Natural history outcome of moderate tricuspid regurgitation with preserved left-ventricular ejection fraction.

Background: The long-term natural history of moderate tricuspid regurgitation (TR) patients with preserved left-ventricular ejection fraction (LVEF) and without severe left-sided valvular heart disease (VHD) remains ambiguous. We aimed to assess the outcomes of patients with moderate TR, preserved LVEF and without concomitant severe left-sided VHD.

Methods: We evaluated patients diagnosed with moderate TR in our centers between 2012 and 2020.

Cardiac CT for Aortic Stenosis: Novel Quantitative Techniques for Comprehensive Patient Assessment.

In recent years, the landscape for the diagnosis and management of patients with aortic stenosis (AS) has rapidly changed, with a dramatic increase in therapeutic options and substantial advances in different imaging modalities. Multidetector CT (MDCT) has become an essential imaging tool for evaluating the feasibility of both surgical and interventional treatments for patients with severe AS. Novel MDCT imaging acquisition protocols, postprocessing tools, and technological advances offer not only detailed anatomic information for adequate procedural planning but also comprehensive quantitative evaluation of the myocardium for assessment of remodeling and function, both of which have prognostic and therapeutic implications.

Redefining the risk of major arrhythmic events in non-ischaemic cardiomyopathy: insights from the DERIVATE-NICM study.

Aims: Selection of the patients for implantable cardioverter defibrillator primary prevention therapy in non-ischaemic cardiomyopathy (NICM) needs to be improved. To evaluate the additional prognostic value of a new cardiac magnetic resonance (CMR) score based on late gadolinium enhancement (LGE) pattern distribution (DERIVATE Risk Score 2.0) when compared with previously published DERIVATE Risk Score 1.

Heart Valve Centre Approach to Severe Tricuspid Regurgitation: Real-World Data and Outcomes.

Background: Severe tricuspid regurgitation (TR) is associated with significant morbidity and mortality but remains markedly undertreated. Optimal management strategies and the timing of intervention are still unclear.

Methods: We retrospectively analysed 476 patients with isolated symptomatic severe TR treated at our heart valve centre from 2018 to 2023.

Early Stroke Volume Variation After Transcatheter or Surgical Aortic Valve Replacement Predicts Clinical Outcomes in Low-Flow Aortic Stenosis.

Background: Little is known about stroke volume index (SVi) change and its prognostic implication in patients with low-flow aortic stenosis (AS) undergoing aortic valve replacement (AVR) and conflicting results are present in literature. The aim of this study was to evaluate the postoperative change in SVi and its impact on outcomes in patients with low-flow severe AS undergoing AVR.

Methods: Retrospective observational study of a high-volume tertiary care center including consecutive patients with low-flow (SVi ≤ 35 mL/m) severe AS who underwent AVR (either surgical or transcatheter) with available comprehensive pre- and post-AVR echocardiographic assessment.

Feasibility of Computed Tomography as a Gatekeeper for Invasive Angiography Before TAVR: A Pragmatic Real-World Experience.

Background: Although pretranscatheter aortic valve replacement-computed tomography angiography (TAVR-CTA) has shown a good correlation with invasive coronary angiography (ICA) for ruling out obstructive coronary artery disease (CAD), its clinical effectiveness and safety as a gatekeeper for ICA pre-transcatheter aortic valve replacement (pre-TAVR) remain unclear. This study aims to determine whether routine TAVR-CTA, without premedication, could safely defer and guide the need for ICA pre-TAVR.

Methods: Patients who underwent TAVR evaluation with either TAVR-CTA or ICA to determine CAD between 2017 and 2022 were included.

The Last Decade in Tricuspid Regurgitation: How Imaging Shaped a Field.

The tricuspid valve has become a major focus of novel structural heart interventions, with the Conformité Européenne approval of 5 devices in Europe and the U.S. Food and Drug Administration approval of 2 devices in the United States.

Prevalence, clinical characterization, management and evolution of bicuspid aortic valve classified according to the 2021 International Consensus Statement in a tertiary care hospital.

Objectives: The 2021 International Consensus for the congenital bicuspid aortic valve (BAV) condition recognizes 3 morphologies of BAV (fused, two-sinus and partial-fusion) and 3 types of aortopathy (ascending, root and extended). The clinical impact of BAV phenotyping on aortopathy evolution has not been evaluated so far. The aims were to assess: (i) prevalence of BAV phenotypes; (ii) frequency of BAV-related aortic valve dysfunction and aortopathy; and (iii) inter-phenotypic differences in aortopathy progression in a real-world population.

Therapeutical approach of tricuspid regurgitation and right heart failure.

Significant tricuspid regurgitation (TR) is a relatively common condition, affecting approximately 4 % of the elderly population. However, there are currently no clear guidelines for its medical management due to a lack of sufficient data in the literature. This review examines the pathophysiology of TR, categorizes its etiologies, and evaluates therapeutic options, both pharmacological and non-pharmacological, to optimize intervention timing and hemodynamic management.

Endocarditis and Hypertrophic Cardiomyopathy.

Infective endocarditis (IE) is an uncommon but potentially fatal complication in patients affected by hypertrophic cardiomyopathy (HCM). The risk has been described to be significantly higher than in the general population, but the incidence of IE in HCM population remains unknown. The complex pathophysiology of this disease, characterized by structural alterations of the mitral valve apparatus and the presence of turbulent flow that promotes the deposition of microorganisms, could provide a substrate for IE and may, to some extent, explain its higher incidence in this specific population.

CarDiac magnEtic Resonance for prophylactic Implantable cardioVerter defibrillAtor ThErapy in Non-Dilated Left Ventricular Cardiomyopathy: a sub-study from the DERIVATE registry.

Aims: Accurate risk stratification for patients with non-dilated left ventricular cardiomyopathy (NDLVC) remains challenging due to lack of dedicated clinical trials. This post hoc analysis aims to delineate the arrhythmic risk and assess the incremental value of cardiac magnetic resonance (CMR) imaging in the CarDiac magnEtic Resonance for prophylactic Implantable-cardioVerter defibrillAtor ThErapy (DERIVATE) study cohort meeting the NDLVC diagnostic criteria.

Methods And Results: Patients with NDLVC from the DERIVATE registry were identified in the absence of left ventricular (LV) dilatation and in the presence of non-ischaemic LV scarring ('fibrotic NDLVC') or isolated LV systolic dysfunction (LV ejection fraction < 50%) without fibrosis ('hypokinetic NDLVC').

Diagnosis of atrial cardiomyopathy: from the electrocardiogram to the new opportunities with multimodality imaging.

Atrial cardiomyopathy (AC) has been defined by the European Heart Rhythm Association as "Any complex of structural, architectural, contractile, or electrophysiologic changes in the atria with the potential to produce clinically relevant manifestations".1 The left atrium (LA) plays a key role in maintaining normal cardiac function; in fact atrial dysfunction has emerged as an essential determinant of outcomes in different clinical scenarios, such as valvular diseases, heart failure (HF), coronary artery disease (CAD) and atrial fibrillation (AF). A comprehensive evaluation, both anatomical and functional, is routinely performed in cardiac imaging laboratories.

Transcatheter Approaches to Atrial Functional Mitral Regurgitation: How Far Have We Come?

Functional mitral regurgitation (MR) is associated with increased cardiovascular morbidity and mortality and over the past decade, the diagnosis of atrial functional mitral regurgitation (aFMR) has been increasingly observed in the elderly, especially in those with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). Annular enlargement, perturbations of annular contraction, and atriogenic leaflet tethering distinguish the pathophysiology of aFMR from the one of ventricular origin. However, no consensus provides recommendations regarding the differential diagnosis and the subsequent management of aFMR.

Left atrial appendage closure in patients with failure of anticoagulation therapy: A multicenter comparative study on the hybrid strategy using DOACs and VKAs.

Background: Patients with non-valvular atrial fibrillation (nvAF) who experienced a cardioembolic (CE) event despite adequate oral anticoagulation (OAC) are at high risk of recurrence and the combination between percutaneous left atrial appendage closure (LAAC) and long-term OAC may be a valuable option. The aim of this study was to compare the safety and the efficacy of post-LAAC long-term assumption of direct oral anticoagulants (DOACs) vs. vitamin K antagonists (VKAs) in this population.

Clinical parameters of death and heart failure hospitalization in biventricular systolic dysfunction assessed via cardiac magnetic resonance.

Aims: While factors associated with adverse events are well elucidated in setting of isolated left ventricular dysfunction, clinical and imaging-based prognosticators of adverse outcomes are lacking in context of biventricular dysfunction. The purpose of this study was to establish role of clinical variables in prognosis of biventricular heart failure (HF), as assessed by cardiac magnetic resonance imaging.

Methods: Study cohort consisted of 840 patients enrolled in DERIVATE registry with coexisting CMR-derived right ventricular (RV) and left ventricular (LV) dysfunction, as defined by RV and LV ejection fractions ≤45 % and ≤ 50 %, respectively.

Incidence, Predictors, and Outcomes of Unplanned Coronary Angiography After Transcatheter Aortic Valve Replacement.

Background: Assessment of coronary artery disease (CAD) is critical in managing severe aortic stenosis. Unplanned coronary angiography after TAVR, with or without percutaneous coronary intervention, may present significant challenges.

Objectives: The aim of this study was to evaluate the incidence, predictors, and outcomes of unplanned coronary angiography after transcatheter aortic valve replacement (TAVR).