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Stress echocardiography (stress echo) is a method in which various stimuli are used to elicit myocardial contractility or provoke cardiac ischemia with simultaneous echocardiographic image acquisition of left ventricular function and valvular flow, if needed. The technique is a well-recognized, safe and widely available stress test used for the diagnosis and assessment of prognosis in coronary heart disease, but may also prove valuable in valvular heart disease. The stressors used include physical exercise, pharmacological agents (dobutamine, vasodilators) and pacing stress, most often with the use of a permanent pacemaker. Two operators should perform the test: a physician experienced in stress echocardiography (at least 100 tests completed under supervision of an expert) and a trained nurse or another doctor. The laboratory should feature a defibrillator and a resuscitation kit with a set of pharmaceuticals, an intubation kit and an AMBU bag. Pacing stress echo requires an external programmer for the implanted permanent pacemaker. Exercise should be the preferred stressor for the diagnosis of ischemic heart disease with alternative of high-dose dobutamine test in cases of contraindications to physical stress. Pacing stress echo is recommended for patients with pacemakers, and dipyridamole test for the assessment of coronary flow reserve. Chest pain in patients with intermediate probability of coronary artery disease, inability to perform physical exercise and non-diagnostic resting or exercise electrocardiography are indications for stress echo. The test is also used in symptomatic patients after revascularization or patients qualified for revascularization for functional assessment of coronary artery stenosis. Low-dose dobutamine test is usually performed in patients after myocardial infarction or with moderate-to-severe left ventricular dysfunction to assess myocardial viability before potential revascularization. [ABSTRACT FROM AUTHOR]

Aims: To assess the right ventricular (RV) function in patients with severe mitral regurgitation (MR); to find a relation between preoperative and postoperative parameters. Methods: RV function was echocardiographically assessed by determining the tricuspid annular plane systolic excursion (TAPSE) and the peak systolic velocity of the lateral tricuspid annulus (Sa) in 45 patients with severe organic MR (53.3% men, age 58 ± 10 years). Mean NYHA class was 2.6 ± 0.4, LVEF was 55.3 ± 12%, RV end-diastolic diameter was 28.7 ± 4.7, left ventricular end-systolic diameter (LVESD) was 44.6 ± 12.6 mm, and LV end-diastolic volume (Simpson) was 160.6 ± 50.3 ml. All patients underwent mitral valve replacement with posterior chordal sparing. Results: Mean preoperative TAPSE and Sa were 19.4 ± 4.3 mm and 10.3 ± 3 cm/sec, respectively. RV dysfunction, defined as TAPSE < 22 mm, had 66.6% of the patients, and Sa < 11 cm/sec was found in 62.2% of the patients preoperatively. Preoperative TAPSE and Sa were significantly correlated (P < 0.00001, r = 0.61). Both TAPSE and Sa were correlated with the RV end-diastolic diameter (P < 0.01), LVESD (P < 0.05) left ventricular dp/dt (P < 0.05), and LVEF (P < 0.0001). Postoperative LVEF was 50% (P < 0.001), Sa 5.3 ± 2 cm/sec (P < 0.001), and TAPSE 8.7 ± 3.2mm (P < 0.001). Twenty-one patients (46.6%) reached the study end point of decrease of LVEF by more than 10%. Univariate predictors were age (P = 0.04), male gender (P = 0.01), TAPSE (P = 0.007), and Sa (P = 0.009), while a trend was found for regurgitation fraction (P = 0.058) and LV end-diastolic volume index (P = 0.09). By multivariate analysis, TAPSE (P = 0.01) and Sa (P = 0.01) were predictive for the study end point. Conclusion: The assessment of the RV function by echocardiography is a simple tool that provides prognostic information in patients with MR. [ABSTRACT FROM AUTHOR]

OBJECTIVES Open in new tab Download slide Open in new tab Download slide The objective of this study was to evaluate the safety and performance of a novel, beating heart procedure that enables echocardiographic-guided beating heart implantation of expanded polytetrafluoroethylene (ePTFE) artificial cords on the posterior mitral leaflet of patients with degenerative mitral regurgitation. METHODS Two prospective multicentre studies enrolled 13 (first-in-human) and 52 subjects, respectively. Patients were treated with the HARPOON beating heart mitral valve repair system. The primary (30-day) end point was successful implantation of cord(s) with mitral regurgitation reduction to ≤moderate. An independent core laboratory analysed echocardiograms. RESULTS Of 65 patients enrolled, 62 (95%) achieved technical success, 2 patients required conversion to open surgery and 1 procedure was terminated. The primary end point was met in 59/65 (91%) patients. Among the 62 treated patients, the mean procedural time was 2.1 ± 0.5 h. Through discharge, there were no deaths, strokes or renal failure events. At 1 year, 2 of the 62 patients died (3%) and 8 (13%) others required reoperations. At 1 year, 98% of the patients with HARPOON cords were in New York Heart Association class I or II, and mitral regurgitation was none/trace in 52% (n  = 27), mild in 23% (n  = 12), moderate in 23% (n  = 12) and severe in 2% (n  = 1). Favourable cardiac remodelling outcomes at 1 year included decreased end-diastolic left ventricular volume (153 ± 41 to 119 ± 28 ml) and diameter (53 ± 5 to 47 ± 6 mm), and the mean transmitral gradient was 1.4 ± 0.7 mmHg. CONCLUSIONS This initial clinical experience with the HARPOON beating heart mitral valve repair system demonstrates encouraging early safety and performance. Clinical registration numbers NCT02432196 and NCT02768870. [ABSTRACT FROM AUTHOR]

Aims: Heart failure outcomes remain poor despite advances in therapy. The European Society of Cardiology Heart Failure III Registry (ESC HF III Registry) aims to characterize HF clinical features and outcomes and to assess implementation of guideline‐recommended therapy in Europe and other ESC affiliated countries. Methods: Between 1 November 2018 and 31 December 2020, 10 162 patients with chronic or acute/worsening HF with reduced, mildly reduced, or preserved ejection fraction were enrolled from 220 centres in 41 European or ESC affiliated countries. The ESC HF III Registry collected data on baseline characteristics (hospital or clinic presentation), hospital course, diagnostic and therapeutic decisions in hospital and at the clinic visit; and on outcomes at 12‐month follow‐up. These data include demographics, medical history, physical examination, biomarkers and imaging, quality of life, treatments, and interventions – including drug doses and reasons for non‐use, and cause‐specific outcomes. Conclusion: The ESC HF III Registry will provide comprehensive and unique insight into contemporary HF characteristics, treatment implementation, and outcomes, and may impact implementation strategies, clinical discovery, trial design, and public policy. [ABSTRACT FROM AUTHOR]

Background: His bundle pacing (HBP) has proved to be a valuable alternative enabling the physiological activation of cardiac contraction in cardiac resynchronization therapy (CRT). At present, however, little is known about the optimal method of programming of the His bundle‐paced CRT systems in terms of achieving the best cardiac output. Aim: The aim of this study was to evaluate the impact of cardiac resynchronization therapy with conduction system pacing (CRT+CSP) on echo‐based hemodynamic parameters in the early post‐operative measurements. Methods: The study enrollment criteria included: permanent atrial fibrillation, heart failure and bundle branch block. All patients underwent implantation of CRT + HBP. During the post‐operative phase, we aimed to optimize HOT‐CRT settings in order to achieve the greatest cardiac output assessed by complex echocardiographic measurements. Results: The study included 21 patients, mean age 71.2 (6.3) years, predominantly men (71.4%) with non‐ischemic cardiomyopathy 62%. All patients had heart failure with NYHA functional class III and IV (81%). Mean left ventricular ejection fraction was 27.5 (9.7%). The mean duration of the QRS complex was 148.8 ms. The effects of resynchronization pacing: HBP alone, HBP with left ventricular pacing, HBP with biventricular pacing (BiV) and BiV without HBP ​​were analyzed consecutively. HBP combined with left ventricular pacing demonstrated the best hemodynamic response. Conclusion: His bundle pacing coupled with LV pacing proved to be the most advantageous pacing program setting with regard to cardiac output. Moreover, it performed better than biventricular pacing and significantly better than RV pacing. [ABSTRACT FROM AUTHOR]

Background: Conventional mitral valve (MV) operations allow direct anatomic assessment and repair on an arrested heart, but require cardiopulmonary bypass, aortic cross-clamping, sternotomy or thoracotomy, and cardioplegic cardiac arrest, and are associated with significant perioperative disability, and risks of morbidity and mortality.Objectives: This study evaluated safety and performance of a transesophageal echocardiographic-guided device designed to implant artificial expanded polytetrafluoroethylene (ePTFE) cords on mitral leaflets in the beating heart.Methods: In a prospective multicenter study, 30 consecutive patients with severe degenerative mitral regurgitation (MR) were treated with a mitral valve repair system (MVRS) via small left thoracotomy. The primary (30-day) endpoint was successful implantation of cords with MR reduction to moderate or less.Results: The primary endpoint was met in 27 of 30 patients (90%). Three patients required conversion to open mitral surgery. There were no deaths, strokes, or permanent pacemaker implantations. At 1 month, MR was mild or less in 89% (24 of 27) and was moderate in 11% (3 of 27). At 6 months, MR was mild or less in 85 % (22 of 26), moderate in 8% (2 of 26), and severe in 8% (2 of 26). Favorable cardiac remodeling at 6 months included decreases in end-diastolic (161 ± 36 ml to 122 ± 30 ml; p < 0.001) and left atrial volumes (106 ± 36 ml to 69 ± 24 ml; p < 0.001). The anterior-posterior mitral annular dimension decreased from 34.7 ± 5.8 mm to 28.2 ± 5.1 mm; p < 0.001 as did the mitral annular area (10.0 ± 2.7 cm2 vs. 6.9 ± 2.0 cm2; p < 0.0001).Conclusions: MVRS ePTFE cordal implantation can reduce the invasiveness and morbidity of conventional MV surgery. The device's safety profile is promising and prospective trials comparing the outcomes of the MVRS to conventional MV repair surgery are warranted. (CE Mark Study for the Harpoon Medical Device [TRACER]; NCT02768870). [ABSTRACT FROM AUTHOR]

Introduction: The treatment of choice for aortic stenosis is a valve replacement. Some patients have post-procedural increased pressure gradient on the implanted prosthesis because of patient-prosthesis mismatch (PPM), known to adversely influence prognosis. The PPM risk should be initially predicted and effort made to avoid this complication, specifically in large body size patients. Aim: To assess the frequency of PPM taking into account the valvular prosthesis type in a real-life population of consecutive patients included in the Krakow aortic stenosis registry. Material and methods: The KRAK-AS registry was conducted in July-October 2016. Patients were assessed before and after valve surgery and during the 3-year follow-up. Patients who underwent aortic valve intervention were clinically and echocardiographically evaluated within a month after surgery and divided into groups depending on the implanted prosthesis type. Analysis of patients with a smaller (< 23 mm) and larger than median (≥ 23 mm) valve diameter was performed. Results: The valve implantation was performed in 229 patients (42 mechanical, 139 biological, 48 transcatheter). No differences between patient groups compared by PPM occurrence was seen at baseline. Median age was 70 years; 55.5% were men. At least moderate PPM (iEOA ≤ 0.85 cm²/m²) was observed in 40% of mechanical valves, 33% of biological valves, and was significantly less frequent (10%) in patients after transcatheter valve implantation, p = 0.0001. Severe PPM (iEOA < 0.65 cm²/m²) was found in 17.6% of mechanical valve PPM patients, 4.3% of biological ones, and no patients after transcatheter procedure. Conclusions: PPM is a frequent phenomenon in the real-life population of patients undergoing surgical aortic valve replacement, being significantly less frequent in the case of a transcatheter procedure. [ABSTRACT FROM AUTHOR]

Aim: Assessment of safety, diagnostic, and prognostic value of a stress echocardiography protocol based on rapid pacing in patients with implanted permanent pacemakers according to the pacing mode (AAI/DDD or VVI) and concomitant antiischemic therapy. Material and methods: 149 rapid pacing stress echo tests were performed in 100 patients (33 females, 67 males, aged 47–79, mean 65 ± 8 years), utilizing previously implanted permanent pacemakers. Left ventricular segmental contractility was assessed at rest, during pacing at the rate of 100/minutes and then at 85% of maximal age-predicted heart rate. Each pacing stage lasted for 3 minutes. The test was performed using only VVI pacing mode in 27 patients in whom atrial pacing was not possible. In the remaining 73 patients AAI/DDD pacing mode was initially used in all 73 patients and followed by VVI pacing in 49 patients. Angiographic coronary stenosis of at least 50% was considered significant. Results: No severe adverse effects were observed. Mean duration of the test was 7 ± 2 minutes for VVI pacing and 10 ± 2 minutes for both AAI/DDD and VVI pacing. Among 149 tests performed, AAI/DDD mode was used in 73 (49%), while in VVI mode was used in 76 (51%) tests. Significant increase in heart rate comparing to baseline was achieved{[ 68/minutes vs. 129/minutes (P < 00001)]}, also in patients treated with beta-blockers{[ 69/minutes vs. 129/minutes (P < 00001)]}, whereas, blood pressure remained unchanged between rest and rapid pacing stage. Wall motion score index increased significantly (from 1.32 vs. 1.49 in AAI/DDD to 1.36 vs. 1.65 in VVI mode). Among all 149 tests, 89 (60%) were considered positive, 57 (38%) negative, and 3 (2%) — nondiagnostic. Sensitivity, specificity, accuracy, positive, and negative predictive values for significant coronary stenosis were respectively: 91%, 75%, 83%, 81%, and 88%. For AAI/DDD mode the above values were: 91%, 81%, 86%, 82%, 91%, while for VVI mode they were: 91%, 68%, 80%, 80%, 84% (ns). In patients treated with beta-blockers test accuracy was – 79%., with ACE inhibitors – 84%, and with nitrates – 93%. During 1-year follow-up 5 (5%) cardiac deaths and 9 (9,1%) myocardial infarctions occurred. The risk of myocardial infarction or cardiac death was significantly higher in patients with positive comparing to negative result of RAPSE test. Complications hazard ratio associated with positive result of RAPSE was 13.5 (95% confidence interval, 1.7–106.0, P + 0.0133) for AAI/DDD mode and 7.9 (95% confidence interval, 1.0–60.9, P + 0.00472) for VVI mode. Conclusions: Rapid pacing stress echo test using permanent pacemaker is a rapid and safe diagnostic technique. The accuracy is good for both pacing modes, including tests performed in patients treated with beta-blockers. The test can be utilized as atechnique of choice in noninvasive diagnostics of coronary disease and prognostic assessment in patientswith permanent pacemakers. [ABSTRACT FROM AUTHOR]

Introduction: Transapical access (TA) transcatheter aortic valve implantation (TAVI) (TA-TAVI) represents one of the possible routes in patients with severe aortic stenosis (AS) who are not suitable for transfemoral access. Aim: To assess early- and mid-term clinical outcomes after TA-TAVI. Material and methods: Patients with severe symptomatic AS undergoing TA-TAVI from November 2008 to December 2019 were enrolled. Clinical and procedural characteristics as well as clinical outcomes including all-cause mortality during 12-month follow-up were assessed. Results: Sixty-one consecutive patients underwent TA-TAVI for native AS. Patients were elderly with median age of 80.0 (76.0- 84.0) years; 55.7% were males. Median baseline EuroSCORE I and STS scores were 18.2% (11.6-27.7) and 4.8% (3.3-8.2), respectively. The procedural success rate was 96.7%. In-hospital, 30-day and 12-month mortality rates were 9.8%; 18.0% and 24.6%, respectively. The main periprocedural and in-hospital complications were bleeding complications (14.8%). The following factors were associated with 12-month mortality: previous cerebrovascular event (CVE), glomerular filtration rate (GFR), aortic valve area (AVA), right ventricular systolic pressure (RVSP) and serum level of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) (RR for CVE 3.17, 95% confidence interval (CI): 1.15-8.76: p = 0.026; RR for AVA per 0.1 cm2 1.28, 95% CI: 1.03-1.55: p = 0.024; RR for GFR per 1 ml/min 0.96: 95% CI: 0.94-0.99: p = 0.007; RR for NT-proBNP per 1000 pg/ml 1.07: 95% CI: 1.01-1.17: p = 0.033; RR for RVSP per 1 mm Hg 1.07: 95% CI 1.02-1.16: p = 0.011). Conclusions: Transapical TAVI in high-risk patients provides good hemodynamic results with acceptable outcomes [ABSTRACT FROM AUTHOR]

Transthoracic echocardiography is the primary non-invasive modality for anatomical and functional cardiac assessment. All one-, two-dimensional and Doppler modes use the same phenomenon, i.e. the piezoelectric effect, to visualize mobile cardiac structures and blood flow in cardiac cavities. Novel techniques for myocardial imaging, such as tissue Doppler and acoustic marker tracing, allow for the assessment of regional myocardial contractility of the left and the right ventricle. Cardiac assessment is performed in standard views characterized by an optimal acoustic window. The goal of each cardiac echo is to assess cardiac function and morphology using all available imaging modes. The evaluation of acquired valvular heart diseases should include morphological and functional changes indicative of the type (stenosis, regurgitation, complex defect) and the mechanism (Carpentier's classification of mitral regurgitation) of the defect, as well as its stage (mild, moderate, severe). The assessment of left and right ventricular function should involve the measurement of global and regional parameters. An echocardiographic report should also include information on septal continuity and the presence of additional structures or intracardiac masses. [ABSTRACT FROM AUTHOR]

Stress echocardiography (stress echo), with use of both old and new ultrasonographic cardiac function imaging techniques, has nowadays become a widely available, safe and inexpensive diagnostic method. Cardiac stress, such as exercise or an inotropic agent, allows for dynamic assessment of a wide range of functional parameters describing ventricles, heart valves and pulmonary circulation. In addition to diagnosis of ischemic heart disease, stress echocardiography is also used in patients with acquired and congenital valvular defects, hypertrophic cardiomyopathy, dilated cardiomyopathy as well as diastolic and systolic heart failure. Physical exercise is the recommended stressor in patients with aortic and especially mitral valvular disease. Nevertheless, dobutamine stress echo is useful for the assessment of contractile and flow reserve in aortic stenosis with reduced left ventricular ejection fraction. Stress echo should always be performed by an appropriately trained cardiologist assisted by a nurse or another doctor, in the settings of an adequately equipped echocardiographic laboratory and with compliance to safety requirements. Moreover, continuous education of cardiologists performing stress echo is needed. [ABSTRACT FROM AUTHOR]

Introduction: Currently, Cardiology Centres are overfilled with patients with degenerative aortic valve stenosis (DAS), usually eldery, with severe concommittant comorbidities, who are referred for further decisions and possible intervention. Aim: To evaluate changes in the risk profile of patients with severe DAS admitted to the cardiology department a decade ago compared with patients currently being admitted. Material and methods: We retrospectively evaluated all patients admitted with confirmed severe DAS, hospitalized during 2005.2006 (group I: 140 patients) and in 2016 (group II: 152 patients), admitted for aortic valve intervention. A standard transthoracic echocardiogram, cardiovascular symptom and risk factor distribution, perioperative risk with the logistic EuroSCORE II and STS mortality scores were obtained. Results: Patients in group II were significantly older (p < 0.001), had more cardiovascular risk factors, and more often presented with atrial fibrillation (27% vs. 11.4%, p = 0.001), renal impairment (34.9% vs. 22.8%; p = 0.024), severe lung disease (17.1% vs. 2.1%, p < 0.001), and extracardiac arteriopathy (40.1% vs. 17.8%, p < 0.001). The aortic valve area (AVA) (p = 0.356), mean-transvalvular pressure gradient (p = 0.215), and left ventricular ejection fraction (p = 0.768) were similar in both groups. However, the prevalence of pulmonary hypertension, severe mitral regurgitation, and low-flow, low-gradient DAS were 3.1-, 8.4- and 1.84-fold more frequent in group II than group I. The percentages of subjects with EuroSCORE II and STS scores . 4% in 2005.2006 were 7.1% and 6.4%, as compared to 27% and 26.3% in 2016 (both p < 0.001). 22% of patients in 2016, as compared to 31% in 2005/2006, were considered ineligible for DAS intervention. Conclusions: In just a decade, the risk profile of patients admitted with DAS has increased hugely, mainly due to older age, accumulation of comorbidities and more advanced disease at presentation. Although transcatheter aortic valve intervention has expanded the indications for intervention in high-risk patients, the number of patients disqualified from interventional treatment remains high. [ABSTRACT FROM AUTHOR]

Introduction: The most common alternative method of treatment for patients with severe mitral regurgitation (MR) is the implantation of a MitraClip device. Aim: To evaluate clinical and echocardiographic outcomes and quality of life (QoL) in patients with severe secondary MR, disqualified from surgical intervention, treated by implantation of a MitraClip in comparison to conservative therapy. Material and methods: A total of 33 patients were included. Patients were stratified by treatment method: group A, MitraClip implantation (n = 10); group B, conservative treatment (n = 23). Clinical, echocardiographic, and QoL (EQ-5D-3L, SF-12v2 Health Survey) characteristics were compared at baseline and at follow-up of 8.0 ±2.3 months. Results: In group A, 2 deaths were observed: one patient died 7 days after MitraClip implantation, and the second patient died 4 months after the procedure. No cases of rehospitalization were reported. In group B, 4 (17.4%) deaths and 6 (26.1%) hospitalizations were reported. After MitraClip implantation a significant reduction of the NYHA class (p = 0.02), decrease in grade of MR (p = 0.01), vena contracta width (p = 0.006), effective regurgitant orifice area (EROA) (p = 0.003), regurgitant volume (p = 0.03) and end-diastolic left ventricle diameter (p = 0.02) as well as an improvement in QoL were reported. There were no significant changes in the NYHA class and QoL in the group treated conservatively. In those patients, we observed increased intercommissural mitral annulus diameter (p = 0.03), left atrium diameter (p = 0.002), and right ventricle dimension (p = 0.008), more severe tricuspid regurgitation (p = 0.02) and lower mitral annular plane systolic excursion (p = 0.01). Conclusions: Patients with severe secondary MR treated with the MitraClip achieved a significant reduction in symptoms and MR grade, as well as an improvement in QoL, as compared to patients treated conservatively. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to compare 12-month mortality rate of patients with and without complete coronary revascularization before transcatheter aortic valve implantation (TAVI).Background: There are limited data on the impact of coronary artery disease burden in patients with severe aortic stenosis undergoing TAVI.Methods: One hundred and one consecutive patients undergoing TAVI were enrolled. Of them 16 (15.8%) had an incomplete coronary revascularization. The primary endpoint was 12-month all-cause mortality.Results: Twelve-month all-cause mortality was higher in patients with incomplete coronary revascularization than in patients with complete coronary revascularization or without significant lesions (75.0% vs 7.1%; P < 0.001). Importantly, incomplete coronary revascularization was an independent predictor of higher mortality rate after 12 months (hazard ratio (HR) for incomplete coronary revascularization 10.86, 95% CI 3.72-31.73; P < 0.001; HR for a history of stroke/TIA 3.93, 95% confidence interval (CI) 1.39-11.07; P < 0.001; HR for blood transfusion 2.84 95% CI (1.06-7.63); P = 0.039). In 9 of 16 (56.3%) patients, incomplete revascularization was related to the presence of chronic total occlusions (CTO). Patients with CTO had an increased mortality rate after 12 months (55.6% vs 14.1%; P = 0.008) as compared to patients without the CTO.Conclusions: Incomplete coronary revascularization and a history of stroke or TIA may be independent predictors of all-cause mortality in patients undergoing TAVI. However, further studies are recommended to confirm the results, especially in terms of the impact of CTO presence on long-term mortality after TAVI. [ABSTRACT FROM AUTHOR]

Background: Degenerative mitral valve (MV) disease is a common cause of severe mitral regurgitation (MR) and accounts for the majority of MV operations. Conventional MV surgery requires cardiopulmonary bypass, aortic cross-clamping, cardioplegia, and a thoracotomy or sternotomy and, therefore, is associated with significant disability, risks, and unpredictable rates of MV repair. Transesophageal echocardiography-guided beating-heart MV repair with expanded polytetrafluoroethylene cordal insertion has the potential to significantly reduce surgical morbidity. We report the first-in-human clinical experience with a novel preformed expanded polytetrafluoroethylene knot implantation device (Harpoon TSD-5) designed to treat degenerative MR.Methods: Through a small left thoracotomy, the device was inserted into the heart and guided by transesophageal echocardiography to the ventricular surface of the prolapsed leaflet. Multiple expanded polytetrafluoroethylene cords were anchored in the leaflet and then adjusted to the correct length to restore MV leaflet coaptation and secured at the epicardium.Results: Eleven patients with posterior leaflet prolapse and severe MR, with mean±SD age of 65±13 years and mean ejection fraction of 69±7%, were treated with 100% procedural success. Immediate postprocedural mean MR grade was trace. At 1 month, the mean MR grade was mild with significant decreases in end-diastolic volume (139 to 107 mL; P=0.03) and left atrial volume (118 to 85 mL; P=0.04).Conclusions: A novel device used for beating-heart image-guided MV repair demonstrates a significant reduction in MR with favorable left ventricular and left atrial reverse remodeling. This approach has the potential to decrease invasiveness and surgical morbidity. Further follow-up is necessary to assess long-term efficacy.Clinical Trial Registration: URL: https://clinicaltrials.gov. Unique identifier: NCT02432196. [ABSTRACT FROM AUTHOR]

Introduction: Transcatheter aortic valve implantation (TAVI) is a less invasive treatment option for elderly, high-risk patients with symptomatic severe aortic stenosis (AS) than aortic valve replacement. More importantly, TAVI improves survival and quality of life as compared to medical treatment in inoperable patients. Aim: To assess early- and mid-term clinical outcomes after TAVI. Material and methods: All consecutive high-risk patients with severe symptomatic AS undergoing TAVI from November 2008 to August 2014 were enrolled. The clinical and procedural characteristics, as well as clinical outcomes including mortality during 12-month follow-up, were assessed. Results: A total of 101 consecutive patients underwent TAVI for native aortic valve stenosis (100%). Patients were elderly, with a median age of 81.0 (76.0-84.0) years, 60.4% were female and 83.2% presented with NYHA III/IV. Median baseline EuroSCORE I and STS scores were 14.0 (10.0-22.5)% and 12.0 (5.0-24.0)%, respectively. The main periprocedural and in-hospital complications were minor vascular complications, bleeding requiring blood transfusions, and the need for a permanent pacemaker. In-hospital, 30-day, 6-month and 12-month mortality rates were 6.9%, 10.9%, 15.8% and 17.8%, respectively. Conclusions: A mortality rate of < 20% after 12 months seems acceptable given the high-risk population enrolled. [ABSTRACT FROM AUTHOR]

Purpose Cardiac resynchronization therapy (CRT) is a valuable option for patients with heart failure and wide QRS to reduce electromechanical dyssynchrony (DYS). High non-responders rate (30%) urges the need to improve selection of candidates for CRT. We hypothesized that low-dose dobutamine stress echocardiography (DSE) can help unmask dyssynchronous motion. The aim of this study is comparison between dyssynchrony index at rest and during low-dose dobutamine stress to predict left ventricular reverse remodeling after CRT. Patients and methods Prospectively, 57 consecutive patients (37 male) aged 61.8 ± 9 who qualified for CRT according to current guidelines were enrolled. Two dimensional echocardiography and tissue Doppler imaging (TDI) were performed before and 6 month after CRT to assess reverse remodeling (rLV). Additionally DSE was performed before CRT. DYS was assessed at rest (DYSr) and peak DSE (DYSd) separately, as a difference between time to peak systolic velocity (Ts) of septum and lateral wall. Ts was corrected for heart rate. Results rLV defined as decrease ≥15% of LVESV at follow-up was found in 38 (67%) patients. DYSr and DYSd were independent predictors of rLV (OR = 1.04, Cl ± 1.02–1.06, p < 0.02 and OR = 1.05, Cl ± 1.03–1.08, p < 0.0002 respectively). ROC analysis found that DYSr > 42 ms and DYSd > 59 ms had sensitivity of 70% and 87%, specificity of 61% and 78%, and accuracy of 70% and 84% respectively for prediction of reverse remodeling LV. Area under Receiver Operating Characteristic Curve for DYSd was higher than for DYSr (0.89 vs 0.71, p < 0.007). Conclusion Exercise intraventricular dyssynchrony assessed by dobutamine stress echo is a strong independent predictor of cardiac resynchronization therapy response. [ABSTRACT FROM AUTHOR]

Abstract: We report a case of pacemaker endocarditis due to Stenotrophomonas maltophilia in a 22-year-old Caucasian man with d-transposition of the great arteries after atrial switch procedure. S.maltophilia isolated from blood cultures was susceptible to trimethoprim-sulfamethoxazole and amikacin, and resistant to ciprofloxacin and all tested β-lactam antibiotics. The infected pacemaker system was completely removed by thoracotomy. Simultaneously, a new DDD pacemaker and epicardial electrodes were successfully implanted and selective antibiotic therapy consisting of trimethoprim-sulfamethoxazole (480 mg i.v. q 6 h) and amikacin (250 mg i.v. twice daily) was continued. However, the post-operative course was complicated by septic shock and the patient died on 9th day after surgery. Importantly, S.maltophilia isolated from extracted pacemaker leads was multidrug-resistant including to trimethoprim-sulfamethoxazole, ciprofloxacin, all tested aminoglycosides, and β-lactams, with the exception of ticarcillin-clavulanate. In conclusion, pacemaker endocarditis due to Stenotrophomonas maltophilia is an extremely rare but serious complication of permanent pacing therapy. The susceptibility of S.maltophilia isolates to antimicrobial agents can change during the course of infection. Despite the inherent resistance of S.maltophilia to most β-lactam antibiotics, multidrug-resistant strains may be susceptible in vitro to ticarcillin-clavulanate. Further studies are needed to determine the optimal management of patients with pacemaker endocarditis caused by Stenotrophomonas maltophilia. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease is a leading cause of heart failure (HF) and major adverse cardiac and cerebral events (MACCE). Objective: To evaluate impact of vascular resistance on HF and MACCE incidence in subjects with cardiovascular risk factors (CRF) and degenerative aortic valve stenosis (DAS). Methods: From January 2016 to December 2018, in 404 patients with cardiovascular disease, including 267 patients with moderate-to-severe DAS and 137 patients with CRF, mean values of resistive index (RI) and pulsatile index (PI) were obtained from carotid and vertebral arteries. Patients were followed-up for 2.5 years, for primary outcome of HF and MACCE episodes. Results: RI and PI values in patients with DAS compared to CRF were significantly higher, with optimal cut-offs discriminating arterial resistance of ≥0.7 for RI (sensitivity: 80.5%, specificity: 78.8%) and ≥1.3 for PI (sensitivity: 81.3%, specificity: 79.6%). Age, female gender, diabetes, and DAS were all independently associated with increased resistance. During the follow-up period, 68 (16.8%) episodes of HF-MACCE occurred. High RI (odds ratio 1.25, 95% CI 1.13–1.37) and PI (odds ratio 1.21, 95% CI 1.10–1.34) were associated with risk of HF-MACCE. Conclusions: An accurate assessment of vascular resistance may be used for HF-MACCE risk stratification in patients with DAS. [ABSTRACT FROM AUTHOR]

We report a rare case of primary antiphospholipid syndrome (APS) in a 43-year-old man presenting as recurrent acute coronary stent thrombosis and complicated by three myocardial infarctions. As illustrated in this report, in APS patients recurrent life-threatening arterial thrombotic events may occur in spite of recommended anticoagulant therapy. We conclude that the APS should be considered as a potential cause of acute coronary syndrome, particularly in young individuals with a history of recurrent thrombotic events and/or with abnormal coagulation test results. Further studies are needed to determine the best therapeutic strategy for APS patients with acute coronary syndrome. [ABSTRACT FROM AUTHOR]

A response from the author of the article "Transapical Beating-Heart Mitral Valve Repair With an Expanded Polytetrafluoroethylene Cordal Implantation Device: Initial Clinical Experience" that was published in the previous issue, is presented.