[From anatomy to echocardiography in secondary tricuspid regurgitation. Controversial issues].

This review article describes two controversial aspects of secondary tricuspid regurgitation: the still poorly understood anatomy of the tricuspid valve and the advantages and limitations of color Doppler echocardiography in evaluating tricuspid regurgitation. The tricuspid apparatus is characterized by a complex anatomical structure that includes a saddle-shaped ring, three leaflets (or more), and a subvalvular apparatus. An in-depth knowledge of the anatomy is essential for understanding the various pathophysiological mechanisms of secondary (atriogenic and ventriculogenic) tricuspid regurgitation.

Right ventricular global work efficiency: A reliable non-invasive estimate of right ventricular contractility.

Background: Right ventricular (RV) myocardial work (RVMW) recently emerged as a non-invasive alternative for the assessment of RV contractility. However, none of the prior studies assessed its variations under different haemodynamic conditions. We aimed to evaluate the variations of the components of RVMW in heart failure (HF) patients with pulmonary hypertension (PH) undergoing a reversibility test.

[ISMETT experience with long-term left ventricular assist devices].

Background: Advanced heart failure is a condition where pharmacological therapies have a limited impact on prognosis. Left ventricular assist devices (LVAD) have been shown to improve survival and quality of life in well-selected patients in this setting. LVAD technology has evolved over time, leading to more efficient devices with fewer complications.

ANMCO position paper: diagnosis and treatment of heart failure with preserved systolic function.

Heart failure is the leading cardiovascular cause of hospitalization with an increasing prevalence, especially in older patients. About 50% of patients with heart failure have preserved ventricular function, a form of heart failure that, until a few years ago, was orphaned by pharmacological treatments effective in reducing hospitalization and mortality. New trials, which have tested the use of gliflozins in patients with heart failure with preserved ejection fraction (HFpEF), have for the first time demonstrated their effectiveness in changing the natural history of this insidious and frequent form of heart failure.

Gaps and Knowledge in the Contemporary Management of Acute Right Ventricular Failure.

Acute right ventricular failure (ARVF) is commonly seen in the intensive care unit and constitutes a significant clinical challenge, with associated high in-hospital mortality. Recently, the treatment of ARVF has significantly changed, with the progressive implementation of mechanical circulatory support devices that now represent important tools for clinicians in treating this condition. However, despite recent advancements, the optimal approach for ARVF remains elusive, and precise treatment algorithms and comprehensive management protocols are still lacking.

Shape of the mitral annulus in normal individuals and dilated cardiomyopathies: computational modeling insights into leaflet stress distribution.

The mitral valve annulus naturally adopts a saddle shape in systole, likely concentrating systolic stress on the commissures where fibrous trigones are located. This study hypothesized that in patients with dilated cardiomyopathies, where the annulus is large and planar, the stress would be redirected. Computational modeling was employed to compare the stress distribution in saddle-shaped mitral valves (n.

The role of left atrio-ventricular coupling index and left atrial ejection fraction in predicting onset of atrial fibrillation and adverse cardiac events in hypertrophic cardiomyopathy.

Background: Several predictors of atrial fibrillation (AF) onset in patients with hypertrophic cardiomyopathy (HCM) have been proposed, however, all of them showed limited accuracy. This study aims to assess the role of new echographic parameters in predicting AF onset and major adverse cardiovascular outcomes (cardiovascular death or heart transplantation).

Methods: Clinical and imaging data from 141 patients with HCM and without a history of AF were retrospectively analyzed over a 5-year period.

Gastrointestinal Bleeding During Long-Term Left Ventricular Assist Device Support: External Validation of UTAH Bleeding Risk Score.

Background: Gastrointestinal bleeding (GIB) is a common complication of left ventricular assist device (LVAD) support. The UTAH bleeding risk score (UBRS) is the only dedicated GIB prediction model, but its efficacy has not been confirmed in an external validation cohort. Furthermore, the reliability of other bleeding risk scores, such as ARC-HBR and HASBLED, has never been tested in this specific population.

[ANMCO Position paper: Management of heart failure with preserved ejection fraction].

Heart failure is the leading cardiovascular cause of hospitalization with an increasing prevalence, especially in older patients. About 50% of patients with heart failure have preserved ventricular function, a form of heart failure that, until a few years ago, was orphaned by pharmacological treatments effective in reducing hospitalization and mortality. New trials, which have tested the use of gliflozins in patients with heart failure with preserved ejection fraction (HFpEF), have for the first time demonstrated their effectiveness in changing the natural history of this insidious and frequent form of heart failure.

Medical Treatments in Patients With Ambulatory Heart Failure: First Data From the BRING-UP-3 Heart Failure Study.

Background: Current European Society of Cardiology guidelines introduced a 4-pillar approach for the treatment of HFrEF and a class IA recommendations for empagliflozin and dapagliflozin in HFmrEF and HFpEF.

Objectives: The BRING-UP-3 Heart Failure (HF) study was designed to guide the Guideline-implementation recommendations for patients with HF enrolled in a large sample of Italian cardiology sites.

Methods: The BRING-UP-3 HF study is an observational, prospective, nationwide investigation encompassing 179 sites and enrolling ambulatory and hospitalized patients with HF.

Functional Mitral Valve Regurgitation, Pathophysiology, Leaflet ReModeling, and the Role of Imaging.

Functional mitral regurgitation (FMR) is a complex left ventricle (LV) and left atrium (LA) disorder in which mitral valve regurgitation is just the "tip of the iceberg." Unlike primary mitral cvalve regurgitation, in which regurgitation occurs due to anatomic abnormalities of the valve itself, the etiology of FMR is multifactorial. Regional and global LV dysfunction, extent and location of fibrotic myocardium (subendocardial/transmural scar), and annulus enlargement are the leading causes of valve regurgitation.

MAD or MADness?

Mitral valve prolapse (MVP) is a common condition affecting approximately 3% of the population, typically with a benign clinical course. However, a small subset of patients (5-10%) may develop severe mitral regurgitation or arrhythmias, which can lead to sudden cardiac death (SCD). Among the morphological features of MVP, mitral annular disjunction (MAD) has emerged as a potential marker of malignant MVP, with some studies suggesting an association with ventricular arrhythmias and SCD.

The Key Role of 3D TEE in Assessing the Morphology of Degenerative Mitral Valve Regurgitation.

Two-dimensional transthoracic echocardiography (2D TTE) and two-dimensional transesophageal echocardiography (2D TEE) are regarded as the main imaging techniques for the assessment of degenerative mitral valve regurgitation (DMVR). However, describing the complex morphology of DMVR with 2D TTE and 2D TEE remains at the very least challenging. Three-dimensional (3D) TEE is an ideal technique for illustrating the extremely variable morphology of DMVR, providing images of unparalleled quality in terms of anatomical detail.

SGLT2 inhibitor therapy in patients with advanced heart failure and reduced ejection fraction.

Aims: Sodium-glucose cotransporter inhibitors (SGLT2-i) improve outcomes in patients with heart failure (HF) and reduced ejection fraction (HFrEF). However, evidence in patients with advanced HF is lacking. We aimed to determine the effect of SGLT2-i in advanced HFrEF compared to their effect on a non-advanced population.

OPTImal PHARMacological therapy for patients with heart failure: Rationale and design of the OPTIPHARM-HF registry.

Aims: Patients with heart failure (HF) remain often undertreated for multiple reasons, including treatment inertia, contraindications, and intolerance. The OPTIimal PHARMacological therapy for patients with Heart Failure (OPTIPHARM-HF) registry is designed to evaluate the prevalence of evidence-based medical treatment prescription and titration, as well as the causes of its underuse, in a broad real-world population of consecutive patients with HF across the whole ejection fraction spectrum and among different clinical phenotypes.

Methods: The OPTIPHARM-HF registry (NCT06192524) is a prospective, multicenter, observational, national study of adult patients with symptomatic HF, as defined by current international guidelines, regardless of ejection fraction.

Impact of systematic diabetes screening on peri-operative infections in patients undergoing cardiac surgery.

Detection of high glycated hemoglobin (A1c) is associated with worse postoperative outcomes, including predisposition to develop systemic and local infectious events. Diabetes and infectious Outcomes in Cardiac Surgery (DOCS) study is a retrospective case-control study aimed to assess in DM and non-DM cardiac surgery patients if a new screening and management model, consisting of systematic A1c evaluation followed by a specialized DM consult, could reduce perioperative infections and 30-days mortality. Effective July 2021, all patients admitted to the cardiac surgery of IRCCS ISMETT were tested for A1c.

MicroRNA-30d and -483-3p for bi-ventricular remodelling and miR-126-3p for pulmonary hypertension in advanced heart failure.

Aims: MicroRNAs play a role in pathogenic mechanisms leading to heart failure. We measured a panel of 754 miRNAs in the myocardial tissue and in the serum of patients with heart failure with reduced ejection fraction due to dilatative idiopathic cardiomyopathy (DCM, N = 10) or ischaemic cardiomyopathy (N = 3), referred to left ventricular assist device implant. We aim to identify circulating miRNAs with high tissue co-expression, significantly associated to echocardiographic and haemodynamic measures.

Bridging the gap in the symptomatic heart failure patient journey: insights from the Italian scenario.

Background: The prognosis for heart failure (HF) patients remains poor, with a high mortality rate, and a marked reduction in quality of life (QOL) and functional status. This study aims to explore the ongoing needs of HF management and the epidemiology of patients followed by Italian HF clinics, with a specific focus on cardiac contractility modulation (CCM).

Research Design And Methods: Data from patients admitted to 14 HF outpatients clinics over 4 weeks were collected and compared to the results of a survey open to physicians involved in HF management operating in Italian centers.

Screening and Management of Coronary Artery Disease in Kidney Transplant Candidates.

Cardiovascular disease (CVD) is a major cause of morbidity and mortality in patients with chronic kidney disease (CKD), especially in end-stage renal disease (ESRD) patients and during the first year after transplantation. For these reasons, and due to the shortage of organs available for transplant, it is of utmost importance to identify patients with a good life expectancy after transplant and minimize the transplant peri-operative risk. Various conditions, such as severe pulmonary diseases, recent myocardial infarction or stroke, and severe aorto-iliac atherosclerosis, need to be ruled out before adding a patient to the transplant waiting list.