Hemodynamic phenotypes of severe aortic stenosis in patients with small aortic annulus and implications for transcatheter aortic valve implantation outcomes.

Patients with severe aortic stenosis (AS) and small aortic annulus pose diagnostic and therapeutic challenges. To investigate the frequency of discordant grading of severe AS in patients with a small aortic annulus and to evaluate the outcomes after transcatheter aortic valve implantation (TAVI). Patients with severe AS, an aortic annulus diameter of < 21 mm on echocardiography, a mean annulus diameter of < 23 mm, and an area ≤ 4.

Clinical Outcomes in Patients With Quadricuspid vs Bicuspid Aortic Valve.

Importance: Congenital aortic valve disease predominantly manifests as bicuspid aortic valve (BAV), while quadricuspid aortic valve (QAV) is considerably rarer. Whether outcomes vary between these 2 types of congenital aortic valve disease remains unknown.

Objective: To compare outcomes between patients with QAV and patients with BAV.

Prognostic Role of Right Atrial Reservoir Strain in Acute Heart Failure.

Background: Right atrial (RA) dysfunction might indicate an advanced stage of heart failure (HF). The prognostic role of RA dysfunction, assessed according to RA reservoir strain (RArS), in hospitalized acute HF patients remains undetermined.

Methods: All consecutive patients hospitalized for acute HF were prospectively enrolled and had speckle-tracking echocardiography at discharge.

Distinct role of minimal and maximal left atrial volumes in assessing LV filling pressures and prognosis in chronic heart failure.

Current guidelines recommend assessing left atrial (LA) maximal volume to grade left ventricular (LV) diastolic dysfunction. However, recent studies suggest a strong association between LA minimal volume and prognosis. The present study aims to investigate the relative merits of minimal and maximal LA volume in reflecting LV filling pressures and on prognosis in chronic heart failure (HF).

Initiating Empagliflozin and Sacubitril/Valsartan Early After Acute Myocardial Infarction: Mechanistic Study.

Background: Empagliflozin and sacubitril/valsartan are established in heart failure treatment, but their effects after myocardial infarction (MI) are less clear. This study evaluated early empagliflozin initiation, with or without sacubitril/valsartan, on post-MI inflammation, oxidative stress, metabolism, fibrosis, cardiac function, and ventricular tachycardia (VT) risk in a pig model.

Methods: A total of 24 of 30 pigs survived the MI procedure and were subsequently randomized to receive beta-blocker treatment alone (control-MI), beta-blocker+empagliflozin, or beta-blocker+empagliflozin+sacubitril/valsartan.

[Use of cardiovascular registries in regulatory pathways: perspectives from the EU-MDR Cardiovascular Collaboratory].

On May 26, 2021, the European Medical Device Regulation (EU-MDR) entered into effect resulting in a major shift in the requirements for assessment of medical devices in Europe. The EU-MDR Cardiovascular Collaboratory (EU-MCVC) was founded to contribute to the development of faster, more efficient, and more effective pathways for innovation of cardiac medical devices. A registry is an organized system that collects uniform data and evaluates specified outcomes in a population defined by a disease, condition, or exposure.

Multiorgan Imaging for Interorgan Crosstalk in Cardiometabolic Diseases.

Cardiometabolic diseases encompass a group of conditions characterized by metabolic and inflammatory abnormalities that increase the risk of diabetes and cardiovascular disease. These syndromes involve multiple organs, including the heart, arterial system, brain, skeletal muscle, adipose tissue, hematopoietic system, liver, kidneys, and pancreas. The crosstalk between these organs contributes to the development of disease.

Tissue characteristics underlying endocardial local impedance subtypes in chronic myocardial infarction.

Background: Local impedance (LI) mapping is feasible and provides additional tissue characterization of the ventricular tachycardia substrate. Data on tissue composition underlying the LI spectrum are lacking.

Objective: To describe the tissue composition underlying different LI subtypes in a chronic myocardial infarction (MI) swine model.

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.

Gender differences in the presentation and management of patients with severe aortic stenosis at specialist versus primary/secondary care centres: A sub-analysis of the IMPULSE enhanced registry.

Background: Management and treatment of severe aortic stenosis (AS) may differ considerably in European countries. To investigate these differences in France, Germany, and the UK, the IMPULSE enhanced registry was established. Previous data revealed differences in how patients were managed in specialist (hub) versus primary/secondary care (satellite) centres.

Key priorities for the implementation of the 2023 ESC Guidelines for the management of endocarditis in low-resource settings.

European Society of Cardiology (ESC) Guidelines provide best practice, evidence-based recommendations for diagnosing and treating patients with cardiovascular diseases. It is not always possible for best practices to be followed, however, particularly in low-resource settings. To address this issue, a set of guideline-related documents were created to identify key priorities for users in these settings.

Best Practices for Imaging of Transcatheter Valve Failure: An Update From the Heart Valve Collaboratory.

This updated Heart Valve Collaboratory framework addresses the growing concern for transcatheter valve failure (TVF) following transcatheter aortic valve replacement (TAVR). With the increasing volume of redo-TAV and surgical TAV explantation, there is a critical need for standardized pathways and protocols for evaluating TVF using echocardiography and cardiac computed tomography (CT) angiography. This document clarifies prior definitions of bioprosthetic valve deterioration and bioprosthetic valve failure in a practical, imaging directed context for TAVR.

The reversibility of cardiac damage after transcatheter aortic valve implantation and short-term outcomes in a real-world setting.

Aims: This study aims to assess the changes in cardiac damage stage in a real-world cohort of patients undergoing transcatheter aortic valve implantation (TAVI), and to investigate the prognostic value of cardiac damage stage evolution.

Methods And Results: Patients with severe aortic stenosis (AS) undergoing TAVI were retrospectively analysed. A five-stage system based on the presence and extent of cardiac damage assessed by echocardiography was applied before and 6 months after TAVI.

Left atrial remodelling and function in various left ventricular hypertrophic phenotypes.

Aims: How the underlying aetiology and pathophysiology of left ventricular (LV) hypertrophy affects left atrial (LA) remodelling and function remains unexplored. The present study aims to investigate the influence of various hypertrophic phenotypes on LA remodelling and function.

Methods And Results: Patients with LV hypertrophy who underwent cardiac magnetic resonance (CMR) were compared to a control group.

Prognostic value of left atrioventricular coupling index in heart failure.

Aims: To investigate the distribution of left atrioventricular coupling index (LACI) among patients with heart failure and left ventricular ejection fraction (LVEF) < 50% and to explore its association with the combined endpoint of all-cause death or HF hospitalization at long-term follow-up.

Methods And Results: Patients with HF and LVEF < 50% undergoing cardiac magnetic resonance were evaluated. Patients with atrial fibrillation or flutter were excluded.

Tricuspid Valve S-Curves and Chamber Views: Implications for Transcatheter Tricuspid and Pulmonary Valve Interventions, Part 2 of the S-Curves and Chamber Views Series.

Despite the challenges associated with periprocedural imaging, transcatheter tricuspid valve interventions have shown important impact on outcomes. A comprehensive understanding of the anatomy of the right heart and surrounding structures is crucial. One way to optimize these interventions is by identifying the optimal fluoroscopic viewing angles along the S-curve of the tricuspid valve.

Qualitative and quantitative assessment of atrial functional mitral regurgitation: analysis from the REVEAL-AFMR registry.

Aims: The prevalence, characteristics, and prognosis of atrial functional mitral regurgitation (AFMR) based on severity remain unclear. No studies have systematically evaluated quantitative thresholds, such as effective regurgitant orifice area (EROA) or regurgitant volume, in relation to outcomes in AFMR. This multicentre study aimed to clarify the clinical implications of both qualitative and quantitative assessments of AFMR severity.