Functional Mitral Regurgitation in the Transcatheter Era: Diagnostic and Therapeutic Pathways.

Functional mitral regurgitation (FMR) is a common condition with significant prognostic implications, primarily driven by left atrial or ventricular remodeling secondary to ischemic or non-ischemic cardiomyopathies. While guideline-directed medical therapy (GDMT) remains the cornerstone of management, reducing mitral regurgitation severity in up to 40-45% of cases, additional interventions are often necessary. In patients where atrial fibrillation (AF) or ventricular dyssynchrony due to abnormal electrical conduction contributes to disease progression, guideline-directed AF management or cardiac resynchronization therapy plays a pivotal role.

Impact of Atrial Fibrillation in Patients With Severe Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair.

Background: Atrial fibrillation (AF) and mitral regurgitation (MR) are closely linked, and one may worsen the other. We investigated the impact of baseline AF in patients with MR undergoing transcatheter edge-to-edge repair.

Methods: One-hundred-fifty-six consecutive patients with symptomatic heart failure (HF) undergoing mitral valve transcatheter edge-to-edge repair for severe MR were studied.

Exercise Doppler Echocardiography of the Right Heart and Pulmonary Circulation in Patients With Cardiovascular Risk Factors: Observations From the RIGHT Heart International NETwork (RIGHT-NET).

Background: The precise impact of cardiovascular risk factors (CVRFs) on the right ventricle-pulmonary circulation unit remains unclear.

Research Question: Are there any differences regarding resting and exercise right ventricular function in patients with CVRFs but without overt cardiovascular disease when compared with healthy control patients?

Study Design And Methods: We extracted from the Right Heart International Network international registry the data of 362 patients with at least 1 CVRF but no overt cardiovascular disease, and 375 healthy control patients. All patients and control patients had undergone resting and exercise echocardiographic evaluations on a semirecumbent cycle ergometer.

Circulating miR-10b-5p, miR-193a-3p, and miR-1-3p Are Deregulated in Patients with Heart Failure and Correlate with Hormonal Deficiencies.

Heart failure (HF) is among the most important causes of worldwide morbidity, hospitalisation, and mortality. A reduction in anabolic hormonal axes seems to potentially play an important role in chronic HF progression and prognosis. Several lines of evidence support the critical roles of miRNAs in the endocrine system, and differentially expressed miRNA patterns were found to be able to detect HF.

Current and future applications of photon-counting computed tomography in cardiovascular medicine.

Photon-counting CT (PCCT) represents a transformative advancement in cardiac imaging, addressing key limitations of conventional CT. This review synthesises current evidence to demonstrate how PCCT's superior spatial resolution, enhanced tissue characterisation and multienergy capabilities broaden the diagnostic potential of cardiac CT. Applications include the precise detection and quantification of coronary artery calcifications, evaluation of coronary plaque burden and composition, improved assessment of coronary stents, and comprehensive myocardial tissue characterisation and perfusion analysis.

PCSK9 Inhibitors "Fast Track" Use Versus "Stepwise" Lipid-Lowering Therapy in Patients with Acute Coronary Syndrome: A Retrospective Single-Center Study in a "Real-World" Population.

: The "fast track" addition (within 48 h) of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) to the optimized oral lipid-lowering therapy (LLT) during hospitalization for acute coronary syndrome (ACS) has been shown to rapidly achieve the low-density lipoprotein cholesterol (LDL-C) therapeutic targets. However, so far, its efficacy in real-world settings remains understudied. : We retrospectively analyzed 128 ACS patients treated at our center, comparing "PCSK9i fast track" use within 48 h to standard "stepwise" LLT.

NAXCARE: a clinical outcome registry for Naxos disease and related cardiocutaneous syndromes.

The NAXCARE (NAXos disease and Cardiocutaneous Assessment and Registry for Evaluation) is a global initiative designed to collect, store, and analyze clinical outcomes data on patients with Naxos disease and related cardiocutaneous syndromes (CCS). This registry aims to fill the gaps in clinical knowledge, enhance treatment approaches, and improve patient outcomes by systematically documenting disease progression, genetic profiles, and patient care pathways. The following methodology outlines the registry's design, data collection protocols, management, security measures, and anticipated contributions to research and clinical practice.

Post-implantation syndrome in patients undergoing thoracic and abdominal endovascular aortic repair: Comprehensive systematic review and meta-analysis.

Post-implantation syndrome (PIS) can lead to prolonged hospitalization and major adverse cardiovascular events (MACE). This systematic review and meta-analysis investigated the clinical profile of PIS after abdominal (EVAR) and thoracic endovascular aortic repair (TEVAR). A comprehensive literature search identified 1463 studies, of which 16 (14 retrospective and 2 prospective) met the inclusion criteria.

Exercise Echocardiography of Left Ventricular Diastolic Function in Healthy Subjects: Insights From the RIGHT-NET.

Background: Exercise transthoracic Doppler echocardiography (TTE) is considered suggestive of left ventricular (LV) diastolic dysfunction when the ratio of mitral Doppler E to tissue Doppler e' waves is >15 with or without a peak tricuspid regurgitation velocity (TRV) >3.4 m/s. However, these measurements may be affected by exercise intensity.

Coronary Artery Disease and Heart Failure: Medical Management and Future Direction.

Coronary artery disease (CAD) is a leading etiology of heart failure (HF) and serves as a significant therapeutic target to ameliorate HF-associated morbidity and mortality. Key management considerations include pharmacologic treatment, electrophysiological devices, and coronary revascularization, aimed toward preventing CAD progression, left ventricular remodeling, sudden death, and reinfarction. The optimal revascularization strategy for patients with CAD and HF who are surgical candidates requires careful assessment of each patients' unique risk/benefit profile and individual preferences.

Comparative Outcomes of Mitral Valve Repair Versus Replacement in Infective Endocarditis: A 16-Year Meta-Analysis of Time-to-Event Data From Over 4000 Patients.

Mitral valve (MV) repair for infective endocarditis (IE) has proven to be a good and safe option, but current trends favor replacement; the available data, in addition, don't allow to reach a general consensus on the preferred first-line approach. The present metanalysis, aimed to compare short- and long-term outcomes between MV repair (MVRep) and MV replacement (MVR) in patients with IE. A search of PubMed was conducted on 30th August 2024, yielding 120 results.

Exercise Training and Rehabilitation in Cardiac Amyloidosis (ERICA) Study: Rationale and Design.

Notwithstanding the dramatic improvement associated with Tafamidis in Heart Failure due to wild-type transthyretin cardiac amyloidosis (ATTRwt-CA), the effect of exercise training on ATTRwt-CA remains unexplored. We hereby present rationale and design of the Exercise training and Rehabilitation in Cardiac Amyloidosis study. This interventional, controlled study will randomize ATTRwt-CA patients into a control group and a training group.

Growth Hormone Replacement Therapy in Heart Failure With Reduced Ejection Fraction: A Randomized, Double-Blind, Placebo-Controlled Trial.

Background: Growing evidence suggests that reduced activity of the growth hormone (GH)/insulin-like growth factor (IGF)-1 axis is common and associated with poor clinical status and outcome in heart failure (HF). In addition, preliminary results of growth hormone deficiency (GHD) correction in HF showed an improvement in quality of life, cardiac structure and function, and cardiovascular performance.

Objectives: The aim of the present double-blind, randomized, placebo-controlled trial was to evaluate the cardiovascular effects of 1 year of GH replacement therapy in a cohort of patients with heart failure and reduced ejection fraction (HFrEF).

Cardiac Tamponade Complicating Type A Acute Aortic Dissection: Insights From 25 Years of Registry Research.

Background: Cardiac tamponade (TMP) is a catastrophic complication of type A acute aortic dissection (TAAAD), increasing the risk of morbidity and mortality.

Objectives: The present study aimed to assess the characteristics, management, and outcomes of TAAAD patients with preoperative TMP enrolled in the International Registry of Acute Aortic Dissection database from 1996 to 2022.

Methods: Data from 63 aortic centers were analyzed and TAAAD patients with and without preoperative TMP were compared.

Transcatheter aortic valve implantation vs. surgery for failed bioprosthesis: a meta-analysis of over 20 000 patients.

Objectives: Valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) has gained popularity as a less invasive alternative to a redo surgical aortic valve replacement (redo-SAVR); which one is the preferred technique in these cases, however, remains a topic of debate, as the available data refer to retrospective studies with few patients or limited follow-up. The present metanalysis aimed to compare the short-term and long-term outcomes of the two techniques in the setting of a failed surgical bioprosthesis.

Methods: PubMed, MEDLINE, and Embase were searched on 10 November 2023 yielding 355 results (PROSPERO ID: CRD42023490612), of which 27 were suitable for meta-analysis.

Naxos Disease and Related Cardio-Cutaneous Syndromes.

Naxos disease is a rare autosomal recessive condition combining arrhythmogenic right ventricular cardiomyopathy, woolly hair, and palmoplantar keratoderma. The first identified causative variant was in the gene encoding the desmosomal protein plakoglobin. Naxos disease exhibits fibro-fatty myocardial replacement with immunohistological abnormalities in cardiac protein and signaling pathways, highlighting the role of inflammation and potential anti-inflammatory treatments.

Association of sodium-glucose cotransporter-2 inhibitors with mortality across the spectrum of myocardial infarction: a systematic review and meta-analysis.

Background: The impact of sodium-glucose cotransporter-2 (SGLT2) inhibitors on mortality following myocardial infarction (MI) remains uncertain. Additionally, the role of type 2 diabetes mellitus (T2DM) and heart failure (HF) in modulating the effectiveness of these drugs post-MI are not fully understood. This meta-analysis aimed to assess the association of SGLT2 inhibitors with all-cause mortality in post-MI patients and to explore key moderators influencing this benefit.

Sex-Specific Differences in Echocardiographic Parameters of Risk Stratification in Pulmonary Arterial Hypertension.

Background: In healthy subjects, sex differences in right heart function have been detected for various echocardiographic parameters. The objective of this study was to investigate sex differences in echocardiographic European Society of Cardiology (ESC)/European Respiratory Society (ERS) risk stratification parameters and their impact on survival estimation in patients with pulmonary arterial hypertension (PAH).

Methods: In this retrospective, cross-sectional study with a mean follow-up time of 3.

A pulmonary hypertension targeted algorithm to improve referral to right heart catheterization: A machine learning approach.

Background: Pulmonary hypertension (PH) is a pathophysiological problem that may involve several clinical symptoms and be linked to various respiratory and cardiovascular illnesses. Its diagnosis is made invasively by Right Cardiac Catheterization (RHC), which is difficult to perform routinely. Aim of the current study was to develop a Machine Learning (ML) algorithm based on the analysis of anamnestic data to predict the presence of an invasively measured PH.

Aortic Dimension in Elite Athletes: Updated Systematic Review and Meta-Analysis.

Aims: To assess the presence and the extent of an "aortic remodeling" in elite athletes.

Methods: A systematic review and meta-analysis of literature were conducted for studies (1981-2024) reporting echocardiographic aortic diameters of elite athletes compared to non-athlete healthy controls. Among the 5,494 studies retrieved, 21 (9,464 elite athletes vs.

Normal Hemodynamic Response to Exercise.

Exercise pulmonary hypertension has been invasively defined as mean pulmonary artery pressure/cardiac output slope greater than 3 mm Hg/L/min. Recent advances suggest the sustainable role of exercise Doppler echocardiography for the study of the right heart and pulmonary circulation unit (RH-PCU). Herein, the authors review the invasive versus non-invasive monitoring of the RH-PCU response to exercise in healthy subjects.