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Introduction: Transcatheter aortic valve implantation (TAVI) is a procedure that alters dramatically the hemodynamics in patients with severe aortic valve stenosis who undergo this procedure. Hypothesis: We investigated the hypothesis that arterial properties and hemodynamics are affected immediately after TAVI as well as in the long-term. Methods: We enrolled 90 patients (mean age 80.2 ± 8.1 years, 50% males) with severe symptomatic aortic stenosis undergoing TAVI. Carotid-femoral and brachial-ankle pulse wave velocity (cfPWV and baPWV) were used for the assessment of arterial stiffness. Augmentation index corrected for heart rate (AIx@75) and subendocardial viability ratio (SEVR) were measured non-invasively. Measurements were conducted at baseline, after the procedure (during hospitalization) and at 1 year. Results: Acutely after TAVI we observed a statistically significant increase in arterial stiffness (7.5 ± 1.5 m/s vs 8.4 ± 1.9 m/s, p=0.001 for cfPWV and 1,773 ± 459 cm/s vs 2,383 ± 645 cm/s, p Conclusions: In conclusion, shortly after TAVI the aorta exhibits a "stiffer" behavior in response to the acute change in hemodynamics, which settles in the long term. Our findings further elucidate the hemodynamic consequences of TAVI and may entail a prognostic role in this growing population.

Introduction: In transcatheter aortic valve replacement (TAVR), prosthesis oversizing prevents paravalvular regurgitation. Although the estimated extent of oversizing depends on annular measurements, oversizing strategies are not well established. Hypothesis: The aim of our study was to evaluate the impact of different degrees of valve oversizing based on multislice computed tomography (MSCT) on the outcome of patients. Methods: Patients with severe and symptomatic aortic stenosis scheduled for TAVR with a self-expanding valve, were prospectively enrolled. All patients underwent pre-procedural MSCT. According to the measurements, patients were classified into three groups for the degree of oversizing: normal (10-15%), moderate (15-20%) and severe (>20%) depending on the ratio between valve prosthesis diameter and the perimeter-derived annulus diameter based on MSCT. The main endpoint was mid-term mortality and secondary endpoints were the Valve Academic Research Consortium (VARC-2) end-points. Results: Overall, 177 patients (mean age: 79±7years, mean logEuroscore 24.9±10%, NYHA III-IV: 90%) were consecutively included in the study. Mean annulus area was 23.3±2.5mm 2 and mean perimeter was 74.36±7.27mm. Ninety-one patients (51%) had normal oversizing, 67 patients moderate (38%) and 19 patients (11%) severe oversizing. There were no cases of annular rupture. The primary clinical end-point occurred in 38 patients (21%) during a follow-up period of 24±12 months. While all-cause mortality rates were similar in all groups (24.1% for normal sizing versus 21.9% for moderate oversizing versus 22.9%, for severe oversizing, p=0.93), post-procedural new pacemaker (PPM) implantation rate was significantly higher in severe compared to the moderate and normal oversizing groups respectively (63.2%, versus 38.8%, versus 30.8%, p=0.03). Patients with normal oversizing had a trend of higher rate of significant paravalvular leak (at least moderate) compared to patients with moderate and severe oversizing (18.7%, versus 7.5%, versus 5.3%, p=0.058). Conclusions: Despite a higher rate of pacemaker implantation, a higher extent of valve oversizing in patients undergoing TAVR, seems to reduce the degree of paravalvular leak.

Objective: Severe aortic stenosis leads to increased pulmonary arterial systolic pressure. A controversy still remains regarding the impact of persistent pulmonary hypertension (PHT) on prognosis of patients undergoing transcatheter aortic valve implantation (TAVI). We sought to investigate the impact of persistent PHT on 2-year all-cause mortality of patients with severe aortic stenosis following TAVI. Methods: Patients with severe and symptomatic aortic stenosis (effective orifice area [EOA]≤1 cm 2 ) who were scheduled for TAVI with a self-expanding valve at our institution were prospectively enrolled. Prospectively collected echocardiographic data before and after TAVI were retrospectively analyzed in all patients. Pulmonary artery systolic pressure was estimated as the sum of the right ventricular to the right atrial gradient during systole and the right atrial pressure. PHT following TAVI was classified as absent if Results: Hundred and forty patients (mean age: 82±9 years) were included in the study. The primary clinical end point occurred in 17 patients (12%) during a median follow-up period of 2 years. Mean pulmonary artery systolic pressure was reduced in all patients following TAVI (45±9 versus 41±6 mmHg, p Conclusions: The persistence of pulmonary hypertension after TAVI is associated with long term mortality. Identifying the population that will clearly benefit from TAVI is still need to be validated by larger trials.

Background: Histological studies have demonstrated a potential role of inflammation and neoangiogenesis in aortic valve stenosis (AVS). Inflammatory activation may generate heat. We investigated in vivo in patients with AVS whether there is: thermal heterogeneity within the valve leaflets, temperature difference between the leaflets and the ascending aortic wall and a possible correlation between heat production, inflammation and neoangiogenesis. Methods: We examined 96 leaflets from 32 patients scheduled for aortic valve replacement. Seventy-five leaflets were from 25 patients with AVS and 21 from 7 patients with aortic valve insufficiency (AVI) (control group). Temperature measurements were performed right before the hypothermic cardioplegia. Temperature difference (ΔT) was assigned as the mean temperature of each aortic leaflet minus the temperature of the aortic wall. Results: Histological, immunohistological analysis for inflammatory cells and vascular endothelial growth factor (VEGF) immunoreactivity was performed. Significant thermal heterogeneity was recorded within the leaflets of AVS, compared AVI (1.52±1.35°C vs 0.13±0.11°C, p Conclusions: Thermal heterogeneity is increased in AVS and correlates with inflammatory mononuclear cell infiltration, expression of pro-inflammatory cytokines and neoangiogenic factors. Future studies need to be performed to investigate possible prognostic and therapeutic implications.

Background: In the clinical setting there are conflicting results regarding the role of inflammatory activation in atrial fibrillation (AF). Coronary sinus (CS) thermography assesses myocardial heat production and is correlated with inflammatory states. The purpose of this study was to investigate in patients (pts) with AF whether there is increased CS blood temperature and the correlation of heat production with systemic inflammation. Methods: We included pts with AF and subjects with sinus rhythm (controls). C-reactive protein (CRP) levels were measured in all pts. CS and right atrium (RA) blood temperature measurements were performed by a dedicated 7F thermography catheter. ΔT was calculated by subtracting RA from CS blood temperature. Results: We included 70 pts: 47 with lone AF and 23 controls. We stratified pts with AF into two groups: normotensive (AFN; n=25) and hypertensive (AFH; n=22). Heart rate was similar between the three groups (AFH: 72.91±4.11/min, AFN: 72.84±4.50/min control:72.52±4.19/min, p=0.89). Mean blood temperature was lower in the RA compared with the CS in AFH (37.27±0.52°C vs 37.47±0.54°C, p Conclusions: Pts with AF have increased myocardial heat production, which is correlated to the systemic inflammation. CS blood temperature measurement may provide significant information for the pathogenesis of AF.

A 61-year-old man presented with unstable angina (Braunwald class 2B). Coronary angiography revealed a mild lesion on the very proximal segment of the left anterior descending coronary artery (LAD) and a significant stenosis (80%) in the mid-segment. Intracoronary ultrasound was used to further evaluate proximal coronary artery stenosis. It was found to be a soft plaque without significant luminal stenosis but without clear definition of the luminal-intimal boundary. Intravenous injection of gas-filled microbubble ultrasound contrast agents have been used for endocardial border detection, especially when they are sonicated by acoustic power and …