bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of percutaneous mitral valve clipping on right ventricular functions
Authors: Rifaie O A A , Abulatta R M , Naem H M , Alamoodi O M , Nosseir I M , Alkhashab K M , Ragab T M 
Published: October 2022

Abstract

Background
Percutaneous mitral valve clipping (PMVC) is being used successfully in the management of severe functional mitral regurgitation (MR) in patients with high surgical risk. However, the impact of (PMVC) on right ventricular volumes and functions is not clear.

Aim
The aim of the present study was to assess the impact of (PMVC) (on both short and intermediate terms) on right ventricular (RV) volumes and functions using trans-thoracic echocardiography.

Methods
The study population included 37 patients with severe (MR), and congestive heart failurewho wereat high surgical risk. The mean age was 61±14 years, 9 (24.3%)were males. (PMVC) was successfully done for all patients.All had clinical and echocardiographic follow up at 6 and 12-months post (PMVC).

Results
MR showed significant improvement after (PMVC). MRwas less than grade II in 29 (78%)of patients at 6 months and persisted at 12 months (P=0.0001). Similarly, tricuspid regurgitation (TR) showed marked improvement. Severe (TR) was seen in 29 patients (78%) before), but decreased to 7 patients (18.9%) after (PMVC) (P=0.004). Left ventricular ejection fraction (LVEF) improved from 32.63±13.35% at base line to 36.31±13.28% at 6 months (P=0.003). This was maintained at 12 months (35.38±91%) Table 1 shows the changes in RV end diastolic volume (RVDV); RV end systolic volume (RVSV) RV ejection fraction (RVEF), Tricuspid annulus plane systolic excursion (TAPSE), RV longitudinal systolic function by tissue Doppler imaging (TDI) as well as peak systolic pulmonary artery pressure (PASP).

Conclusion
(PMVC) induced a significant reverse remodeling of RV by decreasing both (RVDV) and (RVSV). Moreover, it improved longitudinal RV systolic function as well as (RVEF). This was maintained up to one year follow up.

Funding Acknowledgement
Type of funding sources: None.
Extent and determinants of pulmonary hypertension unmasked by handgrip exercise in patients with mitral regurgitation
Authors: Spieker M , Sidabras J , Lagarden H , Veulemans V , Horn P , Akhyari P , Kelm M , Westenfeld R 
Published: October 2022

Abstract

Background
Pulmonary hypertension (PH) is an established prognosticator in patients with mitral regurgitation (MR). However, a substantial proportion of patients with MR presents without PH at rest but may develop PH during exercise. Previous studies already demonstrated the prevalence and prognostic impact of PH during bicycle exercise. Until now, there are no data on exercise PH assessed by handgrip exercise.

Purpose
To assess prevalence and predictors of exercise-induced PH during handgrip exercise in patients with MR.

Methods
We prospectively included patients with MR and at least mild severity that underwent echocardiography at rest and during three minutes of handgrip exercise according to a standardized protocol. PH was defined by systolic pulmonary artery pressure (SPAP) &gt;50 mmHg.

Results
The final patient cohort included 371 patients with primary and secondary MR. Mean age was 74±11 years, 48% were female and 59% had atrial fibrillation. Median NT-proBNP was 2017 (845–4976) ng/l. Thirty-eight percent of patients had primary MR, while 62% presented with secondary MR. At rest, MR severity was graded as mild in 56% of patients, moderate in 32% and severe in 12%. Mean SPAP at rest was 40±12 mmHg, and 63 patients (17%) revealed PH at rest (SPAP &gt;50 mmHg). Handgrip exercise leads to an increase in SPAP by 7±12 mmHg. Thus, during exercise 137 patients (37%) exhibited SPAP &gt;50 mmHg. Together, 110 patients (32%) of those patients without PH at rest, showed PH during handgrip exercise. Left- (OR 1.021 (1.010 to 1.033); p&lt;0.001), and right atrial volume index (OR 1.020 (1.009 to 1.035); p&lt;0.001), RV fractional area change (OR 0.972 (0.949 to 0.994); p=0.013), tricuspid regurgitation (OR 1.863 (1.434 to 2.445); p&lt;0.001) and SPAP at rest (OR 1.131 (1.100 to 1.167); p&lt;0.001) were the predictors of exercise PH. Moreover, there was a linear correlation between the change in MR severity assessed by effective regurgitant orifice area (r=0.359; p&lt;0.001) and regurgitation volume (r=0.370; p&lt;0.001) and the change in SPAP. Patients with exercise PH and patients with PH at rest were more symptomatic according to NYHA functional class than patients without PH (p=0.008) (Fig. 1).

Conclusion(s)
In patients with primary and secondary MR, handgrip echocardiography unmasks exercise PH in every third patient without PH at rest. Bi-atrial dilatation, right ventricular function, tricuspid regurgitation and SPAP at rest were predictors of exercise PH, while changes in MR severity during handgrip exercise correlate with changes in pulmonary pressures.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by the Forschungskommission of the Medical Faculty of the Heinrich Heine University Düsseldorf to Maximilian Spieker for a Clinician Scientist Track.
Supervised learning-derived tailored risk-stratification in patients with severe secondary mitral regurgitation
Authors: Heitzinger G , Spinka G , Prausmueller S , Pavo N , Dannenberg V , Dona C , Kammerlander A , Nitsche C , Kastl S , Strunk G , Huelsmann M , Rosenhek R , Hengstenberg C , Bartko P E , Goliasch G 
Published: October 2022

Abstract

Background
Mitral regurgitation secondary to heart failure (sMR) has considerable impact on quality of life, heart failure (HF) rehospitalizations and mortality. A diverse burden of comorbidities suggests multifaceted aspects of individual risks. This risk-spectrum has never been studied but is essential to understand disease trajectories.

Objectives
To provide a comprehensive and structured decision-tree-like approach to risk-stratification in patients with severe sMR.

Methods
This large-scale, long-term observational study included 1317 patients with severe sMR from the entire HF spectrum (preserved, mid-range and reduced ejection fraction). Primary endpoint was all-cause mortality and survival tree analysis, a supervised learning technique, was applied to identify patient subgroups with excessive risk of mortality (Figure 1).

Results
Eight distinct subgroups that differed significantly in long-term survival were identified (Figure 2). Subgroup 7, characterized by younger age (≤66), higher hemoglobin (&gt;12.7 g/dl) and higher albumin levels (&gt;40.6 g/l) had the best survival. In contrast, subgroup 5 displayed a 20-fold risk of mortality (HR 95% CI: 20.38 ([0.78–38.52]), P&lt;0.001) and presented with older age (&gt;68 years) and low serum albumin (≤40.6 g/l) and higher NT-proBNP levels (≥9750 pg/ml). Results were consistent in internal and temporal validation.

Conclusion
Supervised machine learning reveals an unexpected heterogeneity in the sMR risk-spectrum, indicating the clinical challenges tied to severe sMR. A decision-tree-like model can guide through the risk spectrum and provide tailored risk-stratification. This structured approach provides the foundation to generate hypotheses towards improved therapeutic strategies and optimized patient care.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Austrian Science Fund
Ventricular arrhythmias and sudden cardiac death caused by mitral valve prolapse: should we operate and when?
Authors: Cameron J , Sutherland N , Han H C , Raman J , Lim H 
Published: October 2022

Abstract

Background
Several autopsy and observational studies have investigated the link between mitral valve prolapse (MVP) and sudden cardiac death (SCD) due to the well accepted yet rare occurrence of complex ventricular arrhythmia (VA) in this cohort. Few studies however have investigated whether arrhythmia burden and more importantly SCD are reduced following surgical correction of MVP.

Purpose
To investigate the impact of mitral valve surgery (MVS) (replacement or repair) on VA and SCD in patients with MVP.

Methods
A systematic review of the current literature was conducted using an electronic search of the PubMed database in October 2021. Studies were included if subjects had undergone mitral valve (MV) repair or replacement with documented rates of arrythmias/SCD pre- and post-intervention. Small patient numbers in individual reports precluded formal meta-analysis and results were reported on a per study basis.

Results
19 identified studies (10 cohort studies, nine case studies) comprised 1322 patients with a pooled mean age of 63.4 years and 38.9% were female. 748 of the 1322 patients underwent MVS: 263 MV repair, 18 MV replacement (one with leaflet and papillary muscle excision), two MV repair with Maze procedure, 177 percutaneous transcatheter MV repair, 45 annuloplasty with or without valve repair, and in 243 cases the surgical method was not specified.
Of the 10 included cohort studies, seven of the eight which investigated rates of VA post MVS concluded there was a significant reduction, while one reported the predisposition to arrythmia persisted after relieving the abnormal mechanical effects of non-ischaemic MR (75% due to MVP). One study reported a reduction in SCD post MVS. Each of the nine included case studies showed a reduction in VA post MVS. One study showed mitral annular disjunction (MAD) was independently associated with a higher risk of arrhythmic events, this link persisting with time dependent MVS although reduced compared to medical management.

Conclusions
The underlying mechanisms for VA and SCD associated with MVP are not completely understood, and guidelines for the surgical correction of MVP based on arrhythmic and SCD risk are lacking. This systematic review illustrates a possible reduction in VA following MVS. Further identification of patients at risk of SCD, and potential use of risk stratification algorithms, would allow for consideration of earlier management and appropriate use of implantable cardioverter-defibrillators (ICD) placement / MVS with an expected survival benefit.

Funding Acknowledgement
Type of funding sources: None.
Prognostic significance of mean transmitral pressure gradient in degenerative non-rheumatic mitral valve: insights from a vast echocardiographic database
Authors: Massalha E , Klempfner R , Maor E , Beigel R , Kuperstein R , Matetzky S , Beinart R , Segev A , Guetta V , Fefer P 
Published: October 2022

Abstract

Background
The incidence and prevalence of senile, non-rheumatic mitral valve disease are increasing and there is a renewed interest in new transcatheter structural cardiac interventions intended to treat that valvular disorder. While the severity of rheumatic mitral valve disease can be accurately assessed by echocardiography using various parameters, including mean transmitral pressure gradient, these methods have been questioned for quantifying senile mitral valve disorder and their prognostic significance is still unknown.

Aims
The current study aims to document the natural history of patients with elevated senile mean transmitral pressure gradient (MG) and assess its prognostic significance.

Methods
A vast institutional echocardiography database was retrospectively analyzed from 2009 to 2020 for all patients aged over 60 years with a detailed echocardiography report with valid measurement of transmitral gradients. Patients with rheumatic valvular disease or who underwent surgical or transcatheter valvular replacement/repair were excluded. All-cause mortality was set to be the primary outcome, and survival models utilizing univariable and adjusted multivariable analysis for various clinical and echocardiographic variables were applied.

Results
A total of 5524 patients consisted of the final cohort. They were stratified by the MG into three groups: MG &lt;3 (2914 patients, 53%), 3≤MG&lt;6 (2079 patients, 37.6%) and MG ≥6 mmHg (531 patients,9.6%). The mean age of the total cohort was 77.2±7.9 years; 60.5% were female, 33.3% with diabetes mellitus, 15.1% with chronic kidney disease, and 14.1% with ischemic heart disease. An Adjusted Cox proportional hazard regression model demonstrated that MG is independently associated with all-cause mortality (adjusted HR 1.04 per 1 mmHg increase, 95% CI 1.02–1.05, p&lt;0.001). Moreover, an elevated MG was associated with a rise in all-cause mortality (HR of 1.15 and 1.4 for patients with 3≤MG&lt;6 and MG ≥6 mmHg, respectively (Fig. 1).

Conclusion
The elevated mean transmitral gradient in senile non-rheumatic valves is an independent predictor for all-cause mortality. Interventions and prospective trials intended to mitigate that risk should be needed.

Funding Acknowledgement
Type of funding sources: None.
Cardiac myxoma embolic events: characterization and predictors
Authors: Lacerda Teixeira B , Grazina A , Castelo A , Ferreira V , Bras P , Branco Mano T , Gil R , Moura Branco L , Galrinho A , Timoteo A T , Rio P , Pinto E , Coelho P , Fragata J , Cruz Ferreira R 
Published: October 2022

Abstract

Introduction
Myxomas are the most common heart tumors. Although, myxomas are often diagnosed incidentally in asymptomatic patients, they are frequently associated with embolic events, becoming an important cause of morbidity and mortality. Whether some myxomas' characteristics predict more embolic risk is not well established.

Objectives
This analysis aims to describe the clinical and echocardiographic data in a long cohort of patients with cardiac myxomas and to establish potential predictors of embolic events int these patients.

Methods
Between 1990 and 2021, 88 patients were diagnosed with cardiac myxoma. 84 were included in this analysis. Baseline characteristics, echocardiographic findings and embolic events were noted retrospectively. A binary logistic regression analysis using SPSS statistics software, version 25.0 was performed to establish possible embolic predictors.

Results
84 patients (mean age 63.1±12.9 years old, 75% female) with cardiac myxoma (sporadic type in 100%) were analyzed (table 1). The majority were located in the left atrium (88.1%, n=74), followed by right atrium (10.7%, n=9) and right ventricle (1.2%, n=1). The average dimension (longer axis) was 36.8±17.4mm. 9.6% of the patients (n=8) had Atrial Fibrillation (AF) rhythm. 22.6% of the patients (n=19) experienced embolic events, the majority to the central nervous system (19.0%, n=6), followed by peripheric/limbs (2.4%, n=2), renal (1.2%, n=1) and coronary (1.2%, n=1). The presence of irregular borders (papillary, bosselated) was the only parameter independently associated with increased risk of embolic events, by 6 times (OR 6.78, 95% confidence interval of 2.14–21.51, p-value 0.001). Neither the presence of AF, myxoma dimensions, presence of calcifications, pediculated insertion, myxoma mobility or heterogeneous aspect predicted embolic events with statistical significance (table 2).

Conclusions
Cardiac myxomas are frequently associated with embolic events (22.6% in our population), posing an important cause of morbidity and mortality in these patients. Besides the presence of irregular borders, the other myxoma's characteristics did not consistently predict the occurrence of embolic events. This data supports the well-recognized fact that all cardiac myxomas have the potential to embolic events, and therefore, should be excised, although those with very irregular borders are at much higher risk of embolization.

Funding Acknowledgement
Type of funding sources: None.
Prognostic value of liver stiffness in patients with tricuspid regurgitation
Authors: Gwak S , Seo J W , Cho I S , Hong G R , Shim C Y 
Published: October 2022

Abstract

Background
It has been known that liver stiffness (LS) assessed by transient elastography is associated with right heart dysfunction and the severity of the tricuspid regurgitation. However, the predictive value of LS for adverse outcome in patients with tricuspid regurgitation (TR) is uncertain.

Objectives
The aim of this study was to identify the prognostic value of LS in patients with moderate or greater degree of TR.

Methods
A total of 257 patients with moderate or severe TR who underwent both echocardiography and liver transient elastography were retrospectively analysed. Patients who have congenital heart disease or chronic liver disease including, viral hepatitis, alcoholic liver disease, autoimmune hepatitis, hepatocellular carcinoma were excluded. Severe LS was defined as elevated kilopascal (kPa) ≥11 (High kPa). Primary outcome was defined as the composite of all-cause death and unplanned admission for heart failure.

Results
One hundred forty-one patients had moderate TR and 116 patients had severe TR. One hundred twenty-eight (50%) patients had severe liver stiffness. During a follow-up period (median 637 days, IQR 1317), 116 (45.1%) primary outcomes occurred. In Kaplan-Meier analysis, patients who had severe TR with high kPa showed the worst outcome. Moreover, patients who had high kPa were associated with worse clinical outcome both moderate TR group and severe TR group than patients with low kPa. In multivariate Cox regression analysis, severe liver stiffness was independently associated with primary outcomes (HR=1.66, 95% CI: 1.28–2.16), p&lt;0.001).

Conclusions
LS is independently associated with adverse clinical outcomes in both patients with moderate and severe TR. The degree of liver fibrosis measured by transient elastography may be a useful marker of cardiac hepatopathy related to TR, and this may contribute to predict the prognosis of TR.

Funding Acknowledgement
Type of funding sources: None.
Can a simple echocardiographic Doppler VTI based flow comparison between the RVOT and LVOT assist in identifying patients with a significant atrial septal defect?
Authors: Khav N , Cheng K , Ramkumar S , Nerlekar N , Mottram P , Nicholls S , Moir S 
Published: October 2022

Abstract

Background
Detection of haemodynamically significant shunting from atrial septal defect (ASD) can be identified by using the pulmonary-systemic flow ratio (Qp/Qs). However, calculation of Qp/Qs by echocardiography relies on geometric assumptions that outflow tracts are circular, suffers from squared linear measures, and accurate measurement of right ventricular outflow tract (RVOT) diameter is challenging. Whilst adults with ASD should have overt right ventricular dilatation, RV sizing on echocardiography is often subjective and underappreciated. We evaluated whether a dimensionless index of flow (VTI) differences between the RVOT and left ventricular outflow tract (LVOT) could assist in identifying patients with ASD, and compared it with relative atrial index (RAI), a parameter previously assessed in identifying atrial shunting.

Methods
Data from 64 consecutive patients who underwent ASD closure and had no concomitant lesions, were compared with 63 normal controls. RVOT VTI, LVOT VTI, LVOT diameter, and atrial areas were measured.

Results
Between controls and ASD patients, there was no difference in LVOT VTI or forward stroke volume, but ASD patients had significantly higher RVOT VTI. The RVOT-LVOT VTI ratio was 1:1 in controls and 1.5:1 in ASD patients. Area under the ROC curve analysis of RVOT-LVOT VTI ratio was 0.83, and a ratio of 1.1:1 predicted patients with ASD with 86% sensitivity and 73% specificity. In comparison, the area under the ROC curve analysis of RAI was 0.70, and an RAI of 1.05:1 predicted patients with ASD with 77% sensitivity and 44% specificity.

Conclusion
Calculation of the dimensionless RVOT-LVOT VTI ratio is simple, and may be a useful additional semi-quantitative tool to assist cardiologists and sonographers in detecting atrial shunting, particularly in patients with borderline or overt right heart dilatation, and identify who patients should undergo further evaluation.

Funding Acknowledgement
Type of funding sources: None.
the diagnostic value of left-anterior-descending artery velocity assessed by transthoracic Doppler echocardiography for microvascular dysfunction in stenotic left-anterior-descending artery
Authors: Hada M , Hoshino M , Sugiyama T , Misawa T , Nagamine T , Ueno H , Matsuda K , Sayama K , Yonetsu T , Sasano T , Kakuta T 
Published: October 2022

Abstract

Background
Index of microcirculatory resistance (IMR) has been used as a clinical measure of microvascular function. Transthoracic Doppler echocardiography (TDE) can provide information on the functional status of coronary artery circulation. This study aims to assess the diagnostic value of left-anterior-descending artery (LAD) flow velocity by TDE for microvascular dysfunction.

Methods
Consecutive patients who were scheduled for elective percutaneous coronary intervention (PCI) for LAD lesions were prospectively enrolled in the single tertiary-care center between April 2020 and July 2021. Pre-PCI LAD diastolic peak velocity (DPV) by TDE at rest and hyperemia were measured. By invasive coronary angiography, quantitative coronary angiography and invasive wire-based physiological indices including fractional flow reserve (FFR) and index of microcirculatory resistance (IMR) were measured.

Results
A total of 104 patients were studied. Median FFR and IMR values were 0.70 (0.60–0.74) and 20.68 (14.92–31.69), respectively. No significant relationship was observed between FFR and IMR. The prevalence of microvascular dysfunction defined as IMR≥25 was 39.4%. Basal DPV was 25 (20–33) cm/sec, and hyperemic DPV was 51 (41–67) cm/sec. In lesions with IMR≥25, reference diameter (RD) was significantly greater [2.63 (2.22–3.19) mm vs 2.39 (2.09–2.66) mm, p=0.019], basal DPV was lower [26 (18–29) cm/sec vs 29 (22–37) cm/sec, p=0.022)] and hyperemic DPV was lower [49 (19–54) cm/sec vs 56 (42–70) cm/sec, p=0.023] compared to lesions with IMR&lt;25. ROC analysis showed basal DPV and RD are significant predictors of IMR≥25 [basal DPV: AUC 0.633 (0.525–0.742), best cutoff 29cm/sec RD: AUC 0.636 (0.523–0.750), best cutoff 2.84mm]. Multivariable logistic regression analysis showed basal DPV&lt;29cm/sec and RD&gt;2.84mm are independent predictors for IMR≥25 [Odds ratio: 3.08 (1.22–7.78), p=0.017; odds ratio 4.40 (1.55–12.50), p=0.005].

Conclusion
Basal DPV by non-invasive pre-PCI TDE and reference diameter can predict lesions with coexisting microvascular dysfunction in LAD territory with functionally significant lesions without the need of vasodilator-induced hyperemia and a wire-based invasive physiological measurement.

Funding Acknowledgement
Type of funding sources: None.