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Seismic capacity assessment of existing buildings is of paramount importance for mitigating the seismic risk in earthquake-prone areas. In Europe, the next version of Eurocode 8 and the current version of the Italian standards suggest the adoption of both linear and nonlinear approaches to perform seismic analyses of existing masonry buildings. This paper discusses with the main issues concerning linear and nonlinear analyses methodologies provided by the Italian standards for existing unreinforced masonry buildings. An historical building located in Southern Italy, representative of the Mediterranean basin buildings, has been chosen as a case study and modelled through the equivalent frame model. According to the Italian standards, the influence of in-plane stiffness of floors and spandrels on the overall seismic capacity of the structure has been considered in the analyses. Beyond the code prescriptions, the effect of different ultimate drifts values assumed for the spandrels on nonlinear behavior of the structure has been analysed. The results of two types of linear analyses (lateral static force method and modal response spectrum analysis) have been compared among them and with those provided by the nonlinear static method. Conclusions show that either behavior and overstrength factors provided by the Italian standards are conservative than those estimated through the nonlinear static analyses. Moreover, it has been remarked that the value of ultimate drift adopted for the spandrel can affect significantly the nonlinear response of the structures, although this topic still represents an open issue.

Objectives: The aim of this study was to assess acute regurgitation following transcatheter aortic valve replacement, comparing different implanted transcatheter heart valves. Background: Regurgitation following transcatheter aortic valve replacement influences all-cause mortality. Thus far, no quantitative comparison of regurgitation among multiple commercially available transcatheter heart valves has been performed. Methods: Aortograms from a multicenter cohort of consecutive 3,976 transcatheter aortic valve replacements were evaluated in this pooled analysis. A total of 2,258 (58.3%) were considered analyzable by an independent academic core laboratory using video densitometry. Results of quantitative regurgitation are shown as percentages. The valves evaluated were the ACURATE (n = 115), Centera (n = 11), CoreValve (n = 532), Direct Flow Medical (n = 21), Evolut PRO (n = 95), Evolut R (n = 295), Inovare (n = 4), Lotus (n = 546), Lotus Edge (n = 3), SAPIEN XT (n = 239), and SAPIEN 3 (n = 397). For the main analysis, only valves with more than 50 procedures (7 types) were used. Results: The Lotus valve had the lowest mean regurgitation (3.5 ± 4.4%), followed by Evolut PRO (7.4 ± 6.5%), SAPIEN 3 (7.6 ± 7.1%), Evolut R (7.9 ± 7.4%), SAPIEN XT (8.8 ± 7.5%), ACURATE (9.6 ± 9.2%) and CoreValve (13.7 ± 10.7%) (analysis of variance p < 0.001). The only valves that statistically differed from all their counterparts were Lotus (as the lowest regurgitation) and CoreValve (the highest). The proportion of patients presenting with moderate or severe regurgitation followed the same ranking order: Lotus (2.2%), Evolut PRO (5.3%), SAPIEN 3 (8.3%), Evolut R (8.8%), SAPIEN XT (10.9%), ACURATE (11.3%), and CoreValve (30.1%) (chi-square p < 0.001). Conclusions: In this pooled analysis stemming from daily clinical practice, the Lotus valve was shown to have the best immediate sealing. This analysis reflects the objective evaluation of regurgitation by an academic core laboratory (nonsponsored) in a real-world cohort of patients using a quantitative technique.

Objectives This study aimed to compare differences in patient characteristics and clinical outcomes of nonagenarians undergoing transcatheter aortic valve replacement (TAVR) versus patients younger than 90 years of age and to test the predictive accuracy of the logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation), the EuroSCORE II, and the STS-PROM (Society of Thoracic Surgeons Predicted Risk of Mortality) for mortality after TAVR in nonagenarians. Background The prevalence of severe aortic valve stenosis is increasing due to the rising life expectancy. However, there are limited data evaluating outcomes in patients older than 90 years of age. Moreover, the predictive accuracy of risk scores for mortality has not been evaluated in nonagenarian patients undergoing transfemoral TAVR. Methods The CENTER (Cerebrovascular EveNts in Patients Undergoing TranscathetER Aortic Valve Implantation) collaboration (N = 12,381) is an international collaboration consisting of 3 national registries, 6 local or multicenter registries, and 1 prospective clinical study, selected through a systematic online search. The primary endpoint of this study was the difference in 30-day all-cause mortality and stroke after TAVR in nonagenarians versus patients younger than 90 years of age. Secondary endpoints included differences in baseline characteristics, in-hospital outcomes, and the differences in predictive accuracy of the logistic EuroSCORE, the EuroSCORE II, and STS-PROM. Results A total of 882 nonagenarians and 11,499 patients younger than 90 years of age undergoing transfemoral TAVR between 2007 and 2018 were included. Nonagenarians had considerably fewer comorbidities than their counterparts. Nevertheless, rates of 30-day mortality (9.9% vs. 5.4%; relative risk [RR]: 1.8; 95% confidence interval [CI]: 1.4 to 2.3; p = 0.001), in-hospital stroke (3.0% vs. 1.9%; RR: 1.5; 95% CI: 1.0 to 2.3; p = 0.04), major or life-threatening bleeding (8.1% vs. 5.5%; RR: 1.6; 95% CI: 1.1 to 2.2; p = 0.004), and new-onset atrial fibrillation (7.9% vs. 5.2%; RR: 1.6; 95% CI: 1.1 to 2.2; p = 0.01) were higher in nonagenarians. The STS-PROM adequately estimated mortality in nonagenarians, with an observed-expected mortality ratio of 1.0. Conclusions In this large, global, patient-level analysis, mortality after transfemoral TAVR was 2-fold higher in nonagenarians compared with patients younger than 90 years of age, despite the lower prevalence of baseline comorbidities. Moreover, nonagenarians had a higher risk of in-hospital stroke, major or life-threatening bleeding, and new-onset atrial fibrillation. The STS-PROM was the only surgical risk score that accurately predicted the risk of mortality in nonagenarians.

INTRODUCTION AND OBJECTIVES Acute kidney injury (AKI) is frequently observed after transcatheter aortic valve implantation (TAVI) and is associated with higher mortality. However, the impact of AKI on long-term outcomes remains controversial. Therefore, we sought to evaluate the impact of AKI on short- and long-term outcomes following TAVI using the Valve Academic Research Consortium 2 criteria. METHODS Consecutive patients (n = 794) with severe aortic stenosis who underwent TAVI were included in a multicenter Brazilian registry. Logistic regression analysis was used to identify predictors of AKI. Four-year outcomes were determined as Kaplan-Meier survival curves, and an adjusted landmark analysis was used to test the impact of AKI on mortality among survivors at 12 months. RESULTS The incidence of AKI after TAVI was 18%. Independent predictors of AKI were age, diabetes mellitus, major or life-threatening bleeding and valve malpositioning. Acute kidney injury was independently associated with higher risk of all-cause death (adjusted HR, 2.8; 95%CI, 2.0-3.9; P < .001) and cardiovascular mortality (adjusted HR, 2.9; 95%CI, 1.9-4.4; P < .001) over the entire follow-up period. However, when considering only survivors at 12 months, there was no difference in both clinical endpoints (adjusted HR, 1.2; 95%CI, 0.5-2.4; P = .71, and HR, 0.7; 95%CI, 0.2-2.1; P = .57, respectively). CONCLUSIONS Acute kidney injury is a frequent complication after TAVI. Older age, diabetes, major or life-threatening bleeding, and valve malpositioning were independent predictors of AKI. Acute kidney injury is associated with worse short- and long-term outcomes. However, the major impact of AKI on mortality is limited to the first year after TAVI.

Resumen Introduccion y objetivos El dano renal agudo (DRA) ocurre con frecuencia tras el implante percutaneo de valvula aortica (TAVI) y se asocia con una mayor mortalidad. Sin embargo, el impacto del DRA en la evolucion a largo plazo continua siendo controvertida. Por dicho motivo se evalua el impacto del DRA el resultado a corto y largo plazo tras el TAVI usando los criterios Valve Academic Research Consortium 2. Metodos Se incluyeron 794 pacientes consecutivos con estenosis aortica grave en un registro multicentrico brasileno. Para la identificacion de los predictores de DRA se utilizo el analisis de regresion logistica. La supervivencia a 4 anos se determino mediante las curvas de Kaplan-Meier y para determinar el impacto del DRA en la mortalidad entre los supervivientes a 12 meses se uso un analisis de punto de referencia ajustado. Resultados La incidencia de DRA tras el TAVI fue del 18%. Los predictores independientes de DRA fueron: edad, diabetes mellitus, hemorragia mayor o amenazante para la vida y la malaposicion valvular. El DRA se asocio independientemente con un riesgo mayor de muerte total (HR ajustada = 2,8; IC95%, 2,0-3,9; p Conclusiones El DRA es una complicacion frecuente tras el TAVI. La edad avanzada, la diabetes, la hemorragia mayor o amenazante para la vida y la malaposicion valvular eran factores predictivos de DRA. El DRA se asocio con el pronostico a corto y largo plazo, sin embargo, el impacto del DRA sobre la mortalidad se limito al primer ano tras el TAVI.

Objectives The authors aimed to determine the procedural learning curve and minimum annual institutional volumes associated with optimum clinical outcomes for transcatheter aortic valve replacement (TAVR). Background Transcatheter aortic valve replacement (TAVR) is a complex procedure requiring significant training and experience for successful outcome. Despite increasing use of TAVR across institutions, limited information is available for its learning curve characteristics and minimum annual volumes required to optimize clinical outcomes. Methods The study collected data for patients at 16 centers participating in the international TAVR registry since initiation of the respective TAVR program. All cases were chronologically ordered into initial (1 to 75), early (76 to 150), intermediate (151 to 225), high (226 to 300), and very high (>300) experience operators for TAVR learning curve characterization. In addition, participating institutions were stratified by annual TAVR case volume into low-volume ( 100) groups for comparative analysis. Procedural and 30-day clinical outcomes were collected and multivariate regression analysis performed for 30-day mortality and the early safety endpoint. Results A total of 3,403 patients comprised the study population. On multivariate analysis, all-cause mortality was significantly higher for initial (odds ratio [OR]: 3.83; 95% confidence interval [CI]: 1.93 to 7.60), early (OR: 2.41; 95% CI: 1.51 to 5.03), and intermediate (OR: 2.53; 95% CI: 1.19 to 5.40) experience groups compared with the very high experience operators. In addition, the early safety endpoint was significantly worse for all experience groups compared with the very high experience operators. Low annual volume ( Conclusions TAVR procedures display important learning curve characteristics with both greater procedural safety and a lower mortality when performed by experienced operators. In addition, TAVR performed at low annual volume (

In-plane seismic behaviour of Cross-Laminated Timber (CLT) walls is influenced by panel-to-panel and panel-to-foundation mechanical connections, which consist of hold-downs and angle brackets. Due to the platform constructional technology, the orthogonal to grain timber-to-timber contact is also involved in the seismic response of the panels. To date, literature theoretical approaches to evaluating the flexural load-bearing capacity of CLT panels focus their attention on the schematization of hold-downs and angle brackets only, under evaluating the role of timber compressed in the perpendicular direction. In this paper the influence of orthogonal to grain timber properties on the overall seismic behaviour of CLT walls has been investigated, proposing a general theoretical model to schematize the panel-to-panel and panel-to-foundation connections. A parabola-rectangle constitutive behaviour has been defined to describe the orthogonal to grain timber behaviour in the connection zones, while hold-downs and angle brackets are modelled adopting literature models. Five different failure conditions, described by mathematical formulations, able to describe the entire axial force-bending moment interaction domain have been defined. The proposed model has also been employed to schematize the connection zones in multi-storey CLT walls with openings, allowing to investigate the effect of the orthogonal to grain properties on its seismic behaviour. Results of nonlinear analyses demonstrate a significant influence of orthogonal to grain timber properties on seismic behaviour of the walls, affecting their strength, stiffness, ductility and collapse mechanisms.

The femoral venous approach for percutaneous edge-to-edge repair of the mitral valve with the MitraClip system (Abbott Vascular, Santa Clara, California) may not be possible in patients with occlusion or congenital anomalies of the inferior vena cava (IVC) or limited by the presence of an IVC filter

Background Cardiac biomarker release signifying myocardial injury post-transcatheter aortic valve replacement (TAVR) is common, yet its clinical impact within a large TAVR cohort receiving differing types of valve and procedural approaches is unknown. Objectives This study sought to determine the incidence, clinical impact, and factors associated with cardiac biomarker elevation post TAVR. Methods This multicenter study included 1,131 consecutive patients undergoing TAVR with balloon-expandable (58%) or self-expandable (42%) valves. Transfemoral and transapical (TA) approaches were selected in 73.1% and 20.3% of patients, respectively. Creatine kinase-myocardial band (CK-MB) measurements were obtained at baseline and at several time points within the initial 72 h post TAVR. Echocardiography was performed at baseline and at 6- to 12-month follow-up. Results Overall, 66% of the TAVR population demonstrated some degree of myocardial injury as determined by a rise in CK-MB levels (peak value: 1.6-fold [interquartile range (IQR): 0.9 to 2.8-fold]). A TA approach and major procedural complications were independently associated with higher peak of CK-MB levels (p Conclusions Some degree of myocardial injury was detected in two-thirds of patients post TAVR, especially in those undergoing TA-TAVR or presenting with major procedural complications. A greater rise in CK-MB levels associated with greater acute and late mortality, imparting a negative impact on left ventricular function.

Background Little evidence exists of the burden and predictors of cardiac death after transcatheter aortic valve replacement (TAVR). Objectives The purpose of this study was to assess the incidence and predictors of cardiac death from advanced heart failure (HF) and sudden cardiac death (SCD) in a large patient cohort undergoing TAVR. Methods The study included a total of 3,726 patients who underwent TAVR using balloon (57%) or self-expandable (43%) valves. Causes of death were defined according to the Valve Academic Research Consortium–2. Results At a mean follow-up of 22 ± 18 months, 155 patients had died due to advanced HF (15.2% of total deaths, 46.1% of deaths from cardiac causes) and 57 had died due to SCD (5.6% of deaths, 16.9% of cardiac deaths). Baseline comorbidities (chronic obstructive pulmonary disease, atrial fibrillation, left ventricular ejection fraction ≤40%, lower mean transaortic gradient, pulmonary artery systolic pressure >60 mm Hg; p 160 ms had a greater SCD risk (HR: 4.78, 95% CI: 1.56 to 14.63; p = 0.006). Conclusions Advanced HF and SCD accounted for two-thirds of cardiac deaths in patients after TAVR. Potentially modifiable or treatable factors leading to increased risk of mortality for HF and SCD were identified. Future studies should determine whether targeting these factors decreases the risk of cardiac death.

The aim of this study is to evaluate the predictors of permanent pacemaker (PPM) implantation after TAVI.Between January 2008 and February 2012, 418 patients with severe aortic stenosis underwent TAVI and were enrolled in a Brazilian multicenter registry. After excluding patients who died during the procedure and those with a previous PPM, 353 patients were included in the analysis.At 30 days, the overall incidence of PPM implantation was 25.2%. Patients requiring PPM were more likely to be older (82.73 vs. 81.10 years, p=0.07), have pre-dilation (68.42% vs. 60.07%, p=0.15), receive CoreValve (93.68% vs. 82.55%, p=0.008), and have baseline right bundle branch block (RBBB, 25.26% vs. 6.58%, p0.001). On multivariable analysis, CoreValve vs. Sapien XT (OR, 4.24; 95% CI, 1.56-11.49; p=0.005), baseline RBBB (OR, 4.41; 95% CI, 2.20-8.82; p0.001), and balloon pre-dilatation (OR, 1.75; 95% CI, 1.02-3.02; p=0.04) were independent predictors of PPM implantation.PPM implantation occurred in approximately one-fourth of cases. Pre-existing RBBB, balloon pre-dilatation, and CoreValve use were independent predictors of PPM after TAVI. The type of prosthesis used and pre-balloon dilatation should be considered in TAVI candidates with baseline RBBB.

We developed a Monte-Carlo code for describing the reaction kinematics of the two-body direct processes employed of the EXOTIC beam-line of the Laboratori Nazionali di Legnaro (LNL) for the production of light weakly bound radioactive ion beams at energies of a few MeV/u. The program calculates the phase-space distribution of both primary and secondary beams at the target exit and uses these quantities to optimize the secondary beam selection with the EXOTIC spectrometer. The calculations have been performed and compared with the available experimental data for two reactions: (1)H(2)((17)O, (17)F)n and (3)He((6)Li, (8)B)n. (c) 2008 Elsevier B.V. All rights reserved.

Objectives This study sought to evaluate the main baseline and procedural characteristics, management, and clinical outcomes of patients from a large cohort of patients undergoing transcatheter aortic valve implantation (TAVI) who suffered coronary obstruction (CO). Background Very little data exist on CO following TAVI. Methods This multicenter registry included 44 patients who suffered symptomatic CO following TAVI of 6,688 patients (0.66%). Pre-TAVI computed tomography data was available in 28 CO patients and in a control group of 345 patients (comparisons were performed including all patients and a cohort matched 1:1 by age, sex, previous coronary artery bypass graft, transcatheter valve type, and size). Results Baseline and procedural variables associated with CO were older age (p Conclusions Symptomatic CO following TAVI was a rare but life-threatening complication that occurred more frequently in women, in patients receiving a balloon-expandable valve, and in those with a previous surgical bioprosthesis. Lower-lying coronary ostium and shallow sinus of Valsalva were associated anatomic factors, and despite successful treatment, acute and late mortality remained very high, highlighting the importance of anticipating and preventing the occurrence of this complication.

Proton elastic scattering and inelastic scattering to the first excited state of 6He have been measured over a wide angular range using a 40.9A MeV 6He beam. The data have been analyzed with a fully microscopic model of proton-nucleus scattering using 6He wave functions generated from large space shell model calculations. The inelastic scattering data show a remarkable sensitivity to the halo structure of 6He., Comment: 9 pages, 3 figures. RevTeX. Replaced figure 3 with updated figure

Data regarding operator radiation exposure related to radial versus femoral arterial access in patients undergoing percutaneous coronary intervention (PCI) remain controversial. This study sought to compare operator and patient radiation exposure during PCI with radial versus femoral access. This

FUNDAMENTOS: Os estudos randomizados que testaram os stents farmacológicos no infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAMSST) demonstraram resultados conflitantes. Além disso, a trombose do stent e o seguimento tardio pouco reportado permanecem como os grandes limitantes à expansão da aplicação desses dispositivos no IAMSST. OBJETIVO: Comparar as taxas de eventos cardíacos adversos maiores combinados (ECAM) e as taxas de trombose do stent em pacientes não-selecionados tratados com stents convencionais ou farmacológicos no IAMSST e alocados de forma não-randômica. MÉTODO: Entre janeiro de 2001 e julho de 2007, 251 pacientes consecutivos com IAMSST foram submetidos a angioplastia primária ou de resgate com implante de stent convencional (n = 112) ou farmacológico (n = 139), no Hospital Israelita Albert Einstein - São Paulo, SP. Investigamos a incidência de ECAM (óbito, infarto do miocárdio e revascularização do vaso-alvo [RVA]) e as taxas de RVA e trombose do stent. RESULTADOS: No total, a média das idades foi de 63 ± 13 anos, sendo 77% dos pacientes do sexo masculino. No seguimento mediano de 2,8 anos (1,3-4,4), a incidência de ECAM foi maior nos pacientes tratados com stents convencionais, em comparação com os tratados com stents farmacológicos (25,2% vs. 10,1%; p < 0,01), fundamentalmente pela maior mortalidade tanto global (17,8% vs. 5,1%; p < 0,01) como cardíaca (15,9 vs. 4,3; p < 0,01) no grupo dos stents convencionais. A taxa de RVA foi de 7,5% no grupo dos stents convencionais e de 3,6% no grupo dos stents farmacológicos (p = 0,25). Não observamos diferenças significativas na incidência de trombose do stent (3,7% vs. 2,2%; p = 0,7). CONCLUSÕES: Nessa série observacional, o uso dos stents farmacológicos no IAMSST apresentou menor taxa de ECAM em comparação aos stents convencionais no seguimento clínico tardio.

SUMMARY Sodium-Bicarbonate to Prevent Contrast-InducedNephropathy in Diabetic Patients: a Sub-Analysisof a Multicenter Clinical Trial Background: Contrast-induced nephropathy (CIN) isassociated with worse clinical outcomes both at short andlong-term follow-up. Recent evidence indicates thatintravenous hydration with sodium-bicarbonate may reducethe incidence of CIN. However, this strategy has not beenreported in diabetic patients. Methods: Sub-analysis of amulticenter study involving 301 patients with serumcreatinine ≥ 1,2 mg/dL or creatinine clearance < 50 mL/minsubmitted to coronary angiography or percutaneous coronaryintervention and randomized to intravenous hydration withsodium-bicarbonate or normal saline. All patients receivedlow-osmolar contrast media. We assessed the incidence ofCIN (defined as creatinine increase ≥ 0,5 mg/dL), and theaverage change in creatinine and creatinine clearance48 hours after the procedure. A total of 87 diabetic patientswere analyzed. Results: There was no difference betweengroups regarding baseline characteristics, contrast volu-me used, baseline creatinine levels and creatinine clearance.Eight patients presented CIN: 4 (9.8%) in the bicarbonategroup and 4 (8.9%) in the saline group (p = 0.9). The