vivo myocardial calcium handling.

Purpose
To investigate whether myocardial calcium handling is impaired in patients with either type 1 or type 2 diabetes mellitus in the absence of underlying heart disease.

Methods
In a prospective case-control study, patients with type 1 (n=19) or type 2 (n=10) diabetes mellitus and healthy volunteers (n=15) underwent MEMRI. Participants with prior coronary artery disease, cardiomyopathy or an abnormal electrocardiogram were excluded. Manganese dipyridoxyl diphosphate (0.1 mL/kg) was administered over 10 min and myocardial T1 mapping was performed prior to and every 2.5 min for 30 min after contrast infusion (Figure 1). Quantitative manganese uptake analysis was performed by measuring T1 relaxation times in a region of interest within the interventricular septum and compared to the left ventricular blood pool. The rate of myocardial manganese uptake was determined by Patlak modelling [1].

Results
Participants with type 1 and type 2 diabetes mellitus were older (50±13 and 55±15.3 years) than the healthy volunteers (32±10 years). All participants had preserved left ventricular ejection fraction (type 1 diabetes mellitus, 67.7±6.1%; type 2 diabetes mellitus, 66.8±3.2%; healthy volunteers, 65±3.5%). Mean myocardial manganese uptake was reduced in participants with both type 1 (6.4±0.6 mL/100 g of tissue/min) and type 2 (6.4±0.5 mL/100 g of tissue/min) diabetes mellitus compared with healthy volunteers (8.3±0.5 mL/100 g of tissue/min; p&lt;0.0001 for both, Figure 2). There were no differences in myocardial manganese uptake between those with type 1 or type 2 diabetes mellitus (p=0.22). There was no statistically significant correlation between myocardial manganese uptake and age in the study population (r=−0.28, p=0.07).

Conclusion
Using MEMRI, we have demonstrated that myocardial calcium handling is impaired in patients with either type 1 or type 2 diabetes mellitus even in the absence of left ventricular systolic dysfunction. This suggests altered myocardial calcium handling may underlie, or contribute to, diabetic cardiomyopathy which has implications developing novel therapeutic targets for the prevention and treatment of diabetic cardiomyopathy.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): British Heart Foundation - Clinical Research Training Fellowship (FS/CRTF/20/24087)AstraZeneca - Investigator initiated award (ESR-19-20118)
Valvular changes following anthracycline therapy: is it time to look beyond ejection fraction?
Authors: Zahler D , Arnold J , Rozenbaum Z , Banai S , Arbel Y , Topilsky Y , Laufer-Perl M 
Published: October 2022

Abstract

Background
Advancements in early detection and treatment of breast cancer have improved survival, but with the costs of side effects, with cardiotoxicity being the most significant one. Anthracycline (ANT) is the most recognized therapy leading to cardiotoxicity, mainly manifested as left ventricle (LV) dysfunction. While the changes in LV ejection fraction (LVEF) are well studied, little is known about the effect of ANT on valvular function. We aimed to evaluate the change in valvular function following ANT therapy in patients diagnosed with breast cancer.

Methods
The study population is part of the Israel Cardio-Oncology Registry (ICOR). All patients performed serial echocardiography; before (T1), during (T2), at the end (T3), and following (T4) ANT therapy, assessing valvular changes. Exclusion criteria included age below 18 and baseline LVEF &lt;55%.

Results
The study included 141 female patients diagnosed with breast cancer and treated with ANT with a mean age of 51±12 years (Table 1). During a median follow-up of 255 [IQR 214–313] days, from T1 to T4, we observed a significant increase in the portion of patients developing new mitral regurgitation (MR) (3.5% to 18.7%, p&lt;0.0001), with a trend for developing moderate and above MR (0.7% to 3.3%, p=0.13). While a statistically significant reduction in mean LVEF (60.2%±1.5 to 59.2%±2.7, p=0.0004) and median LV global longitudinal strain (LV GLS) (−21.6% [−20.0 to −23.0] to −20.0% [−19.1 to −21.1], p&lt;0.0001) was observed (Figure 1), the values remain within the normal range with no significant clinical change. In a multivariate binary logistic regression model, age (OR 1.06, 95% CI: 1.01–1.11) and trastuzumab therapy (OR 5.59, 95% CI: 1.95–16.6) were strong independent predictors for MR development, while medical history was not.

Conclusions
MR development following ANT exposure is frequent, increasingly after the completion of ANT therapy. The parallel reduction in LV function might imply a functional mechanism. Larger trials are needed to evaluate the MR prognostic clinical role in cancer patients.

Funding Acknowledgement
Type of funding sources: None.
Coronary artery disease and revascularization associated with immune checkpoint blocker myocarditis – report from an international registry
Authors: Nowatzke J , Guedeney P , Palaskas N , Lehmann L , Ederhy S , Cautela J , Francis S , Courand P Y , Aras M , Arangalage D , Fenioux C , Finke D , Huang S , Moslehi J , Salem J E 
Published: October 2022

Abstract

Purpose
Immune-checkpoint-blocker (ICB) associated myocarditis (ICB-myocarditis) may present similarly and/or overlap with other cardiac pathology including acute coronary syndrome presenting a challenge for prompt clinical diagnosis.

Methods
An international registry was used to retrospectively identify cases of ICB-myocarditis. Presence of coronary artery disease (CAD) was defined as coronary artery stenosis &gt;70% in patients undergoing coronary angiogram.

Results
Among 261 patients with clinically suspected ICB-myocarditis who underwent a coronary angiography, CAD was present in 59/261 (22.6%) (Table 1). Coronary revascularization was performed during the index hospitalization in 19/59 (32.2%) patients. Patients undergoing coronary revascularization less frequently received steroids administration within 24h of admission compared to the other groups (p=0.029). Myocarditis related 90-day mortality was 9/17 (52.7%) in the revascularized cohort, compared to 5/31 (16.1%) in those not revascularized and 25/156 (16.0%) in those without CAD (p=0.001). irAE-related 90-day mortality was 9/17 (52.7%) in the revascularized cohort, compared to 6/31 (19.4%) in those not revascularized and 31/156 (19.9%) in no CAD groups (p=0.007) (Figure 1). All-cause 90-day mortality was 11/17 (64.7%) in the revascularized cohort, compared to 13/31 (41.9%) in no revascularization and 60/158 (38.0%) in no CAD groups (p=0.10). After adjustment on age and sex, coronary revascularization remained associated with ICB-myocarditis-related death at 90 days (Hazard ratio [HR]=4.03, 95%confidence interval [CI] 1.84–8.84, p&lt;0.001) and was marginally associated with all-cause death (HR=1.88, 95% CI 0.98–3.61, p=0.057).

Conclusion
CAD may exist concomitantly with ICB-myocarditis and portend a poorer outcome when revascularization is performed. This is potentially mediated thru delayed diagnosis and treatment or more severe presentation of ICB-myocarditis.

Funding Acknowledgement
Type of funding sources: None.