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.

Long-term outcome of tailored antithrombotic therapy based on platelet function testing in patients undergoing percutaneous coronary intervention: a 5-year retrospective cohort study.

Dual antiplatelet therapy is the standard therapy for the secondary prevention of acute and chronic coronary syndromes in patients undergoing percutaneous coronary intervention (PCI). The introduction of more potent antiplatelet agents and understanding of prognostic implications associated with bleeding have led to a substantial evolution in antiplatelet treatment regimens over the past decades. Several investigations have been conducted to better stratify patients undergoing PCI according to their ischemic and bleeding risks and to optimize antithrombotic regimens accordingly.

Prevalence, classification, and treatment of residual shunt after patent foramen ovale closure.

Background: Residual shunt (RS) after transcatheter patent foramen ovale (PFO) closure has been associated with an increased risk of recurrent stroke over long-term follow-up. However, RS prevalence, anatomical characteristics, and treatment strategies are poorly understood.

Aims: This study aimed to assess the prevalence and causes of RS, as well as to evaluate the safety and feasibility of its percutaneous treatment.

How Can We Reduce Cardiovascular Risk in Women and Improve Risk Stratification?

Purpose Of Review: To explore sex-specific dimensions of cardiovascular disease (CVD) by addressing key questions: (1) What is the true burden of CVD in women, and how does it compare with that in men across diverse populations? (2) Do risk factors for CVD differ between sexes in prevalence, biological impact, and prognostic significance? (3) Should we adopt sex-specific cardiovascular risk stratification tools to improve diagnostic precision in women? (4) Is there a need for earlier or more aggressive preventive strategies in women, particularly for those with sex-specific or predominant risk factors?

Recent Findings: CVD remains the leading cause of morbidity and mortality among women worldwide. Despite advances in care, significant sex-based disparities persist in awareness, diagnosis, risk stratification, and treatment. Women often present with distinct biological and psychosocial risk factors that are underrecognized in standard assessments.

Timing, indications and transition patterns associated with cangrelor use in patients undergoing PCI.

Optimal antiplatelet therapy is crucial in percutaneous coronary intervention (PCI) to balance thrombotic and bleeding risk. Cangrelor, a rapid-acting intravenous P2Y12 inhibitor, is particularly effective in high-risk PCI scenarios, including acute coronary syndrome (ACS) or patients unable to take oral medications. The SMILE study evaluated real-world timing, indications, and outcomes of cangrelor use, along with transition to oral P2Y12 inhibitors, in high-risk patients undergoing PCI.

From Vision to Illumination: The Promethean Journey of Optical Coherence Tomography in Cardiology.

Optical Coherence Tomography (OCT) has evolved from a breakthrough ophthalmologic imaging tool into a cornerstone technology in interventional cardiology. After its initial applications in retinal imaging in the early 1990s, OCT was subsequently envisioned for cardiovascular use. In 1995, its ability to visualize atherosclerotic plaques was demonstrated in an in vitro study, and the following year marked the acquisition of the first in vivo OCT image of a human coronary artery.

Predictors of postprocedural troponin increase in patients undergoing elective percutaneous coronary intervention.

Background: Elevation in serum troponin following elective percutaneous coronary intervention (PCI) is indicative of post-PCI troponin increase (pTI) and is associated with higher mortality rates. In this analysis, we sought to identify clinical and angiographic risk factors for pTI.

Methods: Consecutive patients undergoing elective PCI with drug-eluting stent implantation at Mount Sinai Hospital, New York, USA, between 2012 and 2022 were retrospectively analysed.

Unveiling the Causes of Acute and Non-Acute Myocardial Ischemic Syndromes: The Role of Optical Coherence Tomography.

Despite significant advances in understanding and management, cardiovascular diseases remain the leading cause of mortality worldwide. Historically, diagnostic and therapeutic strategies have typically targeted obstructive coronary arteries. However, growing evidence supports the pivotal role of non-obstructive mechanisms in myocardial ischemia, prompting a new classification that distinguishes Acute Myocardial Ischemic Syndromes from Non-Acute Myocardial Ischemic Syndromes.

Pharmacology in Structural Intervention for Valvular Heart Disease: Current Practice and Future Perspectives.

Over the past 2 decades, structural heart interventions-including procedures like transcatheter aortic valve replacement, transcatheter mitral or tricuspid valve replacement, and transcatheter edge-to-edge mitral or tricuspid valve repair-have emerged as feasible alternatives to traditional surgery for treating valvular heart diseases. Antithrombotic treatment represents a critical aspect of postoperative care, aiming to balance the thromboembolic risk due to the incorporation of prosthetic materials and the consequently altered hemodynamics within the cardiac chambers with the bleeding risk depending on patients' and procedural factors. This continuously evolving interplay underscores the importance of personalized, evidence-based approaches to ensure optimal outcomes.

Rotational Atherectomy With or Without Intravascular Lithotripsy for Patients With Heavy Coronary Artery Calcification.

Recent advances in calcium debulking technologies may contribute to development of new percutaneous coronary intervention (PCI) paradigms for patients with heavy coronary artery calcification (CAC). Comparative data on safety and clinical efficacy of a combination strategy including rotational atherectomy (RA) and intravascular lithotripsy (IVL) is lacking. The aim of the study was to determine the addional effect of IVL when performed after RA in patients with heavy CAC.

Impact of left ventricular function on outcomes in patients with chronic kidney disease undergoing percutaneous coronary intervention.

Background: Reduced left ventricular ejection fraction (LVEF) is associated with increased morbidity and mortality after percutaneous coronary intervention (PCI). The impact of reduced LVEF among patients with chronic kidney disease (CKD) undergoing PCI remains unclear.

Methods: We included all patients who underwent PCI at a tertiary-care center, between 2012 and 2023.

Lifestyle and Pharmacological Interventions to Prevent Anthracycline-Related Cardiotoxicity in Cancer Patients.

Anthracyclines remain a cornerstone of cancer therapy but are associated with a significant risk of cardiotoxicity, which can lead to overt heart failure. The risk is modulated by cumulative dose, pre-existing cardiovascular disease, and patient-specific factors. As cancer survival improves, the long-term cardiovascular consequences of anthracycline exposure have become a growing concern, underscoring the need for effective preventive strategies.

Temporal and Geographic Trends in the Treatment of Peripheral Arterial Disease Stratified by Race Among Medicare Beneficiaries.

Importance: Racial disparities in the management of peripheral arterial disease (PAD) are well established. Analysis of the temporal trends and geographic variation in racial differences in the use of revascularization and major amputation may identify areas for targeted intervention.

Objective: To investigate differences in the treatment of PAD between Black and White patients over time and by US state.

Ticagrelor monotherapy versus ticagrelor plus aspirin in patients with chronic coronary syndrome and high ischaemic risk: a post hoc analysis of the TWILIGHT trial.

Background: Short dual antiplatelet therapy (DAPT) followed by ticagrelor monotherapy may be a valuable therapeutic option for patients with chronic coronary syndrome (CCS) and high ischaemic risk (HIR) undergoing percutaneous coronary intervention (PCI).

Aims: We aimed to compare ticagrelor monotherapy with ticagrelor-based DAPT in CCS patients with and without HIR undergoing PCI.

Methods: The present analysis included the CCS cohort of the TWILIGHT trial, which randomised PCI patients to ticagrelor alone or in combination with aspirin for 12 months after 3 months of ticagrelor-based DAPT.

Residual cholesterol and inflammatory risk in statin-treated patients undergoing percutaneous coronary intervention†.

Background And Aims: Elevated LDL-cholesterol levels and inflammation, as assessed by high-sensitivity C-reactive protein, correlate with cardiovascular risk. However, data on the relative impact of residual LDL-cholesterol and inflammatory risk among statin-treated patients undergoing percutaneous coronary intervention (PCI) is lacking. Hence, this study aimed to investigate the impact of residual cholesterol/inflammatory risk in patients on statin therapy undergoing PCI.

Transfemoral Transseptal Mitral Valve-in-Valve-in-Valve of a Degenerated Transcatheter in Surgical Bioprosthesis.

Objective: The authors describe a transcatheter mitral valve-in-valve-in-valve (VIVIV) for the correction of a degenerated transcatheter in a surgical bioprosthesis, a challenging interventional scenario that will be increasingly frequent in the near future.

Key Steps: The key steps taken were as follows: preprocedural planning integrating data from transesophageal echocardiogram, cardiac computed tomography, and 3mensio reconstruction (Pie Medical Imaging); transfemoral transseptal VIVIV performed with EchoNavigator system (Philips) guidance; Sapien Ultra 3 26-mm valve (Edwards Lifesciences) delivered with buddy balloon maneuvers to uncage the valve from the atrial struts of the previously implanted valve; and atrial septal defect occlusion with the Amplatzer ASO 24 mm (Abbott Cardiovascular).

Potential Pitfalls: The inability to advance the prosthesis into the ventricle, irreversible hemodynamic collapse, residual high transmitral mean gradient because of impingment of the 3 valves, residual paravalvular leaks, and left ventricular outflow tract obstruction.

Prognostic impact of neutrophil-to-lymphocyte ratio in patients with and without diabetes mellitus undergoing percutaneous coronary intervention.

Background: The neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation associated with adverse cardiovascular outcomes. However, limited evidence exists regarding its prognostic role in patients with diabetes mellitus (DM) undergoing percutaneous coronary intervention (PCI), which we sought to explore in this analysis.

Methods: We retrospectively evaluated all patients undergoing PCI at a large tertiary centre between 2012 and 2022.

Prognostic impact of residual inflammatory and triglyceride risk in statin-treated patients with well-controlled LDL cholesterol and atherosclerotic cardiovascular disease.

Aims: Identifying alternative contributors to the residual risk of atherosclerotic cardiovascular disease (ASCVD) beyond LDL cholesterol (LDL-C) levels is crucial. We investigated the relative impact of triglycerides (TGs) and high-sensitivity C-reactive protein (hs-CRP) on outcomes in statin-treated patients with well-controlled LDL-C undergoing percutaneous coronary intervention (PCI) for established ASCVD.

Methods And Results: We included 9446 statin-treated patients with LDL-C < 70 mg/dL undergoing PCI between 2012 and 2022, stratified into four groups: (i) no residual risk (TG <150 mg/dL + hs-CRP <2 mg/L); (ii) residual TG risk (TG ≥150 mg/dL + hs-CRP <2 mg/L); (iii) residual inflammatory risk (TG <150 mg/dL + hs-CRP ≥2 mg/L); and (iv) residual TG and inflammatory risk (TG ≥150 mg/dL + hs-CRP ≥2 mg/L).

Potent P2Y12 Inhibitors vs Clopidogrel in Cancer Patients Undergoing Percutaneous Coronary Intervention.

Background: Patients with cancer undergoing percutaneous coronary intervention (PCI) experience a higher risk of both ischemic and bleeding events. The aim of this study was to assess ischemic and bleeding risks after PCI in cancer patients treated with potent P2Y12 inhibitors (P2Y12i; prasugrel and ticagrelor) compared with clopidogrel.

Methods: Consecutive patients with cancer undergoing PCI at a tertiary center between 2012 and 2022 and discharged on P2Y12i were included in this study.

Clinical outcomes after complex and high-risk percutaneous coronary intervention according to baseline chronic kidney disease.

Background: Chronic kidney disease (CKD) is associated with unfavorable outcomes in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). However, its prognostic role in patients undergoing complex high-risk PCI (CHIP) remains unexplored, prompting our investigation.

Methods: Consecutive CHIP patients treated at a tertiary care center from 2012 to 2022 were included in the current analysis.

Clinical Outcomes According to the Extent of Atherosclerotic Disease in Female Patients Undergoing Transcatheter Aortic Valve Replacement: An Analysis From the WIN-TAVI Registry.

Background: Limited data exist on the impact of polyvascular disease (PolyVD) on clinical outcomes in female patients undergoing transcatheter aortic valve replacement (TAVR). We therefore sought to investigate clinical outcomes in women with versus without PolyVD undergoing TAVR.

Methods: Female participants from the multicentre Women's International Transcatheter Aortic Valve Implantation (WIN-TAVI) registry were categorized based on the presence or absence of PolyVD.

Coronary Plaque Characteristics Assessed by Optical Coherence Tomography and Plasma Lipoprotein(a) Levels in Patients With Acute Coronary Syndrome.

Background: Lipoprotein(a) [Lp(a)] is associated with increased cardiovascular risk, but its influence on plaque characteristics at optical coherence tomography (OCT) evaluation is not fully understood.

Aims: This study seeks to explore the impact of Lp(a) levels on plaque morphology as assessed by OCT in a very high-risk subset of patients.

Methods: Consecutive patients admitted for acute coronary syndrome (ACS) and undergoing OCT-guided percutaneous coronary intervention (PCI) at a large tertiary care center between 2019 and 2022 were deemed eligible for the current analysis.

Validation of a High Bleeding Risk Definition in Cancer Patients undergoing Percutaneous Coronary Intervention.

Aim: Due to the absence of validated bleeding risk tools in cancer patients undergoing percutaneous coronary intervention (PCI), we aimed to validate an adapted version of the Academic Research Consortium (ARC) High Bleeding Risk (HBR) criteria.

Methods: Consecutive patients with active or remission cancer undergoing PCI between 2012 and 2022 at Mount Sinai Hospital (New York, USA) were included. Patients were considered at HBR if they met at least one of the major ARC-HBR criteria, other than cancer, or two minor criteria.