March 2023 at a glance: pathophysiology, medical therapy and devices

Abstract

Interatrial shunt (IAS) devices are emerging as a novel treatment option for patients with heart failure (HF) and mildly reduced or preserved ejection fraction (HFpEF). 1-3 Latent pulmonary vascular disease might affect the benefits of IAS devices. 1 Schuster et al. 4 hypothesized that non-invasive characterization of cardiac and pulmonary physiology by cardiac magnetic resonance (CMR) during exercise may help in patient selection for IAS. Overall, 75 patients with HFpEF who underwent rest and exercise stress right heart catheterization, echocardiography and CMR were included. Latent pulmonary vascular disease, defined as pulmonary vascular resistance during exercise stress ≥1.74 Wood units, was associated with impaired right ventricular (RV) functional reserve and diastolic filling with a consequent reduction in left ventricular cardiac index. Cardiac amyloidosisCardiac amyloidosis (CA) is associated with disproportionally elevated natriuretic peptide and troponin levels. 5,6 Vergaro et al. 7 investigated the diagnostic role of these biomarkers in 1149 patients with suspected CA who underwent a diagnostic work-up in three European centres (n = 343, derivation cohort; n = 806, validation cohort). N-terminal pro-B-type natriuretic peptide <180 ng/L and high-sensitivity troponin T (hs-TnT) <14 ng/L ruled out the diagnosis of CA, whereas hs-TnT ≥86 ng/L was found as a rule-in cut-off for CA.