Topic: Congenital

Abstract
<div><h4>Substance Use Disorders Are Prevalent in Adults With Congenital Heart Disease and Are Associated With Increased Healthcare Use.</h4><i>Shalen EF, McGrath LB, Bhamidipati CM, Garcia IC, ... Broberg CS, Khan AM</i><br /><AbstractText>Adults with congenital heart disease (CHD) represent a heterogeneous group with significant long-term health risks. Previous studies have demonstrated a high prevalence of psychiatric disorders among adults with CHD; however, little is known about the frequency of co-morbid substance use disorders (SUDs) in patients with CHD. The Oregon All Payer All Claims (APAC) database for the years 2014 to 2017 was queried for adults aged 18 to 65 years with International Classification of Diseases, Ninth or Tenth Revision codes consistent with CHD. Alcohol and substance use were identified by International Classification of Diseases codes for use or dependence and classified in mutually exclusive categories of none, alcohol only, and other drugs (with or without alcohol). Descriptive statistics were used to characterize prevalence and chi-square tests were used to test for associations between variables. A total of 12,366 adults with CHD were identified. The prevalence of substance use was 15.7%. The prevalence of isolated alcohol use was 3.9%. A total of 19% of patients used tobacco. Insurance type, presence of a concurrent mental health diagnosis, and age were associated with substance use, whereas CHD complexity was not. Cardiovascular co-morbidities were more common in patients with reported substance use. Inpatient and emergency care use were higher in those with SUD. In conclusion, this study of substance and alcohol use among adults with CHD demonstrates high rates of co-morbid SUD, particularly among patients with mental health disorders and Medicaid insurance, associated with increased healthcare utilization. We identify a population in need of targeted interventions to improve long-term health.</AbstractText><br /><br />Copyright © 2023 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 27 Jan 2023; 192:24-30</small></div>
Shalen EF, McGrath LB, Bhamidipati CM, Garcia IC, ... Broberg CS, Khan AM
Am J Cardiol: 27 Jan 2023; 192:24-30 | PMID: 36709526
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Novel Utilization of Ultrasound Enhancing Agents in Complex Congenital Heart Disease Following Superior Cavopulmonary Connection.</h4><i>Chaszczewski KJ, Linder JR, Campbell MJ, Convery M, ... Kozyak BW, Quartermain MD</i><br /><b>Background</b><br />Children with single ventricle congenital heart disease (CHD) typically undergo a superior cavopulmonary connection (SCPC) as the second stage in their surgical palliation. Postoperatively, stenoses of the SCPC and branch pulmonary arteries (PAs) can occur. If there are clinical concerns and echocardiography is insufficient for diagnosis, patients undergo invasive evaluation with exposure to radiation and anesthesia. The use of ultrasound enhancing agents (UEAs) to improve echocardiographic diagnostic capabilities has not previously been described in this population.<br /><b>Methods</b><br />A single center, retrospective case review of children who underwent an echocardiogram with UEA, following SCPC from 3/1/2020 - 4/15/2022 at the Children\'s Hospital of Philadelphia. Twenty-two patients with hypoxemia or concern for obstruction following SCPC underwent UEA echocardiography. Extracted clinical data included patient demographics, echocardiographic images, angiography, surgical and transcatheter intervention as well as available follow-up data.<br /><b>Results</b><br />Six of the 22 UEA echocardiograms demonstrated stenosis or occlusion of either the SCPC or a PA. All six underwent cardiac catheterization - angioplasty was performed in 5 of these 6 patients, while one patient underwent surgical revision. Sixteen of 22 UEA echocardiograms demonstrated no evidence of stenosis. Ten of these 16 improved, while 6 experienced persistent hypoxemia prompting referral for cardiac catheterization. Angiography confirmed the UEA echocardiogram findings (absence of stenosis) in 4 of these 6 patients. There were no adverse reactions related to UEA administration.<br /><b>Conclusions</b><br />Echocardiography with UEAs is a valuable and safe adjunctive imaging modality following SCPC, particularly when 2D and color imaging is limited. This novel application of UEAs in complex CHD patients provides an \"angiogram-like\" image, better delineating vessel walls and improving assessment of postoperative obstruction. As experience with UEAs increases in the CHD population, there may be opportunities to decrease invasive and costly procedures, while expediting the care of patients in need of intervention.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 12 Jan 2023; epub ahead of print</small></div>
Chaszczewski KJ, Linder JR, Campbell MJ, Convery M, ... Kozyak BW, Quartermain MD
J Am Soc Echocardiogr: 12 Jan 2023; epub ahead of print | PMID: 36642236
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Biventricular Noncompaction Cardiomyopathy in a Patient Presenting With a New Cerebrovascular Event.</h4><i>Madnawat H, Atallah I, Ahmad A, Harjai K</i><br /><AbstractText>Noncompaction (NC) cardiomyopathy (NCCM) is a rare, genetically heterogeneous cardiomyopathy (CM) caused by failure to compact the intertrabecular recesses of the myocardium. This condition usually affects the apical segment of the left ventricle, yet there are noted basal segment, biventricular, and right ventricular predominant cases. NCCM is largely diagnosed in the pediatric population; however, there is increasing recognition in older patients with heart failure and stroke and patients with arrhythmias. Treatment focuses on symptomatic management of heart failure, anticoagulation, and implantable cardiac defibrillators.</AbstractText><br /><br />Copyright © 2022 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 06 Jan 2023; 190:110-112</small></div>
Madnawat H, Atallah I, Ahmad A, Harjai K
Am J Cardiol: 06 Jan 2023; 190:110-112 | PMID: 36621285
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Complications Associated with Transesophageal Echocardiography in Transcatheter Structural Cardiac Interventions.</h4><i>Hasnie A, Parcha V, Hawi R, Trump M, ... Arora P, Arora G</i><br /><b>Background</b><br />Transesophageal echocardiograms (TEEs) performed during transcatheter structural cardiac interventions may have higher complications than those performed in the non-operative setting or even those performed during cardiac surgery. However, there are limited data on complications associated with TEE during these procedures. We evaluated the prevalence of major complications among these patients in the United States (US).<br /><b>Methods</b><br />A retrospective cohort study was conducted using an electronic health record database (TriNetX Research Network) from large academic medical centers across the US for patients undergoing TEE during transcatheter structural interventions from January 2012 to January 2022. Using the American Society of Echocardiography endorsed ICD-10 codes, patients undergoing TEE during a transcatheter structural cardiac intervention, including transaortic, mitral or tricuspid valve repair, left atrial appendage occlusion, atrial septal defect closure, patent foramen ovale closure, and paravalvular leak repair were identified. The primary outcome was major complications within 72 hours of the procedure (composite of bleeding, esophageal and upper respiratory tract injury). The secondary aim was the frequency of major complications, death, or cardiac arrest within 72 hours of patients who completed intraoperative TEE during surgical valve replacement.<br /><b>Results</b><br />Among 12,043 adult patients (mean age: 74 years old, 42% females) undergoing TEE for transcatheter structural cardiac interventions, 429 (3.6%) patients had a major complication. Complication frequency was higher in patients on anticoagulation or antiplatelet therapy compared with those not on therapy (3.9% vs. 0.5%, RR: 8.09, p < 0.001). Compared with those aged <65 years, patients aged ≥ 65 years had a higher frequency of major complications (3.9% vs. 2.2%, RR: 1.75, p < 0.001). Complication frequency was similar among males and females (3.5% vs 3.7%, RR: 0.96, p = 0.67). Among 28,848 patients who completed surgical valve replacement with TEE guidance, 728 (2.5%) suffered a major complication.<br /><b>Conclusions</b><br />This study found that more than 3% of patients undergoing TEE during transcatheter structural cardiac interventions have a major complication which is more common among those on anticoagulant or antiplatelet therapy or who were elderly. With a shift of poor surgical candidates to less invasive percutaneous procedures, the future of TEE-guided procedures relies on comprehensive risk discussion and updating practices beyond conventional methods to minimize risk for TEE-related complications.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 04 Jan 2023; epub ahead of print</small></div>
Hasnie A, Parcha V, Hawi R, Trump M, ... Arora P, Arora G
J Am Soc Echocardiogr: 04 Jan 2023; epub ahead of print | PMID: 36610496
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Adults With Congenital Heart Disease: Trends in Event-Free Survival Past Middle Age.</h4><i>Dellborg M, Giang KW, Eriksson P, Liden H, ... Rosengren A, Mandalenakis Z</i><br /><b>Background</b><br />The survival of children with congenital heart disease has increased substantially over the past decades, with 97% currently reaching adulthood. The total effect of advanced treatment on future mortality and morbidity in adult survivors with congenital heart disease (CHD) is less well described.<br /><b>Methods</b><br />We used data from the Swedish National Inpatient, Outpatient, and Cause of Death Register to identify patients with CHD who were born between 1950 and 1999 and were alive at 18 years of age. Ten controls identified from the Total Population Register were matched for year of birth and sex and with each patient with CHD. Follow-up was from 1968 and 18 years of age until death or at the end of the study (2017). Survival percentage with 95% CI for all-cause mortality were performed with Kaplan-Meier survival function. Cox proportional hazard regression models with hazard ratios (HRs) and 95% CI were used to estimate the risk of all-cause mortality.<br /><b>Results</b><br />We included 37 278 patients with adult CHD (ACHD) and 412 799 controls. Mean follow-up was 19.2 years (±13.6). Altogether, 1937 patients with ACHD (5.2%) and 6690 controls (1.6%) died, a death rate of 2.73 per 1000 person-years and 0.84 per 1000 person years, respectively. Mortality was 3.2 times higher (95% CI, 3.0-3.4; <i>P</i><0.001) among patients with ACHD compared with matched controls. Up to the maximum of 50 years of follow-up, >75% of patients with ACHD were still alive. Mortality was highest among patients with conotruncal defects (HR, 10.13 [95% CI, 8.78-11.69]), but also significantly higher for the more benign lesions, with the lowest risk in patients with atrial septal defects (HR, 1.36 [95% CI, 1.19-1.55]). At least 75% of patients with ACHD alive at 18 years of age lived past middle age and became sexagenerians.<br /><b>Conclusions</b><br />In this large, nationwide, register-based cohort study of patients with ACHD surviving to 18 years of age, the risk of mortality up to 68 years of age was >3 times higher compared with matched controls without ACHD. Despite this, at least 75% of patients with CHD alive at 18 years of age lived past middle age and became sexagenerians. A notable risk decline in the mortality for patients with ACHD was noted for those born after 1975.<br /><br /><br /><br /><small>Circulation: 26 Dec 2022; epub ahead of print</small></div>
Dellborg M, Giang KW, Eriksson P, Liden H, ... Rosengren A, Mandalenakis Z
Circulation: 26 Dec 2022; epub ahead of print | PMID: 36571845
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Temporary ventricular assist device support with a catheter-based axial pump: Changing the paradigm at a pediatric heart center.</h4><i>Tume SC, Fuentes-Baldemar AA, Anders M, Spinner JA, ... Qureshi AM, Adachi I</i><br /><b>Objective</b><br />We report the largest pediatric single-center experience with an Impella (Abiomed Inc) catheter-based axial pump support.<br /><b>Methods</b><br />We conducted a retrospective cohort study of all patients with acute decompensated heart failure or cardiogenic shock requiring catheter-based axial pump support between October 2014 and February 2022. The primary outcome per individual encounter (hospital admission) was defined as bridge-to-recovery, bridge-to-durable ventricular assist device support, bridge-to-cardiac transplantation, or death at 6 months after catheter-based axial pump explantation. Adverse events were defined according to the Pediatric Interagency Registry for Mechanical Circulatory Support criteria.<br /><b>Results</b><br />Our final study cohort included 37 encounters with 43 catheter-based axial pump implantations. A single catheter-based axial pump device was used for support in 33 encounters (89%), with 2 catheter-based axial pump devices used in 3 (8%) separate encounters and 3 catheter-based axial pump devices used in 1 (3%) encounter. The median [range] age, weight, and body surface area at implantation were 16.8 [6.9-42.8] years, 61.1 [23.1-123.8] kg, and 1.7 [0.8-2.5] m<sup>2</sup>, respectively. The predominant causes of circulatory failure were graft failure/rejection in 16 patients (43%), followed by cardiomyopathy in 7 patients (19%), arrhythmia refractory to medical therapies in 6 patients (16%), myocarditis/endocarditis in 4 patients (11%), and heart failure due to congenital heart disease in 4 patients (11%). Competing outcomes analysis showed a positive outcome with bridge-to-recovery in 58%, bridge-to-durable VAD support in 14%, and bridge-to-cardiac transplantation in 14% at 6 months. Fourteen percent of encounters resulted in death at 6 months.<br /><b>Conclusions</b><br />We demonstrate that catheter-based axial pump support in children results in excellent 1- and 6-month survival with an acceptable adverse event profile.<br /><br />Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Thorac Cardiovasc Surg: 24 Dec 2022; epub ahead of print</small></div>
Tume SC, Fuentes-Baldemar AA, Anders M, Spinner JA, ... Qureshi AM, Adachi I
J Thorac Cardiovasc Surg: 24 Dec 2022; epub ahead of print | PMID: 36681561
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Characteristics of exercise intolerance in different subgroups of pulmonary arterial hypertension associated with congenital heart disease.</h4><i>Zhang HD, Yan Y, He YY, Liu QQ, ... Yan XX, Han ZY</i><br /><b>Background</b><br />Exercise intolerance is a major manifestation of pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD). We aimed to investigate the characteristics of exercise intolerance in different subgroups of PAH-CHD.<br /><b>Methods</b><br />We retrospectively enrolled 171 adult patients with PAH-CHD and 30 age and sex-matched healthy subjects and performed cardiopulmonary exercise testing. Gas exchange parameters, including peak oxygen uptake (peak V̇o<sub>2</sub>), anaerobic threshold, and the slope of ventilatory equivalent for carbon dioxide (V̇e/V̇co<sub>2</sub> slope), were recorded.<br /><b>Results</b><br />The median age of patients at enrollment was 27.8 years, and 131 (76.6%) were female. Peak V̇o<sub>2</sub> was reduced in patients compared to healthy controls (median, 14.8 ml/kg/min versus 26.9 ml/kg/min, p < 0.001). Of all 171 patients, 60 (35.1%) had Eisenmenger syndrome, 35 (20.5%) had PAH associated with systemic-to-pulmonary shunts (PAH-SP), 39 (22.8%) had PAH with small defects (PAH-SD), and 37 (21.6%) had PAH after cardiac defect correction (PAH-CD). Patients with Eisenmenger syndrome had the lowest peak V̇o<sub>2</sub> (p = 0.003) and the highest V̇e/V̇co<sub>2</sub> slope (p = 0.012), compared with other patients, representing the worst exercise capacity and ventilatory efficiency. Patients with PAH-SP had the best exercise capacity among the four groups, indicated by the highest peak V̇o<sub>2</sub> (p = 0.003) compared with other patients. Peak V̇o<sub>2</sub> was negatively correlated with pulmonary vascular resistance (r = -0.411, p < 0.001).<br /><b>Conclusions</b><br />Exercise capacity was severely reduced in patients with PAH-CHD. Among the four subgroups, patients with Eisenmenger syndrome had the worst exercise capacity and ventilatory efficiency.<br /><br />Copyright © 2022. Published by Elsevier B.V.<br /><br /><small>Int J Cardiol: 21 Dec 2022; epub ahead of print</small></div>
Zhang HD, Yan Y, He YY, Liu QQ, ... Yan XX, Han ZY
Int J Cardiol: 21 Dec 2022; epub ahead of print | PMID: 36565957
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Massively Hypertrophied Right-Sided Heart with Hypoplastic Left-Sided Heart in a Neonate (A Rare Type of Hypertrophic Cardiomyopathy).</h4><i>Roberts WC, Chinta S, Guileyardo JM</i><br /><AbstractText>Described herein is a newborn boy with likely right-sided hypertrophic cardiomyopathy (HC), who survived for 18 hours after birth. At necropsy, he had a severely thickened right ventricular free wall, ventricular septum, right atrial wall and a hypoplastic left-sided heart. There was a large fossa ovale type atrial septal defect and also a patent ductus arteriosus. During peak systole, the right ventricular outflow tract was obstructed, and its contents were pushed into the thick-walled right atrium, then rapidly into the thin-walled left atrium via a large fossa ovale atrial septal defect. The contents were then pushed into the thin-walled left ventricle and finally into the small ascending aorta and into the lungs via a large patent ductus arteriosus. We were unable to find a similar published case.</AbstractText><br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>Am J Cardiol: 15 Dec 2022; epub ahead of print</small></div>
Roberts WC, Chinta S, Guileyardo JM
Am J Cardiol: 15 Dec 2022; epub ahead of print | PMID: 36528398
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Conduction mapping during complex congenital heart surgery: Creating a predictive model of conduction anatomy.</h4><i>Feins EN, O\'Leary ET, Davee J, Gauvreau K, ... Emani S, DeWitt ES</i><br /><b>Objectives</b><br />The study objectives were to report on a growing experience of conduction system mapping during complex congenital heart surgery and create a predictive model of conduction anatomy.<br /><b>Methods</b><br />Patients undergoing complex cardiac repair with conduction mapping were studied. Intraoperative mapping used a multielectrode catheter to collect His bundle electrograms in the open, decompressed, beating heart. Patient anatomy, operative details, His bundle location, and postoperative conduction status were analyzed. By using classification and regression tree analysis, a predictive model of conduction location was created.<br /><b>Results</b><br />A total of 109 patients underwent mapping. Median age and weight were 1.8 years (range, 0.2-14.9) and 10.8 kg (range, 3.5-50.4), respectively. Conduction was identified in 96% (105/109). Median mapping time was 6 minutes (range, 2-33). Anatomy included atrioventricular canal defect, double outlet right ventricle, complex transposition of the great arteries, and multiple ventricular septal defects. By classification and regression tree analysis, ventricular looping and visceroatrial situs were the greatest discriminators of conduction location. A total of 94 of 105 patients (89.5%) were free of complete heart block. Only 1 patient (2.9%) with heterotaxy syndrome developed complete heart block.<br /><b>Conclusions</b><br />The precise anatomic location of the conduction system in patients with complex congenital heart defects can be difficult for the surgeon to accurately predict. Intraoperative conduction mapping enables localization of the His bundle and adds to our understanding of the anatomic factors associated with conduction location. Predictive modeling of conduction anatomy may build on what is already known about the conduction system and help surgeons to better anticipate conduction location preoperatively and intraoperatively.<br /><br />Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Thorac Cardiovasc Surg: 13 Dec 2022; epub ahead of print</small></div>
Feins EN, O'Leary ET, Davee J, Gauvreau K, ... Emani S, DeWitt ES
J Thorac Cardiovasc Surg: 13 Dec 2022; epub ahead of print | PMID: 36710103
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Cardiopulmonary Exercise Testing in Athletes With Hypertrophic Cardiomyopathy.</h4><i>Newman DB, Garmany R, Contreras AM, Bos JM, ... Ommen SR, Ackerman MJ</i><br /><AbstractText>Patients with hypertrophic cardiomyopathy (HCM) have historically been restricted from athletic participation because of the perceived risk of sudden cardiac death. More contemporary research has highlighted the relative safety of competitive athletics with HCM. However, lack of published data on reference values for cardiopulmonary exercise testing (CPET) complicates clinical management and counseling on sports participation in the individual athlete. We conducted a single-center, retrospective cohort study to investigate CPET in athletes with HCM and clinical characteristics associated with objective measures of aerobic capacity. We identified 58 athletes with HCM (74% male, mean age 18 ± 3 years, mean left ventricular (LV) wall thickness 20 ± 7 mm). LV outflow tract obstruction was present in 22 (38%). A total of 15 (26%) athletes were taking a β blocker (BB), but only 4 (7%) reported exertional symptoms. Overall, exercise capacity was mildly reduced, with a peak myocardial oxygen consumption (peak VO<sub>2</sub>) of 37.9 ml/min/kg (83% of predicted peak VO<sub>2</sub>). Both LV outflow tract obstruction and BB use were associated with reduced exercise capacity. Limited peak heart rate was more common in athletes taking BB (47% vs 9%, p = 0.002). At a mean 5.6 years follow-up, 5 patients underwent myectomy (9%), and 8 (14%) received an implantable cardioverter defibrillator (ICD) for primary prevention. One individual with massive LV hypertrophy experienced recurrent ICD shocks for ventricular fibrillation and underwent myectomy 7 years after initial evaluation and was no longer participating in sports. There were no deaths over the follow-up period. In conclusion, the prognostic role of CPET remains unclear in athletes with HCM. Mildly reduced exercise capacity was common; however, reduced peak VO<sub>2</sub> did not correlate with symptom status or clinical outcomes. A significant proportion went on to require myectomy and/or ICD, thus highlighting the need for close follow-up. These data provide some initial insight into the clinical evaluation of \"real world\" athletes with HCM; however, further study is warranted to help guide shared decision-making, return-to-play discussions, and the potential long-term safety of competitive athletic participation.</AbstractText><br /><br />Copyright © 2022 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 09 Dec 2022; 189:49-55</small></div>
Newman DB, Garmany R, Contreras AM, Bos JM, ... Ommen SR, Ackerman MJ
Am J Cardiol: 09 Dec 2022; 189:49-55 | PMID: 36508762
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Prognostic Value of Left Ventricular Global Longitudinal Strain in Patients With Congenital Heart Disease.</h4><i>Egbe AC, Miranda WR, Anderson JH, Pellikka PA, Connolly HM</i><br /><b>Background</b><br />Left ventricular global longitudinal strain (LVGLS) has been shown to improve risk stratification in patients with LV systolic dysfunction and subsequent recovery of LV ejection fraction (LVEF) in the acquired heart disease population. The purpose of this study was to assess the relationship between LVGLS and cardiovascular events (heart failure hospitalization, sustained ventricular tachycardia/appropriate shock, heart transplant, or cardiovascular death) and deterioration in LVEF (absolute decrease in LVEF ≥10% to LVEF <50%) in adults with congenital heart disease.<br /><b>Methods</b><br />Retrospective cohort study of congenital heart disease patients with previous diagnosis of LV systolic dysfunction (LVEF <50%) and subsequent recovery of LVEF (absolute increase in LVEF of ≥10% to LVEF ≥50%) on subsequent echocardiogram (index echocardiogram). Based on the index echocardiogram, patients were divided into normal LVGLS (absolute LVGLS >18%) versus abnormal LVGLS (absolute LVGLS ≤18%) groups.<br /><b>Results</b><br />Of 193 patients with recovered LVEF, 86 (45%) had normalization of LVGLS at index echocardiogram. A higher absolute LVGLS and use of renin angiotensin aldosterone system antagonist was associated with a lower risk of cardiovascular events and subsequent deterioration in LVEF, while hypertension was associated with higher risk of cardiovascular events and deterioration in LVEF.<br /><b>Conclusions</b><br />These results suggest that patients with congenital heart disease with recovered LVEF remained at risk for adverse outcomes, and LVGLS can be used to identify patients at risk for adverse outcomes. Medical therapy for heart failure and treatment of hypertension may reduce the risk of adverse outcome, but these findings require empirical validation, hence the need for a clinical trial.<br /><br /><br /><br /><small>Circ Cardiovasc Imaging: 07 Dec 2022:e014865; epub ahead of print</small></div>
Egbe AC, Miranda WR, Anderson JH, Pellikka PA, Connolly HM
Circ Cardiovasc Imaging: 07 Dec 2022:e014865; epub ahead of print | PMID: 36475454
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Long-term survival and center volume for functionally single-ventricle congenital heart disease in England and Wales.</h4><i>Brown KL, Huang Q, Hadjicosta E, Seale AN, ... Franklin R, Ridout D</i><br /><b>Objectives</b><br />Long-term survival is an important metric for health care evaluation, especially in functionally single-ventricle (f-SV) congenital heart disease (CHD). This study\'s aim was to evaluate the relationship between center volume and long-term survival in f-SV CHD within the centralized health care service of England and Wales.<br /><b>Methods</b><br />This was a retrospective cohort study of children born with f-SV CHD between 2000 and 2018, using the national CHD procedure registry, with survival ascertained in 2020.<br /><b>Results</b><br />Of 56,039 patients, 3293 (5.9%) had f-SV CHD. Median age at first intervention was 7 days (interquartile range [IQR], 4, 27), and median follow-up time was 7.6 years (IQR, 1.0, 13.3). The largest diagnostic subcategories were hypoplastic left heart syndrome, 1276 (38.8%); tricuspid atresia, 440 (13.4%); and double-inlet left ventricle, 322 (9.8%). The survival rate at 1 year and 5 years was 76.8% (95% confidence interval [CI], 75.3%-78.2%) and 72.1% (95% CI, 70.6%-73.7%), respectively. The unadjusted hazard ratio for each 5 additional patients with f-SV starting treatment per center per year was 1.04 (95% CI, 1.02-1.06), P < .001. However, after adjustment for significant risk factors (diagnostic subcategory; antenatal diagnosis; younger age, low weight, acquired comorbidity, increased severity of illness at first procedure), the hazard ratio for f-SV center volume was 1.01 (95% CI, 0.99-1.04) P = .28. There was strong evidence that patients with more complex f-SV (hypoplastic left heart syndrome, Norwood pathway) were treated at centers with greater f-SV case volume (P < .001).<br /><b>Conclusions</b><br />After adjustment for case mix, there was no evidence that f-SV center volume was linked to longer-term survival in the centralized health service provided by the 10 children\'s cardiac centers in England and Wales.<br /><br />Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Thorac Cardiovasc Surg: 25 Nov 2022; epub ahead of print</small></div>
Brown KL, Huang Q, Hadjicosta E, Seale AN, ... Franklin R, Ridout D
J Thorac Cardiovasc Surg: 25 Nov 2022; epub ahead of print | PMID: 36535820
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Emergency arterial switch: Rescue therapy for life-threatening hypoxemia in infants with transposition of great arteries with intact intraventricular septum.</h4><i>Hussey AD, Gentles TL, Perelini F, Beca J, Finucane K</i><br /><b>Objective</b><br />A small percentage of infants with d-loop transposition of the great arteries with intact intraventricular septum have life-threatening refractory hypoxemia often due to coexistent persistent pulmonary hypertension of the newborn. In this case series we describe the outcomes of a \"rescue\" emergency arterial switch operation (ASO).<br /><b>Methods</b><br />We undertook a retrospective medical record analysis of infants with d-loop transposition of the great arteries with intact intraventricular septum who underwent an ASO in New Zealand from January 1, 1996, to April 30, 2017. Data were compared for those who received an emergency ASO and those with a nonemergency ASO for descriptive purposes. An emergency ASO was defined as one that was undertaken for life-threatening refractory hypoxemia when the only alternative stabilization strategy was preoperative extracorporeal life support. Primary outcome measures were 30-day postoperative mortality and abnormal neurodevelopmental outcome in the survivors. Secondary outcomes were low cardiac output, arrhythmia, renal dysfunction, postoperative seizures, and length of stay. Other known risk factors for morbidity and mortality were also assessed.<br /><b>Results</b><br />Two hundred seventy-two infants underwent an ASO with 25 (9%) who received an emergency ASO. No infants received preoperative extracorporeal life support. The emergency group had greater 30-day postoperative mortality (8.0% vs 0.4%; P = .01) with no difference in abnormal neurodevelopmental outcome among the survivors (17.4% vs 13.8%; P = .35). The emergency group had more therapies for low cardiac output syndrome, more postoperative seizures, and a longer length of stay.<br /><b>Conclusions</b><br />An emergency ASO is a definitive rescue therapy that can be undertaken with acceptable mortality and neurodevelopmental outcome with consideration of the preoperative clinical state.<br /><br />Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Thorac Cardiovasc Surg: 22 Nov 2022; epub ahead of print</small></div>
Hussey AD, Gentles TL, Perelini F, Beca J, Finucane K
J Thorac Cardiovasc Surg: 22 Nov 2022; epub ahead of print | PMID: 36528432
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Left atrial structural and functional response in kidney transplant recipients treated with mesenchymal stromal cell therapy and early tacrolimus withdrawal.</h4><i>Meucci MC, Reinders MEJ, Groeneweg KE, Bezstarosti S, ... De Fijter JW, Delgado V</i><br /><b>Background</b><br />Autologous bone marrow derived mesenchymal stromal cell (MSC) therapy and withdrawal of calcineurin inhibitors (CNIs) in kidney transplant patients has shown to improve systemic blood pressure control and left ventricular hypertrophy regression. In the current sub-analysis, we aimed to evaluate the impact of this novel immunosuppressive regimen on the longitudinal changes of LA structure and function after kidney transplantation.<br /><b>Methods</b><br />Kidney transplant recipients randomized to MSC therapy - infused at week 6 and 7 after transplantation, with complete discontinuation at week 8 of tacrolimus (MSC group) - or standard tacrolimus dose (control group) were evaluated with transthoracic echocardiography at week 4 and 24 after kidney transplantation. The changes in echocardiographic parameters were compared between the randomization arms using an analysis of covariance model, adjusted for baseline variable.<br /><b>Results</b><br />54 participants (MSC therapy =27; tacromilus therapy =27) were included. There was no significant interaction between the allocated treatment and the changes of indexed maximal LA volume (LAVImax) over the time. Conversely, between 4 and 24 weeks post-transplantation, an increase in indexed minimal LA volume (LAVImin) was observed in control subjects, while it remained unchanged in the MSC group, leading to a significant difference between groups (p=0.021). Additionally, patients treated with MSC therapy showed a benefit in LA function, assessed by a significant interaction between changes in LA emptying fraction (LAEF) and LA reservoir strain and the randomization arm (p=0.012 and p=0.027, respectively).<br /><b>Conclusion</b><br />The combination of MSC therapy and CNIs withdrawal prevents progressive LA dilation and dysfunction in the first 6 months after kidney transplantation. LAVmin and LA reservoir strain may be more sensitive markers of LA reverse remodelling, as compared to LAVmax.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 05 Nov 2022; epub ahead of print</small></div>
Meucci MC, Reinders MEJ, Groeneweg KE, Bezstarosti S, ... De Fijter JW, Delgado V
J Am Soc Echocardiogr: 05 Nov 2022; epub ahead of print | PMID: 36347387
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>A new FDA approved stent for congenital heart disease: First-in-man experiences with G-ARMOR.</h4><i>Morgan GJ, Zablah J</i><br /><AbstractText>We present the first clinical experience with a new hybrid cell structure covered stent, designed for congenital heart disease applications. It represents a significant redesign of the Cheatham Platinum (CP) Stent (Numed Inc.), maintaining the traditional benefits of the covered CP whilst significantly decreasing shortening and allowing controlled flaring at the ends through its combination of larger and standard sized cells. We first implanted the stent in 2 patients with superior sinus venosus defects with anomalous drainage of the right upper and middle lobe pulmonary veins. The first was a 40 year male and the second a 36 year old female. The third case was a 60 year old patient with near atresia of the aorta, with pre and poststenotic aortic dilation. The clinical result in all cases was excellent with no obstruction to pulmonary venous return and no visible L-R shunt on the transthoracic echo on 24 h and 2 week follow-up for the patient with sinus venosus defects and uniform complete revascularization of the aorta without any vascular complications in the patient with coarctation. These are the first uses of this stent in human subjects. The design is specifically aimed toward procedures where stent shortening is undesirable. Hence, coarctation of the aorta as well as stent implantation in preparation for percutaneous pulmonary valve placement are obvious use areas, as well as the growing body of evidence supporting percutaneous treatment of sinus venosus defects.</AbstractText><br /><br />© 2022 Wiley Periodicals LLC.<br /><br /><small>Catheter Cardiovasc Interv: 02 Nov 2022; epub ahead of print</small></div>
Morgan GJ, Zablah J
Catheter Cardiovasc Interv: 02 Nov 2022; epub ahead of print | PMID: 36321626
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Aortic valve repair using geometric ring annuloplasty in pediatric and congenital heart disease patients.</h4><i>Lancaster TS, Romano JC, Si MS, Ohye RG</i><br /><b>Objective</b><br />Existing replacement options for the aortic valve have significant drawbacks, especially in children. A geometric annuloplasty ring can help to achieve consistently successful aortic valve repair, but only limited experience with use of this device has been reported in pediatric and congenital heart disease patients.<br /><b>Methods</b><br />All pediatric and adult congenital patients at our institution who underwent aortic valve repair with placement of a geometric annuloplasty ring were reviewed. The study period spanned from July 2018 to April 2022. Hemodynamic outcomes were evaluated using transthoracic echocardiography.<br /><b>Results</b><br />The study included 36 subjects. The median age was 17.4 years (range, 8-30 years). Twenty-one subjects were younger than age 18 years. The most common primary diagnoses were neoaortic valve insufficiency or neoaortic root dilation, and congenital aortic stenosis with bicuspid or functionally unicuspid aortic valve. Of the 34 subjects with procedural success, 31 (91%) had use of additional valve repair techniques and 26 (76%) had an additional concomitant procedure performed. Operative mortality was 0% (0/33), and major complication rate was 6% (2/33). The median follow-up time was 1.9 years (maximum, 3.8 years). The mean grade of aortic insufficiency was signific antly reduced after repair, with no change in mean gradients. Freedom from reoperation over the follow-up period was 97% (33/34), and freedom from ≥3+ recurrent aortic insufficiency was 94% (32/34).<br /><b>Conclusions</b><br />A geometric annuloplasty ring can be used to help achieve consistently successful aortic valve repair with excellent perioperative and follow-up outcomes, even in pediatric and complex congenital heart disease patients.<br /><br />Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Thorac Cardiovasc Surg: 19 Oct 2022; epub ahead of print</small></div>
Lancaster TS, Romano JC, Si MS, Ohye RG
J Thorac Cardiovasc Surg: 19 Oct 2022; epub ahead of print | PMID: 36404145
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Spatio-temporal complexity of vena contracta and mitral regurgitation grading using 3D echocardiographic analysis.</h4><i>Lozano-Edo S, Jover-Pastor P, Osa-Saez A, Buendia-Fuentes F, ... Martinez-Dolz L, Aguero J</i><br /><b>Background</b><br />Spatio-temporal complexity of the color Doppler vena contracta challenging the assumption of a circular and constant orifice may lead to mitral regurgitation (MR) grading inconsistencies. Using 3D transesophageal echocardiography, we characterized spatio-temporal vena contracta complexity and its impact on MR severity grading.<br /><b>Methods</b><br />In 192 patients with suspected moderate or severe MR (100 primary MR, PMR; 92 secondary MR, SMR), we performed 3D vena contracta area (VCA) quantification using single-frame (mid-systolic or VCAmid, maximum or VCAmax) and multiframe (VCAmean) methods, as well as measures of orifice shape (shape index) and systolic variation of VCA. Vena contracta complexity and intermethod discrepancies were analyzed and correlated with functional class and pulmonary vein flow (PVF) patterns, and with cardiac magnetic resonance (CMR) in a subset of cases (n=20).<br /><b>Results</b><br />The vena contracta was non-circular (shape index>1.5) in 90% of patients. Severe non-circularity (shape index > 3) was more prevalent in SMR than in PMR (32.4 vs 14.6%). Variations of the VCA were more prominent in SMR than in PMR. VCAmid showed a low grading agreement with VCAmax (62%) and high with VCAmean (83.3%). PVF systolic reversal was associated with MR severity by VCA in SMR but not in PMR. VCAmid and VCAmean showed a stronger association with systolic flow reversal than VCAmax (AUC 0.88, 0.86 and 0.79, respectively). In the subset of patients with CMR quantification, severe MR by VCAmax was graded as non-severe by CMR more frequently as compared with VCAmid and VCAmean.<br /><b>Conclusions</b><br />Highly prevalent spatio-temporal vena contracta complexity features in MR challenge the assumption of a circular and constant orifice. VCAmid seems the best single-frame approximation to multiframe quantification, and VCAmax may lead to severity overestimation.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 05 Oct 2022; epub ahead of print</small></div>
Lozano-Edo S, Jover-Pastor P, Osa-Saez A, Buendia-Fuentes F, ... Martinez-Dolz L, Aguero J
J Am Soc Echocardiogr: 05 Oct 2022; epub ahead of print | PMID: 36208654
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>A multicenter evaluation of external outflow graft obstruction with a fully magnetically levitated left ventricular assist device.</h4><i>Wert L, Stewart GC, Mehra MR, Milwidsky A, ... Falk V, Potapov EV</i><br /><b>Background</b><br />The HeartMate 3 (HM 3; Abbott) left ventricular assist device (LVAD) has improved hemocompatibility-related adverse outcomes. In sporadic cases, external compression of the outflow graft causing obstruction (eOGO) can result from substance accumulation between the outflow graft and its bend relief. We sought to evaluate the prevalence, course, and clinical implications of eOGO in an international study.<br /><b>Methods</b><br />A multicenter retrospective analysis of HM 3 LVADs implanted between November 2014 and April 2021 (n = 2108) was conducted across 17 cardiac centers in 8 countries. We defined eOGO as obstruction >25% in the cross-sectional area in imaging (percutaneous angiography, computed tomography, or intravascular ultrasound). The prevalence and annual incidence were calculated. Serious adverse events and outcomes (death, transplantation, or device exchange) were analyzed for eOGO cases.<br /><b>Results</b><br />Of 2108 patients, 62 were diagnosed with eOGO at a median LVAD support duration of 953 (interquartile range, 600-1267) days. The prevalence of eOGO was 3.0% and the incidence at 1, 2, 3, 4, and 5 years of support was 0.6%, 2.8%, 4.0%, 5.2%, and 9.1%, respectively. Of 62 patients, 9 were observed, 27 underwent surgical revision, 15 underwent percutaneous stent implantation, 8 received a heart transplant, and 2 died before intervention. One patient underwent surgical revision and later stent implantation. The mortality with therapeutic intervention was 9/53 (17.0%).<br /><b>Conclusions</b><br />Although uncommon, HM 3 LVAD-supported patients might develop eOGO with an increasing incidence after 1 year of support. Although engineering efforts to reduce this complication are under way, clinicians must maintain a focus on early detection and remain vigilant.<br /><br />Copyright © 2022 The American Association for Thoracic Surgery. All rights reserved.<br /><br /><small>J Thorac Cardiovasc Surg: 03 Oct 2022; epub ahead of print</small></div>
Wert L, Stewart GC, Mehra MR, Milwidsky A, ... Falk V, Potapov EV
J Thorac Cardiovasc Surg: 03 Oct 2022; epub ahead of print | PMID: 36562497
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Mathematical analysis of hemoglobin target in univentricular parallel circulation.</h4><i>Ahmed M, Acosta SI, Hoffman GM, Tweddell JS, Ghanayem NS</i><br /><b>Objective</b><br />The hemoglobin threshold for a decision to transfuse red blood cells in univentricular patients with parallel circulation is unclear. A pediatric expertise initiative put forth a \"weak recommendation\" for avoiding reflexive transfusion beyond a hemoglobin of 9 g/dL. We have created a mathematical model to assess the impact of hemoglobin thresholds in patients with parallel circulation.<br /><b>Methods</b><br />A univentricular circulation was mathematically modeled. We examined the impact on oxygen extraction ratios and systemic and venous oxygen saturations by varying hemoglobin levels, pulmonary to systemic blood flow ratios, and total cardiac output.<br /><b>Results</b><br />Applying a total cardiac index of 6 L/m<sup>2</sup>/min, oxygen consumption of 150 mL/min/m<sup>2</sup>, and a Q<sub>p</sub>/Q<sub>s</sub> ∼ 1, we found a hemoglobin level of 9 g/dL would lead to severe arterial (arterial oxygen saturation <70%) and venous (systemic venous oxygen saturation <40%) hypoxemia. To operate above the critical oxygen economy boundary (systemic venous oxygen saturation ∼40%) and maintain arterial oxygen saturation >70% would require either increasing the cardiac index to ∼ 9 L/m<sup>2</sup>/min or increasing the hemoglobin to greater than 13 g/dL. Further, we found a greater improvement in arterial and venous saturation arises when hemoglobin is augmented from levels below 12 g/dL.<br /><b>Conclusions</b><br />Based on our model, a hemoglobin level of 9 g/dL would require a constricted set of features to sustain arterial saturations >70% and systemic venous saturations >40% and would risk unfavorable oxygen economy with elevations in oxygen consumption. Further prospective clinical studies are needed to delineate the impact of restrictive transfusion practices in univentricular circulation.<br /><br />Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Thorac Cardiovasc Surg: 30 Sep 2022; epub ahead of print</small></div>
Ahmed M, Acosta SI, Hoffman GM, Tweddell JS, Ghanayem NS
J Thorac Cardiovasc Surg: 30 Sep 2022; epub ahead of print | PMID: 36357224
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Aerobic fitness change with time in children with congenital heart disease: A retrospective controlled cohort study.</h4><i>Gavotto A, Ladeveze M, Avesani M, Huguet H, ... Matecki S, Amedro P</i><br /><b>Background</b><br />To evaluate the change in aerobic fitness (VO<sub>2max</sub>), measured by cardio-pulmonary exercise test (CPET), in children with congenital heart disease (CHD), compared to matched healthy controls, and identify predictors of VO<sub>2max</sub> change with time in this specific population.<br /><b>Method</b><br />This longitudinal retrospective multicentre cohort study was carried out from 2010 to 2020. We included CHD paediatric patients from the cohort of a previous cross-sectional study, who had a second CPET at least 1 year after the first one, during their follow-up.<br /><b>Results</b><br />We included 936 children, 296 in the CHD group and 640 controls. Mean time between baseline and final CPET was 4.4 ± 1.7 years. After matching on age and gender and adjustment for age and BMI, the mean VO2<sub>max</sub> group difference was 10.5% ± 1.0% of percent-predict VO<sub>2max</sub> at baseline and increased to 19.1% ± 1.3% at final assessment. In the CHD group, the proportion of children with impaired aerobic fitness was significantly higher at final than at baseline CPET assessment (51.4% vs 20.3%; P < 0.01). The mean annual VO<sub>2max</sub> decrease was significantly worse in the CHD group than in controls (-1.88% ± 0.19% of percent-predict VO<sub>2max</sub>/year vs. -0.44% ± 0.27% of percent-predict VO<sub>2max</sub>/year, P < 0.01, respectively). In multivariate analyse, male gender, a high initial VO<sub>2max</sub>, a high BMI, and the number of cardiac surgical procedures ≥2, were predictors of the VO<sub>2max</sub> decrease with time.<br /><b>Conclusion</b><br />The VO<sub>2max</sub> decrease with time is more pronounced in children with CHD compared to healthy matched controls. This study highlighted the importance of serial CPET assessment in children with CHD. Trial registrationNCT04815577.<br /><br />Copyright © 2022. Published by Elsevier B.V.<br /><br /><small>Int J Cardiol: 28 Sep 2022; epub ahead of print</small></div>
Gavotto A, Ladeveze M, Avesani M, Huguet H, ... Matecki S, Amedro P
Int J Cardiol: 28 Sep 2022; epub ahead of print | PMID: 36181952
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Metoprolol Improves Left Ventricular Longitudinal Strain at Rest and during Exercise in Obstructive Hypertrophic Cardiomyopathy.</h4><i>Dybro AM, Rasmussen TB, Nielsen RR, Pedersen ALD, ... Jensen MK, Poulsen SH</i><br /><b>Background</b><br />Patients with obstructive hypertrophic cardiomyopathy (HCM) often experience symptoms of heart failure upon exertion despite having normal left ventricular (LV) ejection fractions. Longitudinal strain (LS) may be a more sensitive marker of systolic dysfunction in patients with LV hypertrophy. The aims of this study were to characterize LV segmental LS and global LS (GLS) at rest and during exercise and to assess if first-line treatment with β-blockers improves LV systolic performance.<br /><b>Methods</b><br />Twenty-nine patients with obstructive HCM and New York Heart Association functional class ≥ II symptoms were enrolled in a double-blind, placebo-controlled, randomized crossover trial. Patients received metoprolol 150 mg or placebo for two consecutive 2-week periods in random order. Echocardiographic assessment with speckle-tracking-derived LS was performed at rest and during peak exercise at the end of each treatment period.<br /><b>Results</b><br />During placebo treatment, resting values of segmental LS showed an apical-basal difference of -10.3% (95% CI, -12.7% to -7.8%; P < .0001), with a severely abnormal value of the basal segment of -9.3 ± 4.2%. Treatment with metoprolol was associated with more negative LS values of the apical segment (-2.8%; 95% CI, -4.2% to -1.3%; P < .001) and the mid segment (-1.1%; 95% CI, -2.0% to -0.3%; P = .007). During peak exercise there was a deterioration in LV GLS, but treatment with metoprolol was associated with more negative peak exercise LV GLS (-1.3 %; 95% CI, -2.6% to -0.1%; P = .03).<br /><b>Conclusions</b><br />Systolic performance assessed by LV GLS showed impaired values at rest and during exercise, with severely depressed values of the basal and mid segments. Treatment with metoprolol improved LV GLS upon exercise, indicating a beneficial effect of β-blocker treatment on LV systolic function.<br /><br />Copyright © 2022 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Soc Echocardiogr: 19 Sep 2022; epub ahead of print</small></div>
Dybro AM, Rasmussen TB, Nielsen RR, Pedersen ALD, ... Jensen MK, Poulsen SH
J Am Soc Echocardiogr: 19 Sep 2022; epub ahead of print | PMID: 36444740
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Prognostic implications of weight gain and weight loss in adults with congenital heart disease.</h4><i>Egbe AC, Miranda WR, Anderson JH, Connolly HM</i><br /><b>Background</b><br />There are conflicting data about the association between obesity and clinical outcomes in adults with congenital heart disease (CHD), and the effects of weight gain or weight loss remain unclear. The purpose of this study was to determine whether a temporal change in body mass index (BMI) was associated with clinical outcomes independent of baseline BMI in adults with CHD.<br /><b>Methods</b><br />Retrospective cohort study of adults with CHD that had clinical assessments at baseline and 5 years afterwards. Weight gain and weight loss were defined as ≥5% change from baseline BMI. Atherosclerotic cardiovascular disease (ASCVD) risk profile (blood pressure [BP], low density lipoprotein cholesterol [LDL-C] and hemoglobin A1C [HBA1c]) and cardiovascular events (heart failure hospitalization, transplant, death) were ascertained.<br /><b>Results</b><br />Of the 3407, 1804 (53%) had stable weight, 1291 (38%) had weight gain, and 312 (9%) had weight loss at follow-up assessment. The median change in BMI (∆ BMI) was +3% (1-5). The baseline BMI and ∆ BMI were associated with worsening ASCVD risk profile (higher BP, LDL-C and HBA1C), and an increase in cardiovascular events in patients with obesity at baseline.<br /><b>Conclusions</b><br />Collectively, the results provide evidence to support lifestyle interventions aimed at weight maintenance in patients with normal weight, and to promote weight loss in patients that are overweight or obese. Further studies are required to determine the optimal type of lifestyle interventions that will be most effective in this population.<br /><br />Copyright © 2022. Published by Elsevier B.V.<br /><br /><small>Int J Cardiol: 18 Sep 2022; epub ahead of print</small></div>
Egbe AC, Miranda WR, Anderson JH, Connolly HM
Int J Cardiol: 18 Sep 2022; epub ahead of print | PMID: 36130618
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Role of Inferior Vena Cava Dynamics for Estimating Right Atrial Pressure in Congenital Heart Disease.</h4><i>Egbe AC, Connolly HM, Pellikka PA, Anderson JH, Miranda WR</i><br /><b>Background</b><br />Inferior vena cava (IVC) size and collapsibility (IVC dynamics) are used for estimating right atrial pressure (RAP). However, the diagnostic performance of the American Society of Echocardiography IVC criteria for estimating RAP in patients with congenital heart disease are unknown. The purpose of this study was to assess the role of IVC dynamics for estimating RAP in adults with congenital heart disease.<br /><b>Methods</b><br />We conducted a retrospective study of adults with congenital heart disease that underwent cardiac catheterization and echocardiogram at Mayo Clinic (2003-2019). IVC diameter was measured at inspiration (IVC<sub>min</sub>) and end-expiration (IVC<sub>max</sub>), and IVC collapsibility index (IVC<sub>CI</sub>) was calculated.<br /><b>Results</b><br />Based on 918 patients, we observed a good correlation between IVC<sub>max</sub> and invasive RAP (<i>r</i>=0.56, <i>P</i><0.001); IVC<sub>min</sub> and RAP (<i>r</i>=0.58, <i>P</i><0.001); and IVC<sub>CI</sub> (<i>r</i>=-0.72, <i>P</i><0.001). There was excellent correlation between invasive RAP and estimated RAP using IVC<sub>CI</sub> (<i>r</i>=0.80, <i>P</i><0.001). We observed that IVC<sub>CI</sub> <60% had superior diagnostic performance as compared with American Society of Echocardiography criteria (IVC<sub>max</sub> >2.1 cm, area under the curve difference 0.15, <i>P</i><0.001; IVC<sub>CI</sub> <50%, area under the curve difference 0.09, <i>P</i>=0.008; combination of IVC<sub>max</sub> >2.1 cm; and IVC<sub>CI</sub> <50%, area under the curve difference 0.06, <i>P</i>=0.02). Estimated RAP >10 mm Hg based on IVC<sub>CI</sub> had comparable prognostic performance as invasive RAP but superior prognostic performance as the American Society of Echocardiography criteria.<br /><b>Conclusions</b><br />IVC<sub>CI</sub> <60% was the best criterion to identify patients with elevated RAP. IVC<sub>CI</sub> was comparable to invasively measured RAP in its relation to prognosis. Further studies are required to determine whether the use of IVC<sub>CI</sub> in clinical decision-making will improve clinical outcomes in this population.<br /><br /><br /><br /><small>Circ Cardiovasc Imaging: 01 Sep 2022; 15:e014308</small></div>
Egbe AC, Connolly HM, Pellikka PA, Anderson JH, Miranda WR
Circ Cardiovasc Imaging: 01 Sep 2022; 15:e014308 | PMID: 36126125
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Ventricular Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy (Analysis Spanning 60 Years Of Practice): AJC Expert Panel.</h4><i>Maron BJ, Dearani JA, Smedira NG, Schaff HV, ... Rowin EJ, Maron MS</i><br /><AbstractText>Surgical myectomy remains the time-honored primary treatment for hypertrophic cardiomyopathy patients with drug refractory limiting symptoms due to LV outflow obstruction. Based on >50 years experience, surgery reliably reverses disabling heart failure by permanently abolishing mechanical outflow impedance and mitral regurgitation, with normalization of LV pressures and preserved systolic function. A consortium of 10 international currently active myectomy centers report about 11,000 operations, increasing significantly in number over the most recent 15 years. Performed in experienced multidisciplinary institutions, perioperative mortality for myectomy has declined to 0.6%, becoming one of the safest currently performed open-heart procedures. Extended myectomy relieves symptoms in >90% of patients by ≥ 1 NYHA functional class, returning most to normal daily activity, and also with a long-term survival benefit; concomitant Cox-Maze procedure can reduce the number of atrial fibrillation episodes. Surgery, preferably performed in high volume clinical environments, continues to flourish as a guideline-based and preferred high benefit: low treatment risk option for adults and children with drug refractory disabling symptoms from obstruction, despite prior challenges: higher operative mortality/skepticism in 1960s/1970s; dual-chamber pacing in 1990s, alcohol ablation in 2000s, and now introduction of strong negative inotropic drugs potentially useful for symptom management.</AbstractText><br /><br />Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 11 Aug 2022; epub ahead of print</small></div>
Maron BJ, Dearani JA, Smedira NG, Schaff HV, ... Rowin EJ, Maron MS
Am J Cardiol: 11 Aug 2022; epub ahead of print | PMID: 35965115
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Blood type O heart transplant candidates have longer waitlist time and higher delisting under the new allocation system.</h4><i>Eapen S, Nordan T, Critsinelis AC, Li B, ... Couper GS, Kawabori M</i><br /><b>Objective</b><br />Prior studies have examined the effect of blood type on heart transplantation (HTx) waitlist outcomes in cohorts through 2015. We aim to analyze the effect of blood type on contemporary waitlist outcomes with a new allocation system focus.<br /><b>Methods</b><br />Adults listed for HTx between April 2015 and December 2020 were included. Survival to HTx and waitlist death/deterioration was compared between type O and non-type O candidates using competing risks regression. Donor/recipient ABO compatibility trends were further investigated.<br /><b>Results</b><br />Candidates with blood type O (n = 7509) underwent HTx less frequently than candidates with blood type other than type O (n = 9699) (subhazard ratio [sHR], 0.56; 95% CI, 0.53-0.58) with higher rates of waitlist death/deterioration (sHR, 1.18; 95% CI, 1.04-1.34). Subgroup analyses demonstrated persistence of this trend under the new donor heart allocation system (HTx: sHR, 0.58; 95% CI, 0.54-0.62; death/clinical deterioration: sHR, 1.27; 95% CI, 1.02-1.60), especially among those listed at high status (1, 2, or 3) (HTx: sHR, 0.69; 95% CI, 0.63-0.75; death/deterioration: sHR, 1.61; 95% CI, 1.16-2.22). Among those listed at status 3, waitlist death/deterioration was modified by presence of a durable left ventricular assist device (left ventricular assist device: sHR, 1.57; 95% CI, 0.58-4.29; no left ventricular assist device: sHR, 3.79; 95% CI, 1.28-11.2). Type O donor heart allocation to secondary ABO candidates increased in the new system (14.5% vs 12.0%; P < .01); post-HTx survival remained comparable between recipients with blood type O and non-type O (log-rank P = .07).<br /><b>Conclusions</b><br />Further logistical considerations are warranted to minimize allocation inequity regarding blood type under the new allocation system.<br /><br />Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Thorac Cardiovasc Surg: 08 Aug 2022; epub ahead of print</small></div>
Eapen S, Nordan T, Critsinelis AC, Li B, ... Couper GS, Kawabori M
J Thorac Cardiovasc Surg: 08 Aug 2022; epub ahead of print | PMID: 36100474
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Robotic degenerative mitral repair: Factors associated with intraoperative revision and impact of mild residual regurgitation.</h4><i>Chen Q, Roach A, Trento A, Rowe G, ... Bowdish ME, Chikwe J</i><br /><b>Objectives</b><br />National registry data show wide variability in degenerative mitral repair rates and infrequent use of intraoperative repair revision to eliminate residual mitral regurgitation (MR). The consequence of uncorrected mild residual MR is also not clear. We identified factors associated with intraoperative revision of degenerative mitral repair and evaluated long-term effects of intraoperative mild residual MR.<br /><b>Methods</b><br />A prospective institutional registry of 858 patients with degenerative MR undergoing robotic mitral surgery was linked to statewide databases. Univariate logistic regression identified factors associated with intraoperative repair revision. Survival was estimated using the Kaplan-Meier method and adjusted with Cox regression. Late freedom from more-than-moderate MR or reintervention was estimated with death as a competing risk.<br /><b>Results</b><br />Repair rate was 99.3%. Repair was revised intraoperatively in 19 patients and was associated with anterior or bileaflet prolapse, adjunctive repair techniques, and annuloplasty band size (all P < .05). Intraoperative repair revision did not result in increased postoperative complications. Intraoperative mild residual MR (n = 111) was independently associated with inferior 8-year survival (hazard ratio, 2.97; 95% CI, 1.33-6.23), worse freedom from more than moderate MR (hazard ratio, 3.35; 95% CI, 1.60-7.00), and worse freedom from mitral reintervention (hazard ratio, 6.40; 95% CI, 2.19-18.72) (all P < .01).<br /><b>Conclusions</b><br />A near 100% repair rate with acceptable durability may be achieved safely with intraoperative revision of postrepair residual MR. Mild residual MR was independently associated with reduced survival, worse freedom from more-than-moderate MR, and worse freedom from mitral reintervention at 8-year follow-up.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Thorac Cardiovasc Surg: 05 Aug 2022; epub ahead of print</small></div>
Chen Q, Roach A, Trento A, Rowe G, ... Bowdish ME, Chikwe J
J Thorac Cardiovasc Surg: 05 Aug 2022; epub ahead of print | PMID: 36182583
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Comparison of and Frequency of Morality, Left Ventricular Assist Device Implantation, Ventricular Arrhythmias, and Heart Transplantation in Patients With Familial Versus Nonfamilial Idiopathic Dilated Cardiomyopathy.</h4><i>Rao RA, Kozaily E, Jawaid O, Sabra M, ... Guglin M, Das MK</i><br /><AbstractText>We postulated that familial idiopathic dilated cardiomyopathy (F-IDC) is associated with a worse prognosis than nonfamilial IDC (nonF-IDC). Patients with F-IDC had either a strong family history and/or proved genetic mutations. We studied long-term prognosis (mean follow-up: 6.1 ± 4.1 years) of 162 patients with IDC (age: 55.5 ± 17.9 years, men: 57.8%, 50% F-IDC) with an implantable cardioverter-defibrillator or cardiac resynchronization therapy. The primary end point was a composite of death, left ventricular (LV) assist device implant, or heart transplantation. The secondary end point was a ventricular arrhythmia event. There was no significant difference in the prevalence of diabetes, hypertension, New York Heart Association class, medical therapy, and years of follow-up between the F-IDC and nonF-IDC groups. Patients with F-IDC were younger than patients with nonF-IDC (49.1 ± 17.0 years vs 61.6 ± 16.5 years, p <0.001). Mean LV ejection fraction was significantly lower in F-IDC group than in the nonF-IDC group (26 ± 12% vs 31 ± 12%, p = 0.022). The primary end point was achieved in 54 patients in F-IDC group (66.7%) versus 19 in the nonF-IDC group (23.5%) (p <0.001). The Kaplan-Meier survival estimates for the composite end point and for ventricular arrhythmia were significantly lower in the F-IDC versus nonF-IDC (log-rank p ≤0.001 and 0.04, respectively). F-IDC was the only multivariable predictor of the primary composite end point (hazard ratio 3.419 [95% confidence interval 1.845 to 6.334], p <0.001). The likelihood of LV remodeling manifested by LV ejection fraction improvement (≥10%) was significantly lower in F-IDC than nonF-IDC (27.1% vs 44.8%, p = 0.042). In conclusion, F-IDC is a predictor of mortality, need for LV assist device, or heart transplantation. F-IDC is associated with significantly lower event-free survival for primary end point and ventricular arrhythmia than nonF-IDC. F-IDC has significantly lower likelihood of LV reverse remodeling than nonF-IDC.</AbstractText><br /><br />Copyright © 2022 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 28 Jul 2022; epub ahead of print</small></div>
Abstract
<div><h4>Prevalence of Metabolic Syndrome in Young Adults With Congenital Heart Disease.</h4><i>Umapathi KK, Thavamani A, Bosco G, Dhanpalreddy H, Nguyen HH</i><br /><AbstractText>Adults with congenital heart disease (ACHD) are at risk of developing metabolic syndrome (MetS) at a younger age. We sought to obtain the prevalence of MetS in ACHD from a large population-based database in the United States. We conducted a retrospective cohort study of patients with ACHD in Explorys (IBM Inc., Armonk, New York) database from 2008 to 2019. The ACHD cohort included patients aged 20 to 39 years, with moderate and severe congenital heart disease, as defined by ACHD anatomic and physiologic classification. Patients were diagnosed with MetS using the modified International Diabetes Federation\'s diagnostic criteria. Logistic regression analysis was performed to compare the risk of MetS in the ACHD cohort. MetS was diagnosed in 1,860 of 6,720 patients with ACHD (27.6%). Among 7,359,470 controls, MetS was seen in 742,010 (10.1%). The average age of MetS in ACHD was 31.5 and 32.7 years in controls (p <0.001). The risk of MetS was higher in ACHD versus controls (odds ratio [OR] 2.75 [2.61 to 2.89], p <0.001). The risk of MetS in ACHD was higher in men (OR 3.01 [2.78 to 3.26], p <0.001) and those aged <25 years (men OR 7.57 [6.31 to 9.07], women OR 4.66 [3.85 to 5.63]; p <0.001). The risk of MetS was higher in patients with severe versus moderate ACHD (OR 1.4 [1.56 to 1.74], p <0.001). In conclusion, MetS and its risk factors are more common in young ACHD than in the general population.</AbstractText><br /><br />Copyright © 2022 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 22 Jul 2022; epub ahead of print</small></div>
Umapathi KK, Thavamani A, Bosco G, Dhanpalreddy H, Nguyen HH
Am J Cardiol: 22 Jul 2022; epub ahead of print | PMID: 35879153
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Serial Assessment of Cardiac Function and Pulmonary Hemodynamics in Infants with Down Syndrome.</h4><i>Smith A, Bussmann N, Breatnach C, Levy P, ... Franklin Mrcpch O, El-Khuffash A</i><br /><b>Background</b><br />There is a dearth of longitudinal data describing the evolution of cardiopulmonary haemodynamics in infants with Down Syndrome (DS) beyond infancy. We hypothesized that babies with DS, independent of the presence of congenital heart disease (CHD), demonstrate biventricular systolic and diastolic impairment and sustained elevation of pulmonary pressures compared to controls over the first two years of age.<br /><b>Methods</b><br />This was a prospective observational cohort study of 70 infants with DS (48 with CHD and 22 without CHD) and 60 controls carried out in three tertiary neonatal intensive care units in Dublin, Ireland. Infants with DS with and without CHD and non-DS controls underwent serial echocardiograms at birth, 6 months, 1 year and 2 years of age to assess biventricular systolic and diastolic function using deformation analysis. Pulmonary vascular resistance (PVR) was assessed using pulmonary artery acceleration time (PAAT) and left ventricular (LV) eccentricity index.<br /><b>Results</b><br />Infants with DS exhibited smaller LV (Birth: 27±4 vs. 31±2 mm, p<0.01; 2 years: 43±5 vs. 48±4 mm, p<0.01) and RV (Birth: 28±3 vs. 31±2 mm, p<0.01; 2 years: 40±4 vs. 44±3 mm, p<0.01) lengths and lower LV (Birth: -19±3 vs. -22±2 %, p<0.01; 2 years: -24±2 vs. -26±2 %, p<0.01) and RV (Birth: -19±4 vs. -22±3 %, p<0.01; 2 years: -29±6 vs. -33±4 %, p<0.01) systolic strain over the two year period. PAAT was lower in the DS group throughout the study period (Birth: 44±10 vs. 62±14 ms, p<0.01; 2 years 71±12 vs. 83±11 ms, p<0.01). No differences were observed between DS infants with and without CHD (all p >0.05).<br /><b>Conclusions</b><br />Infants with DS exhibit impaired maturational changes in myocardial function and PVR. Such novel findings provide valuable insights into the pathophysiology affecting cardiorespiratory morbidity in this population.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 19 Jul 2022; epub ahead of print</small></div>
Smith A, Bussmann N, Breatnach C, Levy P, ... Franklin Mrcpch O, El-Khuffash A
J Am Soc Echocardiogr: 19 Jul 2022; epub ahead of print | PMID: 35868547
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Mitral Annular Elasticity Determines Severity of Regurgitation in Barlow\'s Disease.</h4><i>Dumont KA, Dahl Aguilera HM, Persson R, Prot V, Escobar Kvitting JP, Urheim S</i><br /><b>Aims</b><br />Barlow\'s disease (BD) with late systolic mitral regurgitation provides diagnostic and therapeutic challenges. The mechanisms of the regurgitation are still unclear. We hypothesized that the onset and the severity of late systolic regurgitation are determined by annulus dynamics and the mechanical stresses imposed by the left ventricle.<br /><b>Methods and results</b><br />Ten patients with BD and mitral annulus disjunction (MAD) were compared with ten healthy controls. Resting blood pressure (BP) was measured and transthoracic three-dimensional (3D) echocardiography was analyzed using a holographic display that allows tracking and measurements of mitral annulus surface area (ASA) throughout the cardiac cycle. A novel annulus elastance index (dASA/dP) was calculated between aortic valve opening and onset of mitral regurgitation. Severity of MAD was quantified as the disjunction index (mm*degree). Leaflet coaptation area was calculated using a finite element model. Peak systolic ASA in controls and patients were 9.3±0.6 and 21.1±3.1 cm<sup>2</sup>, respectively (p<0.001). In patients ASA increased rapidly during LV ejection and onset of mitral regurgitation coincided closely with peak upslope of annulus area change (dASA/dt). The finite element model showed a close association between rapid annulus displacement and coaptation area deficit in BD. Systolic annulus elastance index (0.058±0.036 cm<sup>2</sup>/mmHg) correlated strongly with disjunction index (r=0.91, p<0.0001). Moreover, regurgitation volume showed a positive correlation with systolic BP (r=0.80, p<0.01) <br /><b>Conclusion:</b><br/>The present pilot study supports the hypothesis that annulus dilatation may accentuate mitral valve regurgitation in patients with Barlow\'s disease. A novel annulus elastance index may predict the severity of mitral valve regurgitation in selected patients.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 13 Jul 2022; epub ahead of print</small></div>
Dumont KA, Dahl Aguilera HM, Persson R, Prot V, Escobar Kvitting JP, Urheim S
J Am Soc Echocardiogr: 13 Jul 2022; epub ahead of print | PMID: 35842077
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>A multicentric evaluation of pediatric lung transplantation in Italy.</h4><i>Schiavon M, Camagni S, Venuta F, Rosso L, ... Dell\'Amore A, Rea F</i><br /><b>Background</b><br />Pediatric lung transplantation is performed in highly experienced centers due to the peculiar population characteristics. The literature is limited and not representative of individual countries\' differences. The purpose of this study was to analyze the Italian experience.<br /><b>Methods</b><br />A multicentric retrospective analysis was performed on 110 pediatric patients (<18 years old) who underwent lung transplantation from 1992 to 2019 at 9 Italian centers. Heart-lung transplantations and lung retransplantations were excluded.<br /><b>Results</b><br />The population was composed of 44 male and 66 female patients, with a median age of 15 years. The most frequent indication was cystic fibrosis (83%). One quarter of patients were transplanted in an emergency setting. Median donors\' Oto score and age were 1 and 15 years, respectively, with 43% of adult donors. In 17% of patients a graft reduction was performed. Postoperatively, the median duration of mechanical ventilation, intensive care unit, and in-hospital stay were 48 hours, 11 and 35 days, respectively. Thirty-day mortality was 6%, and 1-, 5-, and 10-year survival was 72%, 52%, and 33%, respectively. Risk factors for mortality were Oto score and recipients\' body mass index.<br /><b>Conclusions</b><br />The outcomes of pediatric lung transplantation in Italy are comparable with current literature. Particular attention should be paid to the Oto score and recipient body mass index. Conversely, adult donors and graft reductions can be safely used to expand the donor pool.<br /><br />Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Thorac Cardiovasc Surg: 20 Jun 2022; epub ahead of print</small></div>
Schiavon M, Camagni S, Venuta F, Rosso L, ... Dell'Amore A, Rea F
J Thorac Cardiovasc Surg: 20 Jun 2022; epub ahead of print | PMID: 35863967
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Impact of gender in congenital heart surgery: Results from a national survey.</h4><i>Sinha R, Brimacombe M, Romano JC</i><br /><b>Objective</b><br />There are limited data regarding the impact of gender within congenital heart surgery. Our aim was to assess gender-related experiences by surgeons in this field.<br /><b>Methods</b><br />A cross-sectional survey was emailed to practicing congenital heart surgeons to ascertain the perception of gender in 5 domains: training, professional career, clinical practice, personal life, and career outlook.<br /><b>Results</b><br />The survey response rate was 94% (17/18) for women and 44% (112/257) for men. More than half of women (53%) were discouraged from pursuing congenital heart surgery (P < .001) and reported a negative impact of gender in attaining their first congenital heart surgery job (P < .001) compared with men. Despite similar demographics, women reported lower starting annual salaries ($150K-$250K vs $250K-$400K), lower current annual salaries ($500K-$750K vs $750K-$1M), lower academic ranks (clinical instructor 6% vs 4% [P = .045], assistant professor 35% vs 19% [P = .19], associate professor 41% vs 25% [P = .24], and professor 6% vs 41% [P = .005]) along with lower annual salaries at the associate professor ($500K-$750K vs $1M-$1.25M) and professor levels ($1M-$1.25M vs >$1.5M) compared with men. Sexual harassment was experienced more frequently by women both in training (65% vs 6%, P < .001) and in practice (65% and 4%, P < .001).<br /><b>Conclusions</b><br />This survey highlights many areas of gender-related differences: discouragement due to gender to pursue congenital heart surgery, sexual harassment in training and practice, salary and academic rank differentials, negative gender perception at work, and lower career satisfaction for women. Despite various differences between both genders, the majority in each group would choose to enter this profession again as well as encourage others to do so.<br /><br />Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Thorac Cardiovasc Surg: 17 Jun 2022; epub ahead of print</small></div>
Sinha R, Brimacombe M, Romano JC
J Thorac Cardiovasc Surg: 17 Jun 2022; epub ahead of print | PMID: 35842276
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Improvement in hepatic and renal function following isolated heart transplant in adults with congenital heart disease.</h4><i>EgbeMD AC, MirandaMD WR, JainMD CC, KamathMD PS, ... GodaMD AY, ConnollyMD HM</i><br /><b>Background</b><br />There are limited data about postoperative changes in hepatic and renal function in adults with congenital heart disease (CHD) undergoing isolated heart transplant. The purpose of this study was to assess postoperative changes in hepatic and renal function in this population.<br /><b>Methods</b><br />Retrospective cohort study of adults with CHD undergoing isolated heart transplant at Mayo Clinic (2003-2019). Global hepatic function was assessed using the model for end-stage liver disease excluding international normalized ratio [MELD-XI]) score; hepatic fibrosis was assessed using the fibrosis-4 (FIB-4) score and aspartate/platelet ratio index (APRI); and renal function was assessed using estimated glomerular filtration rate (GFR). All indices were measured preoperatively and postoperatively (at 6 months, 1 year, 2 years).<br /><b>Results</b><br />Of 40 patients (age 41 ± 8 years) in the study, 35 had complete preoperative and postoperative data. There was a temporal improvement in hepatic and renal indices from preop (MELD-XI 14 ± 5, APRI 0.60 ± 0.23, FIB-4 1.44 ± 0.38, GFR 59 [44-83]) to 6 months postop (MELD-XI 12 ± 6, APRI 0.49 ± 0.17, FIB-4 1.29 ± 0.33, GFR 68 [54-96]) and 1-year postop (MELD-XI 9 ± 3, APRI 0.41 ± 0.16, FIB-4 1.12 ± 0.29, GFR 82 [69-108]), p < 0.05 for all comparisons.<br /><b>Conclusions</b><br />CHD patients undergoing isolated heart transplant had significant improvement in hepatic and renal function. These data suggests that selected CHD patients may do well with isolated heart transplant despite reduced hepatic and renal function, and hepatic fibrosis preoperatively. More rigorous prospective studies are required to determine the relative outcomes of isolated versus combined heart-liver transplant in this population.<br /><br />Copyright © 2022. Published by Elsevier B.V.<br /><br /><small>Int J Cardiol: 15 Jun 2022; epub ahead of print</small></div>
EgbeMD AC, MirandaMD WR, JainMD CC, KamathMD PS, ... GodaMD AY, ConnollyMD HM
Int J Cardiol: 15 Jun 2022; epub ahead of print | PMID: 35716930
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Prevalence of Left Ventricular Noncompaction in Newborns.</h4><i>Børresen MF, Blixenkrone-Møller E, Kock TO, Sillesen AS, ... Bundgaard H, Axelsson Raja A</i><br /><b>Background</b><br />Left ventricular noncompaction (LVNC) is characterized by excessive trabeculations of the LV and may be associated with reduced systolic function or severe adverse outcomes. Several aspects remain to be elucidated; there is controversy to whether LVNC cardiomyopathy is a distinct cardiomyopathy caused by failure of the spongy fetal myocardium to condense during fetal development or acquired later in life as a morphological trait associated with other types of cardiomyopathy; the prevalence in unselected populations is unknown and the distinction between normal variation and pathology remains to be defined. In this study, we aimed to determine the prevalence of LVNC and the association to LV systolic function in a large, population-based cohort of neonates. In addition, we assessed the normal ratio of noncompact to compact (NC:C) myocardium in 150 healthy neonates.<br /><b>Methods</b><br />Echocardiographic data were prospectively collected in the population study Copenhagen Baby Heart Study. The ratio of NC:C was measured in 12 ventricular segments. LVNC was defined as NC:C ≥2 in at least one segment. Neonates with LVNC were matched 1:10 to controls on sex, gestational age, and weight and age at the examination day.<br /><b>Results</b><br />In total, 25 590 neonates (52% males, median age 11 [interquartile range, 7-15] days) underwent echocardiography. Among 21 133 with satisfactory visualization of ventricular segments, we identified a prevalence of LVNC of 0.076% (95% CI, 0.047-0.123). LV ejection fraction was lower in neonates with LVNC compared with matched controls (median 49.5 versus 59.0%; <i>P</i><0.0001). In neonates with otherwise healthy hearts, the median NC:C ratio ranged from 0.0 to 0.7 and the 99th percentiles from 1.0 to 1.9 for each of the 12 segments.<br /><b>Conclusions</b><br />The prevalence of LVNC based on neonatal echocardiography was 0.076%. LVNC was associated with lower LV systolic function. The findings in normal newborns support the cutoff NC:C ≥2 as an appropriate diagnostic criterion.<br /><b>Registration</b><br />URL: https://www.<br /><b>Clinicaltrials</b><br />gov; Unique identifier: NCT02753348.<br /><br /><br /><br /><small>Circ Cardiovasc Imaging: 01 Jun 2022; 15:e014159</small></div>
Børresen MF, Blixenkrone-Møller E, Kock TO, Sillesen AS, ... Bundgaard H, Axelsson Raja A
Circ Cardiovasc Imaging: 01 Jun 2022; 15:e014159 | PMID: 35727876
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Jeff Zucker Says Hypertrophic Cardiomyopathy is a Curable Disease: A Patient\'s Perspective.</h4><i>Maron BJ, Maron MS</i><br /><AbstractText>LV outflow obstruction in patients with hypertrophic cardiomyopathy can cause marked limiting symptoms of heart failure, reversible with surgical septal myectomy. Here we provide a patient\'s perspective on heart failure in hypertrophic cardiomyopathy and personal experience undergoing the myectomy operation to correct his substantial disability.</AbstractText><br /><br />Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 01 Jun 2022; 172:154-156</small></div>
Maron BJ, Maron MS
Am J Cardiol: 01 Jun 2022; 172:154-156 | PMID: 35569883
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Fetal growth and gestational age improve outcome predictions in neonatal heart surgery.</h4><i>Steurer MA, Schuhmacher K, Savla JJ, Banerjee M, ... Gaynor JW, Tabbutt S</i><br /><b>Objective</b><br />Current risk adjustment models for congenital heart surgery do not fully incorporate multiple factors unique to neonates such as granular gestational age (GA) and birth weight (BW) z score data. This study sought to develop a Neonatal Risk Adjustment Model for congenital heart surgery to address these deficiencies.<br /><b>Methods</b><br />Cohort study of neonates undergoing cardiothoracic surgery during the neonatal period captured in the Pediatric Cardiac Critical Care Consortium database between 2014 and 2020. Candidate predictors were included in the model if they were associated with mortality in the univariate analyses. GA and BW z score were both added as multicategory variables. Mortality probabilities were predicted for different GA and BW z scores while keeping all other variables at their mean value.<br /><b>Results</b><br />The C statistic for the mortality model was 0.8097 (95% confidence interval, 0.7942-0.8255) with excellent calibration. Mortality prediction for a neonate at 40 weeks GA and a BW z score 0 to 1 was 3.5% versus 9.8% for the same neonate at 37 weeks GA and a BW z score -2 to -1. For preterm infants the mortality prediction at 34 to 36 weeks with a BW z score 0 to 1 was 10.6%, whereas it was 36.1% for the same infant at <32 weeks with a BW z score of -2 to -1.<br /><b>Conclusions</b><br />This Neonatal Risk Adjustment Model incorporates more granular data on GA and adds the novel risk factor BW z score. These 2 factors refine mortality predictions compared with traditional risk models. It may be used to compare outcomes across centers for the neonatal population.<br /><br />Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Thorac Cardiovasc Surg: 28 May 2022; epub ahead of print</small></div>
Steurer MA, Schuhmacher K, Savla JJ, Banerjee M, ... Gaynor JW, Tabbutt S
J Thorac Cardiovasc Surg: 28 May 2022; epub ahead of print | PMID: 35750509
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>22nd Annual Feigenbaum Lecture Right Heart, Right Now: The Role of Three-Dimensional Echocardiography.</h4><i>Muraru D</i><br /><AbstractText>Three-dimensional echocardiography (3DE) is the only ultrasound technique that offers the ability to image the complex right heart in its complete dimensionality. Over the years, the benefits of 3DE imaging to improve our understanding of right heart pathologies and ultimately patients\' care have emerged from numerous publications. The aims of this review article are to highlight the importance of 3DE for a more accurate evaluation of the right heart structures, to discuss the most important recent developments in the field and highlight future directions and needs.</AbstractText><br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 26 May 2022; epub ahead of print</small></div>
Muraru D
J Am Soc Echocardiogr: 26 May 2022; epub ahead of print | PMID: 35644303
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Echocardiographic Abnormalities in Adults With Anorexia Nervosa.</h4><i>Scheggi V, Castellini G, Vanni F, Menale S, ... Ricca V, Marchionni N</i><br /><AbstractText>Anorexia nervosa (AN) is a psychiatric disorder that may lead to cardiac complications. The objective of this study was to evaluate global and regional longitudinal strain changes in patients affected by AN as an early marker of myocardial damage. We prospectively enrolled 48 consecutive patients with AN and 44 age-matched and gender-matched healthy controls. In all subjects, we performed echocardiography, including global longitudinal strain (GLS) measurement. A subset of 33 patients with AN had further echocardiographic examinations during the follow-up. Compared with healthy controls, patients with AN had a greater prevalence of pericardial effusion (9 of 48 vs 0 of 44, p = 0.003), a smaller left ventricular mass (63 ± 15 vs 99 ± 30 g, p < 0.001), a lower absolute value of GLS (-18.9 ± 2.8 vs -20.2 ± 1.8%, p = 0.010) and of basal LS (-15.4 ± 6.0 vs -19.4 ± 2.6%, p < 0.001). The bull\'s eye mapping showed a plot pattern with blue basal areas in 18 of 48 patients with AN versus 1 of 44 controls (p < 0.001). During the follow-up, of 13 patients with blue areas in the first bull\'s eye mapping, 11 recovered completely, and of 20 patients with a red bull\'s eye at the first examination, none presented blue areas at the second one. In conclusion, GLS is significantly altered in patients with AN, and a basal blue pattern on bull\'s eye mapping identifies more severe cases. These changes seem to be reversible.</AbstractText><br /><br />Copyright © 2022 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 18 May 2022; epub ahead of print</small></div>
Scheggi V, Castellini G, Vanni F, Menale S, ... Ricca V, Marchionni N
Am J Cardiol: 18 May 2022; epub ahead of print | PMID: 35597626
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Timing of Repair in Postinfarction Ventricular Septal Defect.</h4><i>Jaswaney R, Arora S, Khwaja T, Shah N, ... Abu-Omar Y, Shishehbor MH</i><br /><AbstractText>The optimal timing of postinfarction ventricular septal defect (PI-VSD) repair is subject to debate. Patients with ventricular septal defect (VSD) and ST-elevation myocardial infarction (STEMI) were queried using appropriate International Classification of Diseases, Ninth and Tenth Revision Clinical Modification codes from the National Inpatient Sample (2003 to 2018). VSD repair was identified using appropriate International Classification of Diseases, Ninth and Tenth Revision Procedure Coding System codes. Data were stepwise stratified by cardiogenic shock (CS) and time of repair from admission to create 6 clinically relevant groups: shock 1 (CS; 0 to 7 days), shock 2 (CS; 8 to 14 days), and shock 3 (CS; >14 days). Nonshock groups were classified similarly. The primary outcome was in-hospital mortality. Multilevel hierarchical logistic regression was used to adjust for confounders for each group. We identified 10,902 patients with PI-VSD. In shock 1 (n = 5,794), VSD repair was associated with lower mortality (OR 0.76; 95% CI 0.68 to 0.86, p <0.001) compared to no VSD repair. In shock 2 (n=1,009) mortality was numerically lower in those who received VSD repair, but not statistically different. In shock 3 (n=483), mortality was numerically higher in those who received VSD repair, but not statistically different. In nonshock 1 (n=5,108), VSD repair was associated with higher mortality (odds ratio [OR] 1.59; 95% confidence interval [CI] 1.33 to 1.90; p <0.001). In nonshock 2 (n = 1,265), mortality was numerically higher in patients with VSD repair, although not statistically different. In nonshock 3 (n = 472), mortality was numerically lower in patients with VSD repair, although not statistically different. Mechanical circulatory support use increased over the 16 years (relative change + 18%, p <0.001), with no significant change in mortality among patients with PI-VSD. In conclusion, in patients with CS, early PI-VSD repair was associated with lower mortality. However, in patients without CS, early PI-VSD repair was associated with higher mortality.</AbstractText><br /><br />Copyright © 2022 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 18 May 2022; epub ahead of print</small></div>
Jaswaney R, Arora S, Khwaja T, Shah N, ... Abu-Omar Y, Shishehbor MH
Am J Cardiol: 18 May 2022; epub ahead of print | PMID: 35597625
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Contemporary Trends and Comparison of Racial Differences in Hospitalizations of Adults With Congenital Heart Disease.</h4><i>Hendrickson MJ, Arora S, Chew C, Sharma M, ... Yancy C, Byku M</i><br /><AbstractText>As advancements in care improve longevity in patients with congenital heart disease (CHD), it is crucial to further characterize this rapidly growing adult population. It is also essential that equitable care is offered across demographic groups. Hospitalizations for adults with CHD in the National Inpatient Sample were identified to describe trends in overall and cause-specific rates of admission per 1,000 adults with CHD from 2000 to 2018. Primary admission causes were then analyzed and stratified by race. An aggregate rate of left-ventricular assist device placements and heart transplants was calculated for each group and trended over the years. A total of 1,562,001 weighted hospitalizations were identified. Overall, annual rates of hospital admissions increased from 39 per 1,000 adults with CHD in 2000 to 74 per 1,000 in 2018, as did rates of cardiovascular admissions (16 of 1,000 to 34 of 1,000, p <0.001 for both). Transient ischemic attack/stroke (2.5 of 1,000 to 10.7 of 1,000), coronary artery disease (4.1 of 1,000 to 5.6 of 1,000), arrhythmias (2.8 of 1,000 to 4.6 of 1,000), and heart failure (2.8 of 1,000 to 5.0 of 1,000) were the most common cardiovascular primary causes of admission (other than CHD itself), and each significantly increased over time (p <0.001 for each). Mean age at all-cause and primary heart failure hospitalization increased for all races but remained 7 to 9 years younger for Black and Hispanic adults than White adults. In conclusion, hospitalization rates of adults with CHD in the United States increased from 2000 to 2018, largely driven by an increase in adults ≥55 years. Although the age at hospitalization increased overall, Black and Hispanic patients were substantially younger at presentation for advanced heart failure. Anticoagulation guidelines in this population may need revisiting as transient ischemic attack/stroke hospitalizations were frequent.</AbstractText><br /><br />Copyright © 2022 Elsevier Inc. All rights reserved.<br /><br /><small>Am J Cardiol: 16 May 2022; epub ahead of print</small></div>
Hendrickson MJ, Arora S, Chew C, Sharma M, ... Yancy C, Byku M
Am J Cardiol: 16 May 2022; epub ahead of print | PMID: 35589425
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Timing of reintervention influences survival and resource utilization following first-stage palliation of single ventricle heart disease.</h4><i>Sengupta A, Gauvreau K, Kaza A, Hoganson D, Del Nido PJ, Nathan M</i><br /><b>Objective</b><br />Outcomes after first-stage palliation of single-ventricle heart disease are influenced by many factors, including the presence of residual lesions requiring reintervention. However, there is a dearth of information regarding the optimal timing of reintervention. We assessed if earlier reintervention would be favorably associated with in-hospital outcomes among patients requiring unplanned reinterventions after the Norwood operation.<br /><b>Methods</b><br />This was a single-center, retrospective review of all patients who underwent the Norwood procedure from January 1997 to November 2017 and required a predischarge unplanned surgical or transcatheter reintervention on 1 or more subcomponent areas repaired at the index operation. Outcomes of interest included in-hospital mortality or transplant, postoperative hospital length of stay, and inpatient cost. Associations between timing of reintervention and outcomes were assessed using logistic regression (mortality or transplant) or generalized linear models (postoperative hospital length of stay and cost), adjusting for baseline patient-related and procedural factors.<br /><b>Results</b><br />Of 500 patients who underwent the Norwood operation, 92 (18.4%) required an unplanned reintervention. Median time to reintervention was 12 days (interquartile range, 5-35 days). There were 31 (33.7%) deaths or transplants, median postoperative hospital length of stay was 49 days (interquartile range, 32-87 days), and median cost was $328,000 (interquartile range, $204,000-$464,000). On multivariable analysis, each 5-day increase in time to reintervention increased the odds of mortality or transplant by 20% (odds ratio, 1.2; 95% confidence interval, 1.1-1.3; P = .004). Longer time to reintervention was also significantly associated with greater postoperative hospital length of stay (P < .001) and higher cost (P < .001).<br /><b>Conclusions</b><br />For patients requiring predischarge unplanned reinterventions after the Norwood operation, earlier reintervention is associated with improved in-hospital transplant-free survival and resource use.<br /><br />Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Thorac Cardiovasc Surg: 15 May 2022; epub ahead of print</small></div>
Sengupta A, Gauvreau K, Kaza A, Hoganson D, Del Nido PJ, Nathan M
J Thorac Cardiovasc Surg: 15 May 2022; epub ahead of print | PMID: 35961880
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Implementation of Appropriate Use Criteria for Transthoracic Echocardiography in Follow up Care of Pediatric Patients with Congenital Heart Disease.</h4><i>Patel T, Kelleman M, Pickard S, Miller J, Suthar D, Sachdeva R</i><br /><b>Background</b><br />Indications for transthoracic echocardiography (TTE) from the 2020 Appropriate Use Criteria (AUC) for congenital heart disease (CHD) were incorporated into our electronic ordering system as a clinical decision support tool. The purpose of this study was to evaluate TTE utilization and factors affecting appropriateness of TTE orders during follow-up care of patients with CHD.<br /><b>Methods</b><br />All TTEs performed during follow-up clinic visits from 5/1/2020 to 11/30/2020 were included. TTE indications were rated appropriate (A), may be appropriate (M), or rarely appropriate (R) based on the AUC, and unclassifiable if indication was not in the document but related to included lesions. CHD was graded as simple, moderate, and complex based on Bethesda classification. Logistic regression was used to determine association of ratings with patient age, insurance status, CHD complexity, clinician experience and specialty.<br /><b>Results</b><br />Of the 5158 studies, 3979 (77.2%) were for CHD included in the AUC document, 322 (8%) were unclassifiable, 37 (0.7%) for CHD not in the document, and 1142 (22.1%) for non-CHD indications. Of the 3657 TTEs to which AUC ratings could be applied, 95.6% were A, 2.4% M, and 2.0% R. The highest utilization of TTE was for follow-up of ventricular septal defects, left ventricular outflow tract obstruction, and single ventricles; 46% for unrepaired CHD; 78% for routine surveillance and the remaining for a change in clinical status. On multivariable analysis, the only significant factor associated with M/R ratings was simple CHD [OR 11.58 (95% CI 5.36 - 24.98), p<0.001].<br /><b>Conclusions</b><br />Three-quarters of the TTEs ordered during follow-up care in pediatric cardiology clinics are for indications related to CHD. Most TTEs for follow-up of CHD were for routine surveillance and indications rated A. TTE orders for M/R ratings were associated with simple CHD. Though the 2020 AUC document successfully stratifies majority of indications related to CHD, future documents should consider the unclassifiable CHD indications and the non-CHD indications.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 11 May 2022; epub ahead of print</small></div>
Patel T, Kelleman M, Pickard S, Miller J, Suthar D, Sachdeva R
J Am Soc Echocardiogr: 11 May 2022; epub ahead of print | PMID: 35568251
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Our experience with 1000 recent thoracoabdominal aneurysm repairs, including endovascular stenting.</h4><i>Svensson LG</i><br /><b>Objective</b><br />Managing patients with thoracoabdominal aneurysms is demanding yet fascinating, and requires a team effort. This invited talk presents lessons learned as our history with open and endovascular procedures evolved for 2578 descending and thoracoabdominal repairs over the past 20 years.<br /><b>Methods</b><br />Beginning in 1985 with an analysis of 596 traumatic aortic ruptures and the risk of spinal cord ischemia, the evolution of research and procedures for thoracoabdominal aneurysms progressed. The focus of these studies, medication trials, and procedure adjustments was on lowering the risk of spinal cord ischemia.<br /><b>Results</b><br />Between January 2002 and December 2021, 2578 aneurysm repairs were performed. The respective mortality rates were 6.8% and 4.0% for all patients treated. The permanent spinal cord ischemia rates were 1.3% for open descending thoracic aortas and 4.9% for open thoracoabdominal aneurysms. A detailed analysis of open and thoracoabdominal repairs showed better long-term outcomes with open repairs.<br /><b>Conclusions</b><br />Through multiple randomized trials and innovations with procedures and techniques, the risk of death and spinal cord ischemia have been reduced. Long-term survival has also been improved. The pursuit of reducing the risks of descending and ascending thoracoabdominal repairs is a fascinating endeavor that has resulted in better patient outcomes. Nevertheless, this is a journey, and there will always be more room to achieve even better results.<br /><br />Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Thorac Cardiovasc Surg: 09 May 2022; epub ahead of print</small></div>
Svensson LG
J Thorac Cardiovasc Surg: 09 May 2022; epub ahead of print | PMID: 35589422
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Normal Ranges of Global Left Ventricular Myocardial Work Indices in Adults: A Meta-Analysis.</h4><i>Truong VT, Vo HQ, Ngo TNM, Mazur J, ... Nagueh SF, Chung ES</i><br /><b>Background</b><br />Recent studies have demonstrated that left ventricular myocardial work (MW) is incremental in diagnosis and prognostication compared with left ventricular ejection fraction and myocardial strain. The authors performed a meta-analysis of normal ranges of noninvasive MW indices including global work index, global constructive work, global wasted work, and global work efficiency and determined confounders that may contribute to variance in reported values.<br /><b>Methods</b><br />Four databases (PubMed, Scopus, Embase, and the Cochrane Library) were searched through January 2021 using the key terms \"myocardial work,\" \"global constructive work,\" \"global wasted work,\" \"global work index,\" and \"global work efficiency.\" Studies were included if the articles reported LV MW using two-dimensional transthoracic echocardiography in healthy normal subjects, either in a control group or comprising the entire study cohort. The weighted mean was estimated by using the random-effect model with a 95% CI. Heterogeneity across included studies was assessed using the I<sup>2</sup> test. Funnel plots and the Egger regression test were used to assess potential publication bias.<br /><b>Results</b><br />The search yielded 476 articles. After abstract and full-text screening, we included 13 data sets with 1,665 patients for the meta-analysis. The reported normal mean values of global work index and global constructive work among the studies were 2,010 mm Hg% (95% CI, 1,907-2,113 mm Hg%) and 2,278 mm Hg% (95% CI, 2,186-2,369 mm Hg%), respectively. Mean global wasted work was 80 mm Hg% (95% CI, 73-87 mm Hg%), and mean global work efficiency was 96.0% (95% CI, 96%-96%). Furthermore, gender significantly contributed to variations in normal values of global work index, global wasted work, and global work efficiency. No evidence of significant publication bias was observed.<br /><b>Conclusions</b><br />In this meta-analysis, the authors provide echocardiographic reference ranges for noninvasive indices of MW. These normal values could serve as a reference for clinical and research use.<br /><br />Copyright © 2022 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Soc Echocardiogr: 01 May 2022; 35:369-377.e8</small></div>
Truong VT, Vo HQ, Ngo TNM, Mazur J, ... Nagueh SF, Chung ES
J Am Soc Echocardiogr: 01 May 2022; 35:369-377.e8 | PMID: 34800670
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Comparison between Nondedicated and Novel Dedicated Tracking Tool for Right Ventricular and Left Atrial Strain.</h4><i>Mirea O, Duchenne J, Voigt JU</i><br /><b>Background</b><br />Recently, dedicated speckle-tracking solutions for right ventricular (RV) and left atrial (LA) strain assessment have become commercially available. The purpose of this study was to assess the level of agreement between nondedicated (left ventricular [LV] tracking software) and novel dedicated tracking software for RV and LA strain.<br /><b>Methods</b><br />In 200 patients with various cardiovascular pathologies, we measured global longitudinal strain (GLS), free wall strain (FWS), and segmental values, as well as LA strain during reservoir, conduit, and contraction phases, by using the (1) LV-tracking software and (2) the novel dedicated tracking software for RV or LA strain analysis. Agreement between corresponding measurements obtained with the LV and dedicated RV or LA software was determined by using mean absolute difference (MAD) and Bland-Altman test. The intra- and interobserver reproducibility related to the nondedicated and novel dedicated tracking software was tested in 30 randomly selected subjects.<br /><b>Results</b><br />The dedicated RV-tracking software provided slightly lower strain values without reaching statistical significance. The agreement between software was best for RV GLS (MAD, 2.4 ± 1.8) and significantly poorer for segmental values (MAD ranging from 4.5 ± 3.8 to 5.1 ± 4.0; analysis of variance, P < .05). The intra- and interobserver reproducibility for RV measurements was similar with both software (P > .05 for all parameters). Left atrial mean values showed no statistical difference when obtained with the two tracking tools. The use of LA dedicated tracking software increased significantly the intra- and interobserver reproducibility for LA strain during reservoir and atrial contraction (P < .01 for both).<br /><b>Conclusions</b><br />Our results suggest that the choice of tracking software does not significantly impact RV strain measurements. Nonetheless, the use of the same tracking software is recommended when performing serial measurements. The use of the dedicated software for LA strain analysis significantly improved the intra- and interobserver reproducibility.<br /><br />Copyright © 2021 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Soc Echocardiogr: 01 May 2022; 35:419-425</small></div>
Mirea O, Duchenne J, Voigt JU
J Am Soc Echocardiogr: 01 May 2022; 35:419-425 | PMID: 34800672
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Total ventricular mass oversizing +50% or greater was a predictor of worse 1-year survival after heart transplantation.</h4><i>Kawabori M, Critsinelis AC, Patel S, Nordan T, ... Chen FY, Couper GS</i><br /><b>Objectives</b><br />Current donor-recipient size matching guidelines rely primarily on body weight, with no specified oversizing cutoff values. Recent literature has explored predicted total ventricular mass matching over body weight matching. We aim to explore the impact of total ventricular mass oversizing on heart transplant outcomes.<br /><b>Methods</b><br />The United Network for Organ Sharing database was queried for adults who underwent primary heart transplant from 1997 to 2017. By using validated equations, donor-recipient total ventricular mass mismatch was calculated. Donor-recipient pairs were divided into 3 groups by total ventricular mass mismatch. Post-heart transplant 1-year survival was analyzed using the Kaplan-Meier method and Cox proportional hazards models. We also investigated post-heart transplant complications, independent predictors for mortality, donor-recipient sex mismatch, and donor-recipient body habitus in total ventricular mass mismatch greater than +50%.<br /><b>Results</b><br />A total of 34,455 donor-recipient pairs were included. Fractional polynomial regression demonstrated increased the risk of mortality with higher total ventricular mass mismatch. Total ventricular mass mismatch of +48.3% maximized the Youden Index. Donor-recipient pairs were subsequently grouped by total ventricular mass mismatch as -20% to +30%, +30% to +50%, and greater than +50%. Total ventricular mass mismatch greater than +50% was an independent risk factor for 1-year mortality (hazard ratio, 1.40, P = .004) and was associated with increased postoperative stroke (P = .002). Some 80.3% of these recipients were smaller female patients with male donors. Total ventricular mass mismatch from +30% to +50% was not associated with worse survival (P = .17).<br /><b>Conclusions</b><br />Total ventricular mass mismatch greater than +50% is associated with worse 1-year survival, although this group comprises a small portion of heart transplant. total ventricular mass mismatch from +30% to +50% is not associated with worse survival. These outcomes should be considered in selecting donors and in efforts to expand the potential donor pool.<br /><br />Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Thorac Cardiovasc Surg: 30 Apr 2022; epub ahead of print</small></div>
Kawabori M, Critsinelis AC, Patel S, Nordan T, ... Chen FY, Couper GS
J Thorac Cardiovasc Surg: 30 Apr 2022; epub ahead of print | PMID: 35688717
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Relation Between Early Diastolic Mid-Ventricular Flow and Elastic Forces Indicating Aneurysm Formation in Hypertrophic Cardiomyopathy.</h4><i>Strachinaru M, Huurman R, Bowen DJ, Schinkel AF, Hirsch A, Michels M</i><br /><b>Background</b><br />The early diastolic paradoxical mid-ventricular flow (EDF) is suggestive of apical aneurysm (AA) formation in hypertrophic cardiomyopathy (HCM). We aimed to determine whether EDF may be a useful screening tool in patients, following the time progression of HCM to the aneurysmal stage.<br /><b>Methods</b><br />121 HCM patients with dominant hypertrophy in the mid and apical segments, based on echocardiography and/or cardiovascular magnetic resonance (CMR), were selected from our HCM database comprising 1332 patients. They were further stratified according to the presence of AA. All imaging studies in a period of 16 years (2005-2021) were considered for time progression. Mid-ventricular Doppler (PW, CW, color and color M-mode) were analyzed.<br /><b>Results</b><br />35 patients (29% of the study group and 2.6% of all HCM patients) had AA. EDF had a sensitivity of 92% and specificity of 98.6% for the detection of AA in the study group. In 108 patients follow-up echocardiography was performed (median 5 [3-9] studies). Sixteen patients (15%), with 10 [7-12] years follow-up, displayed progressive time changes in LV apical morphology and/or mid-LV flow. Ten patients (9%) progressed to an AA, during 7 [4-11] years follow-up. Patients progressing to AA were younger (p=0.009), with more severe LV hypertrophy (p=0.01) and more often a significant mid-LV systolic gradient (≥ 30mmHg, p<0.001). A wall thickness over 20mm had 70% sensitivity and 69% specificity in detecting evolution towards AA. With significant systolic gradient, sensitivity was 80% and specificity 62%. Furthermore, patients with AA had higher incidence of ventricular tachycardia (Log-rank p=0.03).<br /><b>Conclusion</b><br />EDF reliably detects AA presence and should prompt for extra imaging studies. In HCM with mid and apical dominant involvement there is a progressive trend towards aneurysm formation, especially in patients with wall thickness over 20mm and significant mid-LV systolic gradient (≥30mmHg), which can be monitored through serial Doppler studies.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Am Soc Echocardiogr: 27 Apr 2022; epub ahead of print</small></div>
Strachinaru M, Huurman R, Bowen DJ, Schinkel AF, Hirsch A, Michels M
J Am Soc Echocardiogr: 27 Apr 2022; epub ahead of print | PMID: 35489541
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Ross procedure in neonates and infants: A valuable operation with defined limits.</h4><i>Cleveland JD, Bansal N, Wells WJ, Wiggins LM, Kumar SR, Starnes VA</i><br /><b>Objective</b><br />The Ross procedure is an important tool that offers autologous tissue repair for severe left ventricular outflow tract (LVOT) pathology. Previous reports show that risk of mortality is highest among neonates and infants. We analyzed our institutional experience within this patient cohort to identify factors that most affect clinical outcome.<br /><b>Methods</b><br />A retrospective chart review identified all Ross operations in neonates and infants at our institution over 27 years. The entire study population was analyzed to determine risk factors for mortality and define outcomes for survival and reintervention.<br /><b>Results</b><br />Fifty-eight patients underwent a Ross operation at a median age of 63 (range, 9-156) days. Eighteen (31%) were neonates. Eleven (19%) patients died before hospital discharge. Multiple regression analysis of the entire cohort identified young age (hazard ratio [HR], 1.037; P = .0045), Shone complex (HR, 17.637; P = .009), and interrupted aortic arch with ventricular septal defect (HR, 16.01; P = .031) as independent predictors of in-hospital mortality. Receiver operating characteristic analysis (area under the curve, 0.752) indicated age younger than 84 days to be the inflection point at which mortality risk increases. Of the 47 survivors, there were 2 late deaths with a mean follow-up of 6.7 (range, 2.1-13.1) years. Three patients (6%) required LVOT reintervention at 3, 8, and 17.5 years, respectively, and 26 (55%) underwent right ventricular outflow tract reintervention at a median of 6 (range, 2.5-10.3) years.<br /><b>Conclusions</b><br />Ross procedure is effective in children less than one year of age with left sided obstructive disease isolated to the aortic valve and/or aortic arch. Patients less than 3 months of age with Shone or IAA/VSD are at higher risk for morbidity and mortality. Survivors experience excellent intermediate-term freedom from LVOT reintervention.<br /><br />Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Thorac Cardiovasc Surg: 25 Apr 2022; epub ahead of print</small></div>
Cleveland JD, Bansal N, Wells WJ, Wiggins LM, Kumar SR, Starnes VA
J Thorac Cardiovasc Surg: 25 Apr 2022; epub ahead of print | PMID: 35599209
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Atrioventricular septal defect in Fontan circulation: Right ventricular dominance, not valve surgery, adversely affects survival.</h4><i>King G, Buratto E, Cordina R, Iyengar A, ... d\'Udekem Y, Konstantinov IE</i><br /><b>Objective</b><br />The effect of ventricular dominance and previous atrioventricular valve (AVV) surgery on patient outcomes after Fontan operation remains unclear. We sought to determine the effect of ventricular dominance and previous AVV surgery on transplantation-free survival and long-term AVV competency in patients with atrioventricular septal defect (AVSD) and Fontan circulation.<br /><b>Methods</b><br />We conducted a retrospective study of 1703 patients in the Australia and New Zealand Fontan Registry, who survived Fontan operation between 1987 and 2021.<br /><b>Results</b><br />Of 174 patients with AVSD, 60% (105/174) had right ventricular (RV) dominance and 40% (69/174) had left ventricular (LV) dominance. The cumulative incidence of moderate or greater AVV regurgitation at 25 years after Fontan operation in patients with LV dominance was 56% (95% CI, 35%-72%), compared with 54% (95% CI, 40%-67%) in patients with RV dominance (P = .6). Nonetheless, transplantation-free survival at 25 years in patients with LV dominance was 94% (95% CI, 86%-100%), compared with 67% (95% CI, 52%-87%) in patients with RV dominance (hazard ratio, 5.9; 95% CI, 1.4-25.4; P < .01). Of note, transplantation-free survival was not different in patients who underwent AVV surgery before or at Fontan completion compared with those who did not (15 years: 81% [95% CI, 62%-100%] vs 88% [95% CI, 81%-95%]; P = .3).<br /><b>Conclusions</b><br />In patients with AVSD and Fontan circulation the rate of moderate or greater common AVV regurgitation is similar in those with LV and RV dominance. RV dominance, rather than previous AVV surgery, is a risk factor for death or transplantation.<br /><br />Crown Copyright © 2022. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Thorac Cardiovasc Surg: 20 Apr 2022; epub ahead of print</small></div>
King G, Buratto E, Cordina R, Iyengar A, ... d'Udekem Y, Konstantinov IE
J Thorac Cardiovasc Surg: 20 Apr 2022; epub ahead of print | PMID: 36008181
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Abstract
<div><h4>Prevalence and Prognostic Implications of Left Ventricular Systolic Dysfunction in Adults With Congenital Heart Disease.</h4><i>Egbe AC, Miranda WR, Pellikka PA, DeSimone CV, Connolly HM</i><br /><b>Background</b><br />Although the prevalence and prognostic implications of left ventricular systolic dysfunction (LVSD), and the effect of cardiac therapies on LVSD are well described in patients with acquired heart disease, such data are sparse in adults with congenital heart disease (CHD).<br /><b>Objectives</b><br />The purpose of this study was to determine the prevalence, risk factors, and prognostic implications of LVSD, and the effect of cardiac therapies (guideline-directed medical therapy [GDMT] and cardiac resynchronization therapy [CRT]) on LVSD in adults with CHD.<br /><b>Methods</b><br />This was a retrospective study of adults with CHD with systemic LV (2003-2019). LVSD was defined as left ventricular ejection fraction (LVEF) <52%/<54% (men/women). Cardiovascular event was defined as heart failure hospitalization, heart transplant, and cardiovascular death.<br /><b>Results</b><br />Of 4,358 patients, 554 (12%) had LVSD, and the prevalence of LVSD was higher in right-sided lesions compared with left-sided lesions (15% vs 10%; P < 0.001). Cardiovascular events occurred in 312 (7%) patients. LVEF was independently associated with cardiovascular events (HR: 0.95; 95% CI: 0.93-0.97; P = 0.009). Of 544 patients with LVSD, 311 received GDMT and 48 patients received CRT. LVEF increased by 6% (95% CI: 2%-10%) and 11% (95% CI: 8%-14%), and N-terminal pro-hormone brain natriuretic peptide decreased by 151 pg/mL (95% CI: 62-289 pg/mL) and 201 pg/mL (95% CI: 119-321 pg/mL) in patients who received GDMT and CRT, respectively.<br /><b>Conclusions</b><br />LVSD was present in 12% of adults with CHD, was more common in patients with right-sided lesions, and was associated with cardiovascular events. GDMT and CRT were associated with improvement in LVEF. These results provide a foundation for clinical trials to rigorously test the benefits of these therapies in CHD patients.<br /><br />Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Am Coll Cardiol: 12 Apr 2022; 79:1356-1365</small></div>
Egbe AC, Miranda WR, Pellikka PA, DeSimone CV, Connolly HM
J Am Coll Cardiol: 12 Apr 2022; 79:1356-1365 | PMID: 35393016
Go to: DOI | PubMed | PDF | Google Scholar |
Impact:
Older ...

This program is still in alpha version.