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Transcatheter tricuspid valve replacement (TTVR) abolishes tricuspid regurgitation (TR) and has emerged as a definitive treatment for TR. The purpose of this multicenter, observational study was to determine the clinical characteristics and short-term outcomes of patients with TR screened for TTVR. Patients underwent TTVR screening at 7 centers on a compassionate-use basis. The primary endpoints were NYHA functional class and TR grade at 30-day follow-up. Secondary endpoints included all-cause mortality, heart failure hospitalization, technical success, and reasons for TTVR screening failure. A total of 149 patients (median age 79 years [Q1-Q3: 72-84 years], 54% women) underwent TTVR screening. The TTVR screening failure rate was 74%, mainly related to large tricuspid annular diameter. Patients undergoing TTVR (n = 38) had significant functional improvements (NYHA functional class I or II from 21% to 68%; P < 0.001), with TR ≤1+ in 97% at 30-day follow-up (P < 0.001 from baseline). Technical success was achieved in 91%, with no intraprocedural mortality or conversion to surgery. At 30-day follow-up, mortality was 8%, heart failure hospitalization 5%, major bleeding 18%, and reintervention 9%. Patients who failed screening for TTVR and subsequently underwent "bailout" transcatheter edge-to-edge repair (n = 26) had favorable outcomes (NYHA functional class I or II from 27% to 58%; P < 0.001), with TR ≤1+ in 43% at 30-day follow-up (P < 0.001 from baseline). This first real-world report of TTVR screening demonstrated a high screening failure rate, mainly related to large tricuspid annular diameter. Patients undergoing TTVR had superior TR reduction and symptom alleviation compared with bailout tricuspid transcatheter edge-to-edge repair, at the cost of greater procedural complications. [Display omitted] [ABSTRACT FROM AUTHOR]

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The purpose of this observational first-in-human experience was to investigate the feasibility and safety of the EVOQUE tricuspid valve replacement system and its impact on short-term clinical outcomes. Transcatheter tricuspid intervention is a promising option for selected patients with severe tricuspid regurgitation (TR). Although transcatheter leaflet repair is an option for some, transcatheter tricuspid valve replacement (TTVR) may be applicable to a broader population. Twenty-five patients with severe TR underwent EVOQUE TTVR in a compassionate-use experience. The primary outcome was technical success, with NYHA (NYHA) functional class, TR grade, and major adverse cardiac and cerebrovascular events assessed at 30-day follow-up. All patients (mean age 76 ± 3 years, 88% women) were at high surgical risk (mean Society of Thoracic Surgeons risk score 9.1 ± 2.3%), with 96% in NYHA functional class III or IV. TR etiology was predominantly functional, with mean tricuspid annular diameter of 44.8 ± 7.8 mm and mean tricuspid annular plane systolic excursion of 16 ± 2 mm. Technical success was 92%, with no intraprocedural mortality or conversion to surgery. At 30-day follow-up, mortality was 0%, 76% of patients were in NYHA functional class I or II, and TR grade was ≤2+ in 96%. Major bleeding occurred in 3 patients (12%), 2 patients (8%) required pacemaker implantation, and 1 patient (4%) required dialysis. This first-in-human experience evaluating EVOQUE TTVR demonstrated high technical success, acceptable safety, and significant clinical improvement. Larger prospective studies are needed to confirm durability and safety and the impact on long-term clinical outcomes. [ABSTRACT FROM AUTHOR]

Purpose To determine the prognostic value of visually detected coronary artery calcification (CAC) on unenhanced non-gated thoracic computed tomography (CT) for non-fatal myocardial infarction (MI) and all-cause mortality. Methods This retrospective single-centre cohort study comprised of 410 consecutive patients aged 40–80 years without any known cardiovascular disease at baseline. CT images without electrocardiogram-gating were acquired for a variety of respiratory medicine indications. CAC was examined by a single reader blinded to clinical data and outcome, using 1) the Agatston coronary calcium score (CCS), 2) visual CAC and 3) number of visually calcified coronary arteries. Results Visible CAC was identified in 201 (49.0%) of the 410 patients (60.5 ± 10.0 years old, 42.4% males). After a median follow up of 7.0 years, 39 patients (9.5%) experienced an event (death or non-fatal MI). After adjustment for cardiovascular risk factors, those with 1) higher CCS, 2) presence of visual CAC or 3) greater number of calcified coronary arteries by visual assessment, had an increased risk of adverse outcome (all p-value <0.05). There was no significant difference in c-statistics of the three methods of assessment (0.81, 0.80, 0.81 respectively), indicating that simple visual assessment of CAC may have a prognostic value similar to CCS. Conclusion Among patients with no known cardiovascular disease who underwent unenhanced non-gated CT for a pulmonary-related indication, visually detected CAC was a strong independent predictor of non-fatal MI and all-cause mortality. [ABSTRACT FROM AUTHOR]

Background Indications for the primary prevention of sudden death using an implantable cardioverter defibrillator (ICD) are based predominantly on left ventricular ejection fraction (LVEF). However, right ventricular ejection fraction (RVEF) is also a known prognostic factor in a variety of structural heart diseases that predispose to sudden cardiac death. We sought to investigate the relationship between right and left ventricular parameters (function and volume) measured by cardiovascular magnetic resonance (CMR) among a broad spectrum of patients considered for an ICD. Methods In this retrospective, single tertiary-care center study, consecutive patients considered for ICD implantation who were referred for LVEF assessment by CMR were included. Right and left ventricular function and volumes were measured. Results In total, 102 patients (age 62±14 years; 23% women) had a mean LVEF of 28±11% and RVEF of 44±12%. The left ventricular and right ventricular end diastolic volume index was 140±42 mL/m 2 and 81±27 mL/m 2 , respectively. Eighty-six (84%) patients had a LVEF <35%, and 63 (62%) patients had right ventricular systolic dysfunction. Although there was a significant and moderate correlation between LVEF and RVEF ( r =0.40, p <0.001), 32 of 86 patients (37%) with LVEF <35% had preserved RVEF, while 9 of 16 patients (56%) with LVEF ≥35% had right ventricular systolic dysfunction (Kappa=0.041). Conclusions Among patients being considered for an ICD, there is a positive but moderate correlation between LVEF and RVEF. A considerable proportion of patients who qualify for an ICD based on low LVEF have preserved RVEF, and vice versa. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to examine the frequency and type of outlier dose metrics for three common CT examination types on the basis of a root-cause analysis (RCA) approach.Methods: Institutional review board approval was obtained for this retrospective observational study. The requirement to obtain informed consent was waived. Between January 2010 and December 2013, radiation dose metric data from 34,615 CT examinations, including 26,878 routine noncontrast CT head, 2,992 CT pulmonary angiographic (CTPA), and 4,745 renal colic examinations, were extracted from a radiation dose index monitoring database and manually cleaned. Dose outliers were identified on the basis of the statistical distribution of volumetric CT dose index and dose-length product for each examination type; values higher than the 99th percentile and less than the 1st percentile were flagged for RCA.Results: There were 397 noncontrast CT head, 52 CTPA, and 80 renal colic outliers. Root causes for high-outlier examinations included repeat examinations due to patient motion (n = 122 [31%]), modified protocols mislabeled as "routine" (n = 69 [18%]), higher dose examinations for patients with large body habitus (n = 27 [7%]), repeat examinations due to technical artifacts (n = 20 [5%]), and repeat examinations due to suboptimal contrast timing (CTPA examinations) (n = 18 [5%]). Root causes for low-outlier examinations included low-dose protocols (n = 112 [29%]) and aborted examinations (n = 8 [2%]). On the basis of examination frequency over a 3-month period, the 90th and 10th percentile values were set in the radiation dose index monitoring database as thresholds for sending notifications to staff members responsible for outlier investigations.Conclusions: Systematic RCA of dose outliers identifies sources of variation and dose excess and pinpoints specific protocol and technical shortcomings for corrective action. [ABSTRACT FROM AUTHOR]

Hypertension is prevalent in patients with end–stage renal disease and is strongly associated with left ventricular hypertrophy (LVH), an independent predictor of cardiovascular mortality. Blood pressure (BP) monitoring in hemodialysis patients may be unreliable because of its lability and variability. We compared different methods of BP measurement and their relationship with LVH on cardiac magnetic resonance imaging. Sixty patients undergoing chronic hemodialysis at a single dialysis center had BP recorded at each dialysis session over 12 weeks: pre–dialysis, initial dialysis, nadir during dialysis, and post–dialysis. Forty–five of these patients also underwent 44–hour inter–dialytic ambulatory BP monitoring. Left ventricular mass index (LVMI) was measured using cardiac magnetic resonance imaging and the presence of LVH was ascertained. Receiver operator characteristic curves were generated for each BP measurement for predicting LVH. The mean LVMI was 68 g/m 2 (SD = 15 g/m 2 ); 13/60 patients (22%) had LVH. Mean arterial pressure measured shortly after initiation of dialysis session was most strongly correlated with LVMI (Pearson correlation coefficient r = 0.59, P < .0001). LVH was best predicted by post–dialysis systolic BP (area under the curve, 0.83; 95% confidence interval, 0.72–0.94) and initial dialysis systolic BP (area under the curve, 0.81; 95% confidence interval, 0.70–0.92). Forty–four–hour ambulatory BP and BP variability did not significantly predict LVH. Initial dialysis mean arterial pressure and systolic BP and post–dialysis systolic BP are the strongest predictors of LVH, and may represent the potentially best treatment targets in hemodialysis patients to prevent end–organ damage. Further studies are needed to confirm whether treatment targeting these BP measurements can optimize cardiovascular outcomes. [ABSTRACT FROM AUTHOR]

We report 4 cases of left main coronary artery (LMCA) compression after remote repair of conotruncal lesions and their successful surgical management. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is available in the text. Background: In ischemic cardiomyopathy, cardiac magnetic resonance assessment of the peri-infarct zone, a potential substrate for arrhythmogenesis, may serve as a novel prognosticator and guide the optimal use of implantable cardioverter-defibrillators. We undertook a systematic review and meta-analysis assessing the prognostic value of the peri-infarct zone on late gadolinium enhancement cardiac magnetic resonance in ischemic cardiomyopathy. Methods: We searched MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Medical Literature Analysis and Retrieval System Online), and CENTRAL (Medical Literature Analysis and Retrieval System Online) from inception to January 2019 for prognostic studies relating peri-infarct size with clinical outcomes in ischemic cardiomyopathy. Two authors independently performed study selection and data extraction. Pooled effect estimates were calculated with random effects models, risk of bias and strength of evidence were assessed by the Quality in Prognostic Studies tool and Grading of Recommendations Assessment, Development, and Education, respectively. Results: Twenty studies were eligible, representing 14 cohort studies (n=1518) with mean follow-up of 3.6 years and 6 cross-sectional studies (n=189). The extent of the peri-infarct zone was significantly predictive of all-cause mortality (3 studies; n=539; hazard ratio, 1.34/10 g [95% CI, 1.13–1.59]; I 2 =0%; high-quality evidence), appropriate implantable cardioverter-defibrillator therapy (5 studies; n=361; hazard ratio, 1.31/10 g [95% CI, 1.17–1.47]; I 2 =0%; high-quality evidence), and inducibility of ventricular tachycardia on electrophysiological study (5 studies; n=167; OR, 2.63/g [95% CI, 1.39–4.96]; I 2 =14%; low-quality evidence). After adjusting for age and left ventricular ejection fraction, the peri-infarct zone, as a percentage of total infarct size, remained an independent predictor of all-cause mortality (2 studies; n=445; hazard ratio, 1.29/10% [95% CI, 1.15–1.44]; I 2 =0%; high-quality evidence). Conclusions: There is limited but consistent evidence that quantification of the peri-infarct zone predicts long-term mortality and appropriate implantable cardioverter-defibrillator therapy in ischemic cardiomyopathy. Future studies should confirm whether late gadolinium enhancement-cardiac magnetic resonance assessment may improve implantable cardioverter-defibrillator treatment decisions. Clinical Trial Registration: URL: https://www.crd.york.ac.uk/prospero/. Unique identifier: CRD42017077337. [ABSTRACT FROM AUTHOR]