Left ventricular ejection fraction and benefit of tricuspid valve interventions - insights from the international TRIGISTRY.

Aims: The impact of treatment for tricuspid regurgitation (TR) across different levels of left ventricular ejection fraction (LVEF) remains uncertain. This study aimed to compare the outcomes of surgical and transcatheter tricuspid valve interventions (TTVI) to conservative (medical) management across LVEF categories.

Methods And Results: Patients with severe isolated TR from the TRIGISTRY, a multicentre international registry, were categorized based on LVEF (preserved ejection fraction [pEF]: ≥50%, mildly reduced ejection fraction [mrEF]: 41-49%, and reduced ejection fraction [rEF]: ≤40%).

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.

Disproportionate Left Ventricular Enlargement in Mitral Valve Prolapse: Prevalence, Predictors, and Association With Outcomes.

Background: Left ventricular (LV) end-systolic enlargement in severe degenerative mitral-regurgitation (MR) is a class I surgical trigger. Whether it occurs disproportionately to less-than-severe MR due to mitral valve prolapse and is associated with mortality are unknown. We aimed to analyze prevalence and association with survival of disproportionate LV enlargement in less-than-severe MR.

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.

Incidence, predictors and outcomes of tricuspid regurgitation progression after left-sided valvular intervention.

Background: Tricuspid regurgitation (TR) progression following left-sided valvular heart disease (VHD) correction is a critical clinical concern. This study aimed to determine the incidence, predictors and outcomes of TR progression in a contemporary cohort.

Methods: We analysed 1644 patients (mean age 73 years, 62% men) without severe TR who underwent surgical or transcatheter treatment for aortic or mitral disease between 2014 and 2018.

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.

Prognostic implications of functional tricuspid regurgitation in asymptomatic degenerative mitral regurgitation.

Aims: Functional tricuspid regurgitation (FTR) associated with degenerative mitral regurgitation (DMR) accentuates the severity of heart failure and is a marker of poor prognosis. Little is known about FTR associated with asymptomatic DMR.

Methods And Results: The study included 1249 asymptomatic patients with moderate or severe DMR from the Mitral Regurgitation International Database-Quantitative (MIDA-Q) registry (mean age 64 ± 15 years, 25% female).

Reactivation of Oxidized Soluble Guanylate Cyclase as a Novel Treatment Strategy to Slow Progression of Calcific Aortic Valve Stenosis: Preclinical and Randomized Clinical Trials to Assess Safety and Efficacy.

Background: Pharmacological treatments for fibrocalcific aortic valve stenosis (FCAVS) have been elusive for >50 years. Here, we tested the hypothesis that reactivation of oxidized sGC (soluble guanylate cyclase), the primary receptor for nitric oxide, with ataciguat is a safe and efficacious strategy to slow progression of FCAVS.

Methods: We used quantitative real-time reverse transcription polymerase chain reaction, Western blotting, and immunohistochemistry to characterize sGC signaling and the biological effects of ataciguat on signaling cascades related to nitric oxide, calcification, and fibrosis in excised human aortic valve tissue, aortic valve interstitial cells, and mouse aortic valves.

Prevalence, aetiology, and outcomes of native pulmonary regurgitation in the general adult population.

Aims: Pulmonary regurgitation (PR) after reparative intervention for congenital heart disease has been studied extensively. However, the burden, distribution of causes, and outcome of PR in adults is unknown. The study aimed to evaluate the prevalence, types, and outcomes of moderate/severe PR in adults in the community setting.

Prognostic Implications of Right Ventricular Dysfunction in Severe Degenerative Mitral Regurgitation.

Background: The prevalence and impact of right ventricular dysfunction (RVD) in degenerative mitral regurgitation (DMR) is unknown. We aimed to determine whether RVD assessed by echocardiography in routine clinical practice is independently associated with mortality in patients with DMR.

Methods And Results: We used data from the MIDA-Q (Mitral Regurgitation International DAtabase-Quantitative) registry, which included patients with isolated DMR due to mitral valve prolapse from January 2003 to January 2020 from 5 tertiary centers across North America, Europe, and the Middle East.

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).

TRIVALVE Score: A Risk Score for Mortality/Hospitalization Prediction in Patients Undergoing Transcatheter Tricuspid Valve Intervention.

Background: Transcatheter tricuspid valve intervention (TTVI) has been increasingly adopted in recent years for the treatment of patients with tricuspid regurgitation (TR). However, no dedicated risk stratification has been established for patients undergoing TTVI.

Objectives: The aim of the present study was to propose a dedicated risk score for patients affected by severe TR undergoing TTVI.

Degenerative mitral stenosis by echocardiography: presentation and outcome.

Aims: Degenerative mitral stenosis (DMS) is due to degenerative mitral annular calcification (MAC) and valvular calcification. However, DMS impacts on the outcome, and therefore, potential treatment needs are poorly known. We aimed at evaluating survival after DMS diagnosis by Doppler echocardiography in routine practice.