Objective transcatheter tricuspid valve repair (TTVR) has recently become available as a treatment option for patients with symptomatic significant tricuspid regurgitation (TR) not eligible for tricuspid valve surgery. In the absence of a single reliable measure of the RV systolic function, a number of surrogate echocardiographic parameters have been proposed for clinical use (tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (FAC), peak S wave velocity of the lateral tricuspid annulus by tissue Doppler imaging (S’ RV-TDI) and RV 2D-FWS. At present, TTVR is not recommended in patients with severe PH and poor RV function, but exact cut-offs when TTVR should be rejected are lacking. Aim of this study was to assess RV function before and after Triclip implantation. Materials and methods from June 2021 to June 2022 clinical and echocardiographic data of 8 patients with TR who underwent TTVR intervention in our division were evaluated for RV function. TAPSE, FAC, S’RV-TDI, RV GS and RV FWS at baseline and 1 month of follow up were assessed. Continuous variables are presented as mean ± standard deviation (SD). Categorical variables were presented as frequencies and percentages. Results the mean values of RV function assessed before and after Triclip implantation were respectively (18,75 mm± 4,04 vs 18,38 mm ± 3,34) for TAPSE, (10,50 cm/sec± 2,33 vs 10,38 cm/sec ± 1,19) for S’ RV-TDI, (38% ± 0,05 vs 37% ± 0,04) for FAC, and (-17% ± 0,03 vs -19% ± 0,02) for RV FWS. The number of patients that show at baseline RV dysfunction, according to the cut-offs indicated from guidelines, were 4 for TAPSE; 3 S’ RV-TDI; 1 for FAC and 7 for RV 2D-FWS. At 1 month of follow-up, patients with ventricular dysfunction were respectively 3,2,2,4. Conclusions in the presence of significant TR, the accurate assessment of RV function becomes even more challenging as a result of the load and angle dependency of TAPSE, RVFAC. Significant TR results in a reduction in RV afterload, which may preserve the aforementioned markers of RV function even when contractility is impaired. Probably RV 2D-STE is less angle and load dependent than traditional RV function indices and less confounded by RV geometry and passive motion.
Background mitral regurgitation (MR) is the second most common valvular heart disease in Europe. In the contest of functional (or secondary) MR recently has emerged a new entity, the atrial functional MR. This form is due to left atrial dilatation, it has no significant degenerative change in mitral valve complex or significant LV systolic disfunction. Conversely the ventricular functional mitral regurgitation (V-FMR) is due to systolic disfunction and left ventricular dilatation. Aim the aim of this study was to evaluate the differences in clinical characteristics and outcomes of patients with AFMR and VFMR treated with Mitraclip. Methods a retrospective analysis collected consecutive patients with functional MR who underwent transcatheter mitral valve repair using Mitraclip system in our division. A total of 161 patients were divided into the following two categories: VFMR (127 patients), defined as EF<40% or EF ≥40% with history of myocardial infarction, and AFMR (34 patients) identified as EF≥50% and LAVi >48 mL/m2. Baseline and clinical characteristics, echocardiographic parameters and 12 months clinical outcomes (overall mortality at 12 months, MACE at 12 months, re-hospitalization for heart failure (HF), re-hospitalization from other causes at 12 months and number of re-hospitalization at 12 months) were analyzed. Results compared to AFMR, patients with VFMR were younger (73 vs 78 years) had a higher man prevalence (72,4% vs 50%), higher rate of: hypercholesterolemia (79,5% vs 67,6%), smokers (14,2% vs 5,9%), diabetes (39,4% vs 20,6%), chronic kidney disease (55,9% vs 47,1%), NT-proBNP mean value (4403,437 pg/ml vs 2063,409 pg/ml), NYHA class ≥III (84.3 vs 52.9%) and lower rate of hypertension (85% vs 97.1%). In AFMR population there was higher prevalence of atrial fibrillation (70.6% vs 45.7%) and tricuspid valve regurgitation ≥2+ (82.3% vs 68,5%). Moreover, in this group, was lower the all-cause mortality rate at 12 months (9.4 vs 22%), MACE at 12 months (4.5 vs 24.5%), re-hospitalization for HF (15.6% vs 33.1%), re-hospitalization from other causes at 12 months (18.8% vs 31.6%) and number of re-hospitalization at 12 months ≥1 (31,3% vs 59.9%). Conclusion our analysis demonstrated that clinical outcomes at 12 months were lower for the AFMR group. These data are consistent with the literature, where AFMR is considered to have a better prognosis than VFMR, and underline the importance of differentiating these two types of population.
Introduction the septal perforating arteries of the heart usually branch off from the anterior and inferior interventricular arteries and supply the interventricular septum and the conduction system therein. Aim we present the case of hypertrophic septal perforating branch in a 71-year-old man who experienced dyspnoea in which was initially misinterpreted as interventricular defect. Materials and methods transthoracic echocardiography without and with contrast, coronary angiography and angioTC with 3D reconstructions were performed. Results echocardiography showed dilative cardiopathy with EF 30%, akinesia of IVS, apical and inferior wall. Hypokinesia of the remaining walls. At color-Doppler: severe mitral regurgitation and moderate tricuspidal regurgitation. Coronary angiography showed severe multivessel atherosclerotic coronary artery disease. At the echocardiographic control was reported the presence of turbulent flows at the level of medio-basal segment of posterior IVS. Echo-power-Doppler showed no shunts. For persisting suspect of interventricular defect was performed contrast echocardiography that showed hypoperfusion of IVS after contrast infusion but no clear signs of interventricular shunts. To complete the diagnostic iter was performed finally CT-Scan of coronary arteries that reported a presence of hypertrophic septal perforating branch with long intramyocardial course in the interventricular septum, but was no detected interventricular defect. Conclusions Septal perforating arteries have a large variability in their anatomy. Particular clincal conditions such as chronic coronary syndromes could lead to a reactive hypertrophy. Is important recognise it due to its similarity with interventricular defect or myocardial bridging effect. A better understanding of these arteries will help physicians to enhance cardiac care for their patients.
Background The comprehensive management of patients affected by heart failure with reduced ejection fraction (HFrEF) should pursue the goals of improving quality of life and reducing hospitalizations. Disease amelioration and cardiovascular mortality reduction are currently obtained by following guidelines-directed medical therapy (GDMT) that includes beta blockers, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), angiotensin receptor-neprilysin inhibitors (ARNIs), diuretics and mineralocorticoid receptor antagonists (MRAs); recently, sodium-glucose cotransporter-2 inhibitors (SGLT2Is) have been added on top of previous drugs, but real-world data are yet missing. Whether clinical management of patients affected by HFrEF bearing either implantable cardioverter/defibrillators (ICD) or cardiac resynchronization therapy devices (CRT-D) with a digital application (App) might further reduce hospitalization for HF independently of GDMT yet needs to be addressed. Materials and methods From February 2021 to June 2022 a total of 28 patients with HFrEF in GDMT previously undergone ICD/CRT-D implants were remotely monitored at our institution. Patients were instructed to download a dedicated application (MYTRIAGEHF) on their smartphones/tablets. Clinical data were retrieved monthly, through the App, according to data sent from answering to the following questions: i) shortness of breath; ii) feet, legs or ankles swelling; iii) feeling tired; iv) fatigue, lack of energy; v) weight gain in the last 3 days; vi) inconstant intake of diuretic therapy. Medical therapy was optimized accordingly. Results Satisfaction and regular use of the app was reported by 18/28 patients; most data came from ICD-implanted subjects (n=12, 75% dual chamber; 25% single chamber), while remaining were CRT-D. Eleven percent of App-users received SGLT2 inhibitors on top of medical therapy. Remarkably, only one patient of the non-App group was treated with SGLT2 inhibitors on top of medical therapy. Remaining non-App users as well as patients not in therapy with SGLT2 inhibitors are lost at follow-up; they presented with ischemic etiology in most cases and significantly reduced ejection fraction compared to App-group. Conclusion Our cohort demonstrated that implementing therapy with SGLT2 inhibitors and/or digital applications that follow patients remotely are valuable tools for the optimization of HFrEF clinical condition. Although cause and effect cannot be decisive from this study, the utilization of remote monitoring for therapy adjustments requires further investigation. The use of digital technologies to ensure a more personalized decision-making process will lead better care assistance.
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