Iatrogenic Ventricular Septal Defect Following Simple PVC Ablation: A Case of Delayed Percutaneous Closure.

Background: Iatrogenic muscular ventricular septal defect (VSD) is a rare but serious complication of premature ventricular complex (PVC) ablation. Timely diagnosis and management are essential.

Case Summary: A 77-year-old woman underwent radiofrequency ablation for symptomatic parahisian PVCs.

Leveraging institutional echocardiographic registry to assess clinical profiles and outcomes in tricuspid regurgitation.

Tricuspid regurgitation (TR) is a common valvular heart disease that is associated with increased morbidity and mortality. We utilized our large institutional echocardiographic registry, integrated with the electronic medical record-based health system registry to identify patients with varying degrees of TR, and to assess its association with long-term outcomes. Patients were categorized by TR severity as none, mild, moderate, or severe.

Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography and for Heart Failure With Preserved Ejection Fraction Diagnosis: An Update From the American Society of Echocardiography.

Echocardiographic assessment of left ventricular (LV) diastolic function is an integral part of the routine evaluation of patients presenting with symptoms of dyspnea or clinical concerns for heart failure. Given the presence of diastolic dysfunction in many cardiovascular diseases, clinical reports should include comments on diastolic function and/or left atrial (LA) pressure whenever possible. Since the publication of the 2016 ASE/EACVI guidelines for assessment of LV diastolic function, new data on additional echocardiographic variables as left atrial strain and their association with LV filling pressures have emerged.

New Algorithm for Estimating Left Ventricular Filling Pressure by Echocardiography.

Background: Evaluation of whether dyspnea has a cardiac cause is essential. Guidelines from 2016 were reported to result in a high incidence of indeterminate left ventricular (LV) filling pressure. We sought to validate a new algorithm for the estimation of LV filling pressure (LVFP) in a multicenter study, with the objective of decreasing the yield of indeterminate filling pressure and increasing accuracy.

Relation of left ventricular diastolic function to LV structure and outcomes in patients with aortic regurgitation.

Aims: This study aimed to investigate the relationship between diastolic dysfunction (DD) and extracellular volume (ECV), scar burden, and myocyte volume in patients with at least moderate aortic regurgitation (AR) by cardiac magnetic resonance (CMR). We also sought to determine the association of DD with mortality in AR patients.

Methods And Results: Patients with at least moderate AR and who underwent echocardiographic and CMR imaging with a median time of 4 days between the two studies (interquartile range 1-43 days) were included.

The impact of obesity on myocardial flow reserve and its prognostic utility.

Background: Obesity is a major cardiovascular risk factor associated with coronary microvascular dysfunction, which can be noninvasively assessed using myocardial flow reserve (MFR) on positron emission tomography (PET). As impaired MFR identifies high-risk patients, we assessed whether body mass index (BMI) modifies the association between MFR and cardiovascular outcomes.

Methods: Consecutive patients with no known coronary artery disease who had a clinically indicated PET were enrolled and followed prospectively for incident outcomes (all-cause death, major adverse cardiovascular events (MACE), and heart failure admissions).

Understanding the Effects of Mitral Transcatheter Edge-to-Edge Repair on Left Ventricular Function Using Pressure-Volume Loops.

Background: Mitral transcatheter edge-to-edge repair (M-TEER) is an effective treatment for mitral regurgitation (MR) patients.

Objectives: The aim of this research was to study M-TEER effects on left atrial (LA) and left ventricular (LV) functions.

Methods: LV function was evaluated using conductance catheters for pressure volume loops in 22 patients with primary MR and a control group of 17 heart transplant recipients with normal function.

Cardiac MRI Evaluation of Determinants and Prognostic Implications of Right Ventricular Dysfunction in Aortic Regurgitation.

Purpose To investigate the determinants and effect of right ventricular (RV) dysfunction in aortic regurgitation (AR) using cardiac MRI. Materials and Methods This study included patients with moderate or severe AR who were enrolled in the DEBAKEY-CMR registry between January 2009 and June 2020. Patients with previous valve intervention, cardiomyopathy deemed unrelated to AR, severe aortic stenosis, and other confounders were excluded.

Standard-of-Care Medication Withdrawal in Patients With Obstructive Hypertrophic Cardiomyopathy Receiving Aficamten in FOREST-HCM.

Background: Standard-of-care (SoC) medications for the treatment of obstructive hypertrophic cardiomyopathy (oHCM) are recommended as first-line therapy despite the lack of evidence from controlled clinical trials and well known off-target side effects.

Objectives: We describe the impact of SoC therapy downtitration and withdrawal in patients already receiving aficamten in FOREST-HCM (Follow-Up, Open-Label, Research Evaluation of Sustained Treatment with Aficamten in Hypertrophic Cardiomyopathy; NCT04848506).

Methods: Patients receiving SoC therapy (beta-blocker, nondihydropyridine calcium-channel blocker, and/or disopyramide) were eligible for protocol-guided SoC downtitration and withdrawal at the discretion of the investigator and after achieving a stable dose of aficamten for ≥4 weeks.

Left ventricular diastolic dysfunction in non-myocardial disorders.

This article reviews and discusses non-myocardial disorders that represent diagnostic challenges when evaluating patients for suspected heart failure with preserved left ventricular ejection fraction. This includes pre-capillary pulmonary hypertension, which is important to differentiate from post-capillary hypertension caused by left-sided heart disease. The impact of electrical disorders on LV diastolic function is also reviewed, and includes a discussion of left bundle branch, which has both a direct effect on LV diastolic function, as well as a long-term effect due to remodelling.

Impact of Left Atrial Pressure on Outcomes After Mitral Transcatheter Edge-to-Edge Repair.

Background: Increased left atrial pressure (LAP) has been associated with adverse outcomes after mitral transcatheter edge-to-edge repair (M-TEER). We sought to evaluate outcomes based on differences in postprocedural LAP measured after the final clip deployment.

Methods: We included consecutive patients who underwent M-TEER at our institution between 2014 and 2022 with LAP monitoring.

Evaluation of left ventricular filling pressure by echocardiography in patients with atrial fibrillation.

Background: Echocardiography is widely used to evaluate left ventricular (LV) diastolic function in patients suspected of heart failure. For patients in sinus rhythm, a combination of several echocardiographic parameters can differentiate between normal and elevated LV filling pressure with good accuracy. However, there is no established echocardiographic approach for the evaluation of LV filling pressure in patients with atrial fibrillation.

Prognostic Value of Right Ventricular Afterload in Patients Undergoing Mitral Transcatheter Edge-to-Edge Repair.

Background: Pulmonary hypertension (PH) and secondary mitral regurgitation (MR) are associated with adverse outcomes after mitral transcatheter edge-to-edge repair. We aim to study the prognostic value of invasively measured right ventricular afterload in patients undergoing mitral transcatheter edge-to-edge repair.

Methods And Results: We identified patients who underwent right heart catheterization ≤1 month before transcatheter edge-to-edge repair.

Echocardiographic Profiling Predicts Clinical Outcomes After Mitral Transcatheter Edge-to-Edge Repair.

Background: Prior studies investigating the impact of residual mitral regurgitation (MR), tricuspid regurgitation (TR), and elevated predischarge transmitral mean pressure gradient (TMPG) on outcomes after mitral transcatheter edge-to-edge repair (TEER) have assessed each parameter in isolation. We sought to examine the prognostic value of combining predischarge MR, TR, and TMPG to study long-term outcomes after TEER.

Methods And Results: We reviewed the records of 291 patients who underwent successful mitral TEER at our institution between March 2014 and June 2022.

Noninvasive Prediction of Pulmonary Capillary Wedge Pressure in Patients With Normal Left Ventricular Ejection Fraction: Comparison of Cardiac Magnetic Resonance With Comprehensive Echocardiography.

Background: Cardiac magnetic resonance (CMR) was recently reported to predict mean pulmonary capillary wedge pressure (PCWP). However, there is a paucity of data on its accuracy for estimation of PCWP in patients with normal left ventricular (LV) ejection fraction (EF). We sought to examine its accuracy against the invasive gold standard and to compare it with the accuracy of comprehensive echocardiography.