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BackgroundThe development of transcatheter tricuspid edge-to-edge repair for tricuspid regurgitation is a therapeutic milestone but a specific periprocedural risk assessment tool is lacking. TRI-SCORE has recently been introduced as a dedicated risk score for tricuspid valve surgery.AimsThis study analyzes the predictive performance of TRI-SCORE following transcatheter edge-to-edge tricuspid valve repair.Methods180 patients who underwent transcatheter tricuspid valve repair at Ulm University Hospital were consecutively included and stratified into three TRI-SCORE risk groups. The predictive performance of TRI-SCORE was assessed throughout a follow-up period of 30 days and up to 1 year.ResultsAll patients had severe tricuspid regurgitation. Median EuroSCORE II was 6.4% (IQR 3.8–10.1%), median STS-Score 8.1% (IQR 4.6–13.4%) and median TRI-SCORE 6.0 (IQR 4.0–7.0). 64 patients (35.6%) were in the low TRI-SCORE group, 91 (50.6%) in the intermediate and 25 (13.9%) in the high-risk groups. The procedural success rate was 97.8%. 30-day mortality was 0% in the low-risk group, 1.3% in the intermediate-risk and 17.4% in the high-risk groups (p < 0.001). During a median follow-up of 168 days mortality was 0%, 3.8% and 52.2%, respectively (p < 0.001). The predictive performance of TRI-SCORE was excellent (AUC for 30-day mortality: 90.3%, for one-year mortality: 93.1%) and superior to EuroSCORE II (AUC 56.6% and 64.4%, respectively) and STS-Score (AUC 61.0% and 59.0%, respectively).ConclusionTRI-SCORE is a valuable tool for prediction of mortality after transcatheter edge-to-edge tricuspid valve repair and its performance is superior to EuroSCORE II and STS-Score.

Transcatheter aortic valve replacement (TAVR) has emerged as an alternative treatment for patients with pure severe aortic regurgitation (PSAR) who are contraindicated for surgery or have a high surgical risk. However, the therapeutic efficacy and safety of TAVR in low Society of Thoracic Surgeons (STS) score risk patients remain to be clarified. This study aimed to explore the feasibility of TAVR treatment in different STS-risk patients and to compare the adverse events between the groups. In this study, patients with PSAR who underwent TAVR at Zhongshan Hospital, Fudan University, China, during the inclusion period were included and categorized into 3 groups based on STS scores. The baseline data, imaging results, and follow-up data of the patients were documented. Therefore, of 75 TAVR patients, 38 (50.7%) were categorized as low risk (STS <4), and 37 (49.3%) patients were categorized as intermediate and high risk (STS ≥4). Compared with patients at intermediate and high risk, those in the low-risk group were younger, had a lower body mass index, had a lower prevalence of hypertension, chronic obstructive pulmonary disease, and previous percutaneous coronary intervention, and had better cardiac function (p all <0.05). In the hospital and at the 1-month follow-up, the degree of aortic regurgitation and cardiac function were significantly improved. No significant difference was found between the 2 groups in the hospital or during the 30-day follow-up. In conclusion, TAVR for PSAR in low-STS-risk patients is safe and efficient during 30 days of follow-up compared with intermediate- and high-STS-risk groups. TAVR for PSAR should not be limited to inoperable or STS-defined high-risk patients. Long-term follow-up is needed for further investigation.

Drought is one of the most important abiotic stresses affecting wheat growth. Evaluation of a structured population over seasons and moisture conditions allow for the detection of genes involved in drought tolerance. The aims of the present study were to analyze root and agronomic characters under two moisture conditions and identify marker-trait associations in 220 doubled haploid (DH) lines developed from a cross between Kukri and RAC875. The DH lines were evaluated for grain yield (GY) and several root and agronomic traits in four trials included drought stress experiments (DrExp) at heading stage and well-watered conditions (NExp) throughout the growth season in 2015 and 2016. A linkage map comprised of 1333 SSR, DArT and SNP markers were used for the analysis of quantitative traits loci (QTL). The results of QTL analysis showed that four and seven QTL were identified for root traits in the DrExp 15 and DrExp 16 trials, respectively. The results of QTL analysis suggested that the contribution of the three genomes to drought tolerance was not similar. The Q.Rdrw-4A QTL explained 7.05 and 10.43% of root dry weight variances in the DrExp15 and DrExp 16 trials, respectively. A QTL mapped on the D_GA8KES401CIKOJ–160-BS00067285_51 marker interval for root length was co-localized with a QTL for grain weight per spike under drought conditions. A year-specific main effect QTL and several stable epistatic QTL were identified for days to heading in the DrExp and NExp experiments, respectively. Search for gene annotation in the wheat genome showed that the position of this QTL was overlapped with the tRNA, sRNA and protein-encoding genes. Three QTL were identified for GY of which the Q.Gy-2D QTL identified in NExp 16 whilst Q.Gy-3D and an epistatic effect detected in drought conditions. The common QTL identified allows for increasing selection efficiency and the fine-tuning of root and agronomic traits for sustainable wheat production under water deficit conditions.

To evaluate the powers of European Heart Surgery Risk Assessment System II (EuroSCORE II) and the Society of Thoracic Surgeons (STS) score in predicting in-hospital and medium-term mortality of patients undergoing coronary artery bypass grafting (CABG). Totally 1628 Chinese patients were included between January 2000 and January 2018. Their perioperative clinical data were collected and the patients were closely followed up. According to the length of follow-up time, the total cohort was divided into 1-year, 2-year, 3-year, 4-year and 5-year groups. The in-hospital and medium-term risk prediction of EuroSCORE II and STS score were comparatively assessed by calibration, discrimination, decision curve analysis (DCA), net reclassification index (NRI), integrated discrimination improvement (IDI) and Bland-Altman analysis. About 36 (2.21%) patients died during hospitalization. Both EuroSCORE II and STS score performed extremely well in predicting in-hospital mortality (area under curve = 0.900 and 0.879, respectively). However, calibration and discrimination analyses showed gradual decrease when these two risk evaluation systems were used to predict mortality during the follow-up period. At the same time, the predictive ability of EuroSCORE II was better than STS score. DCA curves showed that the performances of the two evaluation systems were roughly equal between the threshold probability of 0% to 20%. The percentage of correct reclassification of EuroSCORE II was 21.64% higher than that of STS score in predicting 2-year postoperative mortality. The IDI index showed that the predictive capabilities of these two systems were roughly equivalent. Bland-Altman analysis showed no significant difference between the values of the two systems. EuroSCORE II and STS score have excellent predictive powers in predicting in-hospital mortality of patients undergoing CABG. In particular, EuroSCORE II is superior in calibration and discrimination. The prediction efficiency of the two risk evaluation systems is still acceptable for two-year postoperative mortality, but decreases year by year.

Background Quantifiable biomarkers may be useful for a better risk and frailty assessment of patients referred for transcatheter aortic valve implantation (TAVI). Hypothesis To determine if adiponectin serum concentration predicts all‐cause mortality in patients undergoing TAVI. Methods 77 consecutive patients, undergoing TAVI, were analyzed. The CT axial slices at the level of the fourth lumbar vertebra were used to measure the psoas muscle area, and its low‐density muscle fraction (LDM (%)). To assess the operative risk, the STS (Society of Thoracic Surgeons Predicted Risk of Mortality) score, Log. Euroscore, and Euroscore II were determined. A clinical frailty assessment was performed. ELISA kits were used to measure adiponectin serum levels. We searched for a correlation between serum adiponectin concentration and all‐cause mortality after TAVI. Results The mean age was 80.8 ± 7.4 years. All‐cause mortality occurred in 22 patients. The mean follow‐up was 1779 days (range: 1572–1825 days). Compared with patients with the lowest adiponectin level, patients in the third tertile had a hazards ratio of all‐cause mortality after TAVI of 4.155 (95% CI: 1.364–12.655) (p = .004). In the multivariable model, including STS score, vascular access of TAVI procedure, LDM (%), and adiponectin serum concentration, serum adiponectin level, and LDM(%) were independent predictors of all‐cause mortality after TAVI (p = .178, .303, .042, and .017, respectively). Adiponectin level was a predictor of all‐cause mortality in females and males (p = .012 and 0.024, respectively). Conclusion Adiponectin serum level is an independent and incremental predictor of all‐cause mortality in patients undergoing TAVI.

Background Postoperative stroke is one of the most serious consequences of cardiac surgery. Morbidity risk assessment is critical for preoperative risk assessments and resource allocation. In this article, we aim to investigate the predictive value of Society of Thoracic Surgeons (STS) score’s effectiveness in stroke risk in cardiothoracic surgery patients in our population. Methods This retrospective cohort study was conducted at Aga Khan University Hospital (AKUH) using a consecutive sampling technique. The study included all eligible patients aged 18 years or older who underwent cardiac surgical procedures between January 2010 and December 2016. Of the 3,898 patients initially identified, 814 records were excluded due to incomplete data or pre-existing conditions. Statistical analyses, including chi-square tests, t-tests, and logistic regression, were performed to identify significant predictors of stroke. Prediction accuracy was assessed using a Receiver Operating Characteristic (ROC) curve, with Youden’s J statistic employed to determine optimal sensitivity and specificity thresholds. Results Out of 3,084 patients, 52 (1.7%) experienced a postoperative stroke. Stroke patients were significantly older (mean age 62.8 years vs. 57.7 years). They also had higher white blood cell count (10.7 ± 5.1 vs. 9.3 ± 3.3) and a longer history of myocardial infarction (9.2 ± 9.3 years vs. 6.9 ± 7.6 years). Cardiovascular interventions (15.4% vs. 7.7%), postoperative congestive heart failure (21.1% vs. 7.3%), and use of inotropes (5.8% vs. 1.6%) were more prevalent in stroke patients. Emergent surgical status (19.2% vs. 13.4%) and complications such as dialysis, prolonged ventilation, and intra-aortic balloon pump use were also significantly higher. The predictive model demonstrated strong accuracy in predicting postoperative stroke (AUC: 0.841, CI: 0.794–0.888). The ROC analysis for the STS stroke model showed high sensitivity (90.4%) and negative predictive value (99.7%), with moderate specificity (64.3%) and overall accuracy (64.8%), indicating excellent performance in ruling out stroke but moderate reliability in identifying positive cases. Conclusion The STS risk score demonstrated strong predictive accuracy for postoperative stroke risk in cardiothoracic surgery patients, effectively incorporating clinical factors already accounted for in the comprehensive set of 70 variables used in its calculation.

BackgroundMortality risk assessment is vital for preoperative risk evaluation and resource allocation. This article presents a single-center comprehensive analysis of Society of Thoracic Surgeons (STS) scores and factors impacting outcomes in cardiothoracic surgery patients. It aims to assess the effectiveness of the STS risk score in predicting mortality. This retrospective cohort calculates STS scores for a diverse cohort of 3084 patients who underwent cardiac surgery between January 2010 and December 2016 at a Tertiary care Hospital in Pakistan. Stata-14 was used for the analysis.ResultsDemographics analysis showed the mean age of the study population was 58 years. The predominance of males and the most common procedures were isolated coronary artery bypass graft, mitral valve replacement, and aortic valve replacement. Hypertension (68.5%) and diabetes (50.7%) were the most prevalent comorbid conditions, with a family history of coronary artery disease found in 46.7% of the patients. Mortality rates were higher for females (5.5% vs. 2.6%), the elderly (4.3% vs. 1.3%), those with mitral insufficiency (22%) and patients on adenosine diphosphate inhibitors (8.8%) for anticoagulation. Post-operative complications, including dialysis, stroke, prolonged ventilation and length of stay, were linked to higher mortality. An STS score ≥ 1.645 indicated a high mortality risk group with a 10.3% mortality rate. This cutoff had a sensitivity of 74.5% and specificity of 78.2%, contributing to an accuracy of 78.08%.ConclusionsThe STS risk calculator demonstrated robust predictive performance in this cohort, supporting its utility in the local context.

BackgroundFor risk stratifying patients undergoing coronary artery bypass graft (CABG), the Society of Thoracic Surgeons (STS) risk score and the European System for Cardiac Operative Risk Evaluation (EuroSCORE) are currently used. However, the superiority of one over the other in the context of Indian patients has not been assessed. The aim of this study was to compare these 2 scoring systems in Indian patients undergoing CABG.MethodologyThis was a retrospective analysis of prospectively collected data between January 2015 and September 2020 of all patients undergoing CABG. Observed mortality in the cohort was compared with the predicted mortality using the STS and the EuroSCORE II. Sensitivity and specificity were calculated for both the scores. Receiver operating characteristic (ROC) curves were constructed for both the STS and the EuroSCORE II and area under the ROC curve (AUC) was calculated.ResultsA total of 4895 patients were included in the study. The overall observed mortality in the entire cohort was 74 (1.5%). The EuroSCORE II–predicted mortality was 1.9 ± 2.5 whereas the STS score–predicted mortality was 1.2 ± 1.8. The observed to predicted mortality ratio for EuroSCORE was 0.79 and 1.25 for the STS score. The discriminative ability for operative mortality of the STS score was 0.72 (0.71 to 0.74) and 0.713 for the EuroSCORE, suggesting satisfactory discriminatory power. There was no difference between the STS score and the EuroSCORE in terms of discriminatory power (p = 0.58) and a difference in the AUC being 0.01. The discriminatory power of the EuroSCORE and the STS score was best in the high-risk category.ConclusionsBoth the EuroSCORE and the STS scores had satisfactory and similar discriminatory power. However, in the Indian population, while the EuroSCORE II overestimated mortality, the STS score underestimated it to a similar degree of error.

To assess and compare the predictive ability of three risk evaluation systems (SinoSCORE, EuroSCORE II and the STS risk evaluation system) in patients aged ≥70, and who underwent coronary artery bypass grafting (CABG) in East China. Three risk evaluation systems were applied to 1,946 consecutive patients who underwent isolated CABG from January 2004 to September 2016 in two hospitals. Patients were divided into two subsets according to their age: elderly group (age ≥70) with a younger group (age <70) used for comparison. The outcome of interest in this study was in-hospital mortality. The entire cohort and subsets of patients were analyzed. The calibration and discrimination in total and in subsets were assessed by the Hosmer-Lemeshow and the C statistics respectively. Institutional overall mortality was 2.52%. The expected mortality rates of SinoSCORE, EuroSCORE II and the STS risk evaluation system were 0.78(0.64)%, 1.43(1.14)% and 0.78(0.77)%, respectively. SinoSCORE achieved the best discrimination (the area under the receiver operating characteristic curve (AUC) = 0.829), followed by the STS risk evaluation system (AUC = 0.790) and EuroSCORE II (AUC = 0.769) in the entire cohort. In the elderly group, the observed mortality rate was 4.82% while it was 1.38% in the younger group. SinoSCORE (AUC = .829) also achieved the best discrimination in the elderly group, followed by the STS risk evaluation system (AUC = .730) and EuroSCORE II (AUC = 0.640) while all three risk evaluation systems all had good performances in the younger group. SinoSCORE, EuroSCORE II and the STS risk evaluation system all achieved positive calibrations in the entire cohort and subsets. The performance of the three risk evaluation systems was not ideal in the entire cohort. In the elderly group, SinoSCORE appeared to achieve better predictive efficiency than EuroSCORE II and the STS risk evaluation system.

Background The assessment of procedural risk is crucial in patients with severe symptomatic aortic stenosis. Logistic EuroSCORE and STS score are currently used to estimate procedural risk and mortality for surgical and transcatheter aortic valve implantation (TAVI). The recently published EuroSCORE II might provide a helpful tool. Methods The new EuroSCORE II was calculated in 206 patients undergoing transfemoral TAVI and compared to the established logistic EuroSCORE and STS mortality score. Discriminative power and calibration of each test was statistically evaluated. Results 30-day and 1-year mortality rates were 6.8 % (14/206) and 27.2 % (56/206). In-hospital mortality rate was 29.2 ± 17.8 % with logistic EuroSCORE, 9.5 ± 6.8 % with STS score, and 9.22 ± 7.12 % with EuroSCORE II: Logistic EuroSCORE and EuroSCORE II were significantly increased in non-survivors compared to survivors at 30 days and at 1 year. EuroSCORE II and STS score ( r  = 0.49, p  < 0.001) showed moderate correlation, whereas strong correlation was found between EuroSCORE II and logistic EuroSCORE ( r  = 0.71, p  < 0.001). ROC curve analyses for the prediction of 30-day mortality (AUC 0.79 vs. 0.69 vs. 0.71) and 1-year mortality (AUC 0.72 vs. 0.70 vs. 0.70) were performed. Statistical comparison revealed no difference between the AUCs ( p  > 0.05). Conclusion In percutaneous TAVI patients, 30-day mortality was best approximated by the new EuroSCORE II, whereas the logistic EuroSCORE best reflected 1-year mortality. However, EuroSCORE II does not provide additional prognostic information beyond the established logistic EuroSCORE. For more exact risk prediction in TAVI, a distinct TAVI risk score would be desirable.