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Aims To evaluate the prognostic impact of pre-procedural right ventricular longitudinal strain (RVLS) in patients with secondary mitral regurgitation (SMR) undergoing transcatheter edge-to-edge repair (TEER) in comparison with conventional echocardiographic parameters of RV function. Methods and results This is a retrospective study including 142 patients with SMR undergoing TEER at two Italian centres. At 1-year follow-up 45 patients reached the composite endpoint of all-cause death or heart failure hospitalization. The best cut-off value of RV free-wall longitudinal strain (RVFWLS) to predict outcome was −18% [sensitivity 72%, specificity of 71%, area under curve (AUC) 0.78, P < 0.001], whereas the best cut-off value of RV global longitudinal strain (RVGLS) was −15% (sensitivity 56%, specificity 76%, AUC 0.69, P < 0.001). Prognostic performance was suboptimal for tricuspid annular plane systolic excursion, Doppler tissue imaging-derived tricuspid lateral annular systolic velocity and fractional area change (FAC). Cumulative survival free from events was lower in patients with RVFWLS ≥ −18% vs. RVFWLS < −18% (44.0% vs. 85.4%; < 0.001) as well as in patients with RVGLS ≥ −15% vs. RVGLS < −15% (54.9% vs. 81.7%; P < 0.001). At multivariable analysis FAC, RVGLS and RVFWLS were independent predictors of events. The identified cut-off of RVFWLS and RVGLS both resulted independently associated with outcomes. Conclusion RVLS is a useful and reliable tool to identify patients with SMR undergoing TEER at high risk of mortality and HF hospitalization, on top of other clinical and echocardiographic parameters, with RVFWLS offering the best prognostic performance.

COAPT-trial entry criteria are useful to identify patients with better outcomes after transcatheter edge-to-edge repair (TEER). However, up to one-half of real-world patients with secondary mitral regurgitation (SMR) undergoing TEER do not meet these highly selective criteria and no study has formally investigated them. The aim of this study was to evaluate the predictors of good outcome after TEER in COAPT-ineligible patients.All consecutive patients with SMR and heart failure (HF) treated with MitraClip at 3 European centres were retrospectively screened. The presence of at least 1 COAPT exclusion criterion was used to define a COAPT-ineligible profile, allowing the inclusion in the study population. Freedom from all-cause death or HF hospitalisation was evaluated at 2-year follow-up (primary end point).A total of 305 patients (47%) had a COAPT-ineligible profile. An overall 58% rate of all-cause death or HF hospitalisation was detected at 2 years. Patients with a single COAPT exclusion criterion experienced fewer adverse events than those with multiple criteria (55% vs 69%). At multivariable Cox regression analysis, New York Heart Association functional class II, younger age (75 years), lower serum creatinine (2 mg/dL), lower left ventricular end-diastolic volume (240 mL), and the absence of hemodynamic instability, atrial fibrillation, and chronic obstructive pulmonary disease were independently associated with good outcome.In this real-world series of patients with SMR undergoing TEER, a COAPT-ineligible profile was common. The presence of only 1 COAPT exclusion criterion or the absence of hemodynamic instability were associated with the most favourable outcomes.

Chronic kidney disease (CKD) is strongly related to outcomes in cardiovascular diseases. Limited data are available regarding the independent prognostic role of CKD after transcatheter mitral valve repair with MitraClip. We sought to evaluate the real impact of CKD in a large series of patients with heart failure (HF) and secondary mitral regurgitation (SMR) who underwent MitraClip treatment. The study included 565 patients with severe SMR from a multicenter international registry. Patients were stratified into 3 groups according to estimated glomerular filtration rate (eGFR) assessment before MitraClip implantation: normal eGFR (≥60ml/min/1.73m2) (n=196), mild-to-moderate CKD (30 to 59ml/min/1.73m2) (n=267), and severe CKD (

Objectives The aim of this study was to evaluate the impact of edge-to-edge PMVR on short and mid-term clinical outcomes in patients with CS and severe MR.Background Severe mitral regurgitation (MR) in the setting of cardiogenic shock (CS) is associated with three times higher risk of 1-year mortality. In refractory CS, edge-to-edge percutaneous mitral valve repair (PMVR) can be a potential therapeutic option.Methods We retrospectively included consecutive patients with refractory CS and concomitant severe MR treated with MitraClip (R) system. CS was defined according to the criteria used in the SHOCK trial and procedural success according to Mitral Valve Academic Research Consortium (MVARC) criteria. The 30-day and 6-month mortality were the primary and secondary endpoints respectively.Results Thirty-one patients (median age 73 years [interquartile range, IQR 66-78], 25.8% female), STS mortality score 37.9 [IQR 30.4-42.4]), with CS and concomitant severe MR treated with edge-to-edge PMVR were retrospectively enrolled. Procedural success was 87.1%. Thirty-day and 6-month survival rates were 78.4 and 45.2% respectively. Univariate Cox Regression Model analysis showed that procedural success was a predictor of both 30-day (HR = 0.12, 95% CI 0.03-0.55, p < .01) and 6-month survival (HR = 0.22, 95% CI 0.06-0.84, p = .027).Conclusions Edge-to-edge PMVR in patients with CS and concomitant severe MR was associated with good procedural safety and success with acceptable short and mid-term survival rates. It could be considered a bailout option in this setting of patients.

Percutaneous therapeutic options for an increasing variety of structural heart diseases (SHD) have grown dramatically. Within this context of continuous expansion of devices and procedures, there has been increased demand for physicians with specific knowledge, skills, and advanced training in multimodality cardiac imaging. As a consequence, a new subspecialty of ‘Interventional Imaging’ for SHD interventions and a new dedicated professional figure, the ‘Interventional Imager’ with specific competencies has emerged. The interventional imager is an integral part of the heart team and plays a central role in decision-making throughout the patient pathway, including the appropriateness and feasibility of a procedure, pre-procedural planning, intra-procedural guidance, and post-procedural follow-up. However, inherent challenges exist to develop a training programme for SHD imaging that differs from traditional cardiovascular imaging pathways. The purpose of this document is to provide the standard requirements for the training in SHD imaging, as well as a starting point for an official certification process for SHD interventional imager.

Background: Myocardial injury (MI) can be detected during the acute phase of Coronavirus disease 19 (COVID-19) and is associated with a dismal prognosis. Recent imaging studies described the persistence of cardiac abnormalities after the recovery. The aim of the study was to investigate the spectrum of cardiac abnormalities at mid-term follow-up in patients recovered from COVID-19 using clinical assessment, laboratory tests, and imaging evaluation with comprehensive echocardiography. Methods: This is an observational, cross-sectional study assessing an unselected cohort of consecutive patients recovered from COVID-19. MI was defined by elevated plasma levels of high sensitive troponin T (hsTnT). At the follow-up, a complete examination including echocardiography was performed. Results: The 123 patients included were divided into two groups according to the presence of MI during hospitalization: group A (without MI) and group B (with MI). After a median of 85 days, group B patients were more frequently symptomatic for dyspnea and had significantly higher values of hsTnT and N-Terminal prohormone of Brain Natriuretic Peptide (NT-proBNP), compared to Group A. No differences between the two groups in left nor right ventricle dimension and ejection fraction were found. However, in group B a significant reduction of mean left ventricle global longitudinal strain was observed (-15.7±.7vs -18.1±.3 in group A, p&nbsp

Mitral regurgitation is the most prevalent valve disease worldwide. Percutaneous mitral valve interventions are emerging as alternative options for high-risk patients with severe mitral regurgitation not eligible for conventional surgery. Accurate patient selection is based on a detailed pre-procedural multimodality imaging evaluation. Morphology and functional anatomy of the mitral valve should be evaluated to determine the feasibility of treatments and to identify the best therapeutic approach. The procedures are guided by fluoroscopy, transoesophageal echocardiography and fusion imaging, ensuring a continuous communication between the interventionalist and the imaging specialist. The present review will cover the pre-procedural planning and the intra-procedural guidance of the most used transcatheter approaches in the setting of native mitral valve regurgitation: edge to edge repair, percutaneous direct and indirect annuloplasty, transapical beating-heart chordal implantation and transcatheter mitral valve replacement.

Background Whether fluoroscopic-echocardiographic fusion imaging (FI) might offer added value for intraprocedural guidance during transcatheter edge-to-edge mitral valve repair is yet unknown, and few data exist regarding the safety and feasibility of this novel technology. Methods The aim of this single-center study was to test and validate a FI protocol for intraprocedural monitoring of transcatheter edge-to-edge mitral valve repair and assess its clinical usefulness. Eighty patients underwent MitraClip implantation using FI guidance (FI+) for either degenerative (35%) or functional (65%) mitral regurgitation and were compared with the last 80 patients before FI introduction, treated using conventional echocardiography and fluoroscopic monitoring (FI−). Results The number of patients treated for functional and degenerative mitral regurgitation was similar between the FI+ and FI− groups, as well as the number of devices implanted (1.51 ± 0.5 vs 1.58 ± 0.6, P = .46). The prevalence of complex mitral anatomy for percutaneous repair was high (32.5%, up to 39.2% in the hybrid arm). Fluoroscopy time was significantly lower in FI+ patients (37.3 ± 14.6 vs 48.3 ± 28.3 min, P = .003), but not kerma area product (91.5 ± 74.1 vs 108.8 ± 105.0 Gy · cm2, P = .23) or procedural time (92.2 ± 36.1 vs 103.1 ± 42.7 min, P = .086). After adjusting for confounding factors (MitraClip XT device and complex anatomy), FI reduced fluoroscopy time (coefficient = −10.4 min; 95% CI, −18.03 to −2.82; P = .007) and improved procedural success at the end of the procedure (odds ratio, 2.87; 95% CI, 1.00 to 8.24; P = .049) and discharge (odds ratio, 2.24; 95% CI, 1.04 to 4.80; P = .039). Rates of periprocedural complications were similar in both groups (8.9% vs 13.0%, P = .40). Conclusions The authors describe the systematic use of an FI protocol for intraprocedural guidance during transcatheter edge-to-edge mitral valve repair, demonstrating a reduction in fluoroscopy time and an improvement in procedural success in a population with a high prevalence of challenging mitral anatomy for percutaneous repair.

A 46-year-old woman underwent percutaneous patent foramen ovale closure at another institution for recurrent cerebral transient ischemic attacks in the context of hereditary thrombophilia. Because anatomy was considered appropriate, the novel suture-based “deviceless” NobleStitch EL (Kardia

Ventricular septal defect (VSD) has been reported as a rare complication after transcatheter aortic valve implantation (TAVI), presenting with signs of heart failure. Furthermore, left ventricular outflow tract obstruction (LVOTO) may worsen after TAVI, especially in cases of severe left ventricular hypertrophy and small cavity. However, the simultaneous appearance of VSD and LVOT after TAVI has not been reported before. We report a case of combined VSD and LVOTO after TAVI.

The right ventricle and tricuspid valve (TV) have long been neglected by cardiologists. Functional tricuspid regurgitation (TR) is nowadays the most common cause of severe TR and is emerging as a prognostic factor in many heart diseases. A multimodality imaging approach is fundamental for defining the pathophysiology of TR, using both two-dimensional and three-dimensional echocardiography, as well as CT scan. In particular, 3D echocardiography can characterize TV apparatus and tricuspid annulus; CT offers complementary information about annular structure, and its relationship with the right coronary artery. The following review will describe TV anatomy, define transthoracic and transesophageal echocardiographic views for evaluating TV morphology, function and TR grading with some clues on interventional perspectives.

A 66-year-old man with a history of ischemic cardiomyopathy (ejection fraction 35%) and severe functional mitral regurgitation underwent coronary artery bypass grafting and mitral valve repair by quadrangular resection of the posterior leaflet and 30-mm Carpentier-Edwards annuloplasty ring (Edwards

The use of conventional echocardiography in the intensive care unit (ICU) is today established to assess left and right ventricular systolic function, for preload determination and procedural guidance. Next step in ICU echocardiography could be the use of novel ultrasound techniques such as strain echocardiography to assist in the management of patients with acute coronary syndrome, heart failure, or pulmonary embolism. This review has gathered the available evidence supporting the incremental value of strain in the diagnostic workup of cardiac diseases treated in ICU.

In this work, the Thermographic technique (IRT) was used to characterize the fracture mechanics behaviour of stainless steels. In particular, IRT is proposed for evaluating the dissipated energy and the plastic area around the crack tip in order to study the fatigue crack growth. Experimental approaches used for the measure of dissipated energy require an accurate equipment and suitable techniques that may restrict the applications just to laboratory tests. The proposed approach is based on thermal signal investigation in the frequency domain in order to separate the two heat sources related to the material behaviour during fracture mechanics test: thermoelastic sources and intrinsic dissipations. These latter are directly related to the plastic phenomena around the crack tip and occur at the twice of the loading frequency. Both amplitude and phase signals at the twice of the loading frequency can be used for evaluating the crack growth rate. In particular, the first index through an estimation of the heat dissipated while the second due to the effects occurring at the crack tip. It was also demonstrated as the proposed approach is capable of monitoring the crack growth over time and in automatic way by means of such the contactless and full field technique.

A 73-year-old woman presented with heart failure, systemic congestion, and fatigue despite optimal medical therapy. Her medical history included stage IV kidney disease and previous hepatitis B virus infection. In 2014, she experienced a non–ST-segment elevation myocardial infarction: coronary

Percutaneous tricuspid valve (TV) repair procedures are emerging therapies for patients with symptomatic severe tricuspid regurgitation (TR) who are deemed inoperable. Some of these procedures target the tricuspid annulus (TA), mimicking the Kay procedure, or the leaflets, mimicking Alfieri stitch

In recent years different experimental methods have been experienced to enhance the fatigue characterisation of materials with the aim to overcome the Standard long-lasting tests, i.e. Wohler curve determination. Standard fatigue treatment requires at least 15 specimens being tested to get an estimation of material fatigue limit and it is worth noting that this kind of tests do not provide any information on damage phenomena occurring in the material. Thus, topic to be addressed in this research have to do with development of lock-in infrared measurement based thermal method for rapid evaluation of fatigue limit. By performing a single test , the adopted method leads to match different parameter information. The Assessed parameters are in number more than the ones provided by TSA, as well. Moreover, the adopted technique points to study damage by analysing the different phenomena involved in fatigue and in this regard, the aim of this paper is to show how a thermal technique can attain an early assessment of the failure processes during a cyclically loading test. The author is, also, focused on to illustrate the strong points of a method based on infrared measurements for assessing endurance limit for both austenitic and martensitic stainless steels while considering, as reference, the Standard Test methods.

The analysis of the thermal dynamic behaviour of buildings is an important tool for reducing inefficiencies and then wasted energy. In this field, European Standards specify the procedures to obtain information about the thermal behaviour of building in terms of decrement factor and time lag. However, these procedures are based on a theoretical approach that does not take into account the real factors involved in the heat exchange phenomena such as the correct knowledge of thermo-physical parameters and the presence of non-homogeneous materials or defects in the investigated walls. In this work, we propose an innovative experimental procedure based on the application of stimulated thermography with the aim of investigate the thermal dynamic behaviour of walls. In particular, two prototype walls were compared: an empty wall and one made with an insulating filler of vegetable nature (hemp fibre). The results were then compared with those obtained with a numerical simulation and with the Standard procedure EN ISO 13786:2007, highlighting the differences between the three approaches. © 2017 Elsevier B.V.

Nowadays some percutaneous options for tricuspid valve (TV) repair are available: Tricinch (4Tech Cardio, Galway, Ireland) mimicking the Kay procedure, Trialign (Mitralign, Boston, MA, USA) aiming to bicuspidise TV, MitraClip (Abbott Vascular, Abbott Park, Illinois, USA) mimicking Alfieri's stitch, direct transcatheter annuloplasty with Cardioband (Valtech Cardio, Or Yehuda, Israel) and transcatheter Forma Repair (Edwards Lifesciences, Irvine, California, USA) providing a surface for leaflet coaptation. A multimodality imaging approach is fundamental for defining the pathophysiology of tricuspid regurgitation (TR), preprocedural planning and intraprocedural monitoring. Both 2-dimensional and 3-dimensional (3D) transthoracic echocardiography and transoesophageal echocardiography (TOE) are essential for grading and anatomical characterisation of TR, and evaluation of dimensions and function of right ventricle (RV) and estimation of pulmonary pressure. In particular, 3D echocardiography provides a better anatomical definition of TV apparatus and tricuspid annulus (TA) and additional information about the anatomical relationships of TV and surrounding structures. CT offers complementary information during the preprocedural planning especially for procedures targeting TA such as annular structure and dimensions, quality and amount of annular tissue and its relationship with the right coronary artery, and the sizing of the inferior vena cava. Moreover, appropriate patient selection is crucial. The best candidate seems to be a patient with functional TR due to predominant annular dilatation with modest apical tethering, at least partial preservation of leaflets coaptation, not severe pulmonary hypertension and not advanced RV dilation and dysfunction. An example of intraprocedural multimodality imaging approach with TOE, fluoroscopy, angiography and intracardiac echocardiography is also reported.

Determination of the Paris Law constants implies the knowledge of both Stress Intensity Factor (SIF) and the crack growth rate (da/dN). In this regard, the crack length and the SIF values can be measured using various methods suggested by literature and proposed by Standards, but most of them require an off-line measurement of the crack with consequent high testing time and cannot be applied on actual structural components. In this work, the Thermoelastic Stress Analysis (TSA) technique is used for the monitoring of fatigue crack growth during fracture mechanics tests on four stainless steels: AISI 422 and ASTM A182 grade F6NM with martensitic lattice and CF3M and CF8M with austenitic lattice. In particular, an automatic procedure based on the TSA technique was proposed for the continuous evaluation of the crack tip position and the SIF value. Advantages with respect to classical methods can be obtained in terms of reduction of: testing time, experimental set-up, data processing and data report.

We demonstrate that in patients with stress cardiomyopathy the type of triggering event is associated with different clinical, instrumental, and laboratory features that characterize the phenotype at presentation.

Aims: Von Willebrand factor (VWF), a key player in hemostasis and thrombosis, is released from endothelial cells during inflammation. Upon release, VWF is processed by ADAMTS13 into an inactive conformation. The aim of our study was to investigate whether plasma levels of active VWF, total VWF, ADAMTS13, osteoprotegerin (OPG) and the ratios between VWF and ADAMTS13 are risk factors for first ST-segment elevation myocardial infarction (STEMI). Methods and results: We assessed 1026 patients with confirmed first STEMI and 652 control subjects from China, Italy and Scotland, within six hours after their cardiovascular event. Median plasma levels of total VWF, active VWF, OPG and ratios VWF/ADAMTS13 were increased, while plasma levels of ADAMTS13 were decreased in patients compared to controls. The odds ratio (OR) of STEMI in patients with high plasma levels of active VWF was 2.3 (interquartile range (IQR): 1.8–2.9), total VWF was 1.8 (1.4–2.3), ADAMTS13 was 0.6 (05–0.8), OPG was 1.6 (1.2–2.0) and high VWF/ADAMTS13 ratios was 1.5 (1.2–2.0). The OR for total VWF, active VWF and ratios VWF/ADAMTS13 remained significant after adjustment for established risk factors, medical treatment, C-reactive protein, total VWF, ADAMTS13 and OPG. When we adjusted for levels of active VWF, the significance of the OR for VWF and ratios VWF/ADAMTS13 disappeared while the OR for active VWF remained significant. Conclusions: We found evidence that plasma levels of active VWF are an independent risk factor for first STEMI in patients from three different ethnic groups. Our findings confirm the presence of VWF abnormalities in patients with STEMI and may be used to develop new therapeutic approaches.

In this work microwaves were used as heating source to quantitatively evaluate the extension of damaged areas in composite materials using the thermographic technique. In particular, microwave pulsed thermography was carried out on CFRP damaged specimens. A new procedure was developed to process thermographic data obtained by microwave thermography tests and a new algorithm was used to processing thermography data. The approach used to evaluate the damaged areas is based on the characteristic non-linear heating behaviour and an higher slope of heating and cooling curves respect to undamaged area. The results obtained with new procedure were compared with other NDT techniques such as X-ray and lock-in thermography. Numerical simulations were carried out in order to assess the potential sensitivity of the new procedure. The aim of this work is to develop a quick procedure and data analysis in order to allow the non destructive testing of composite large structures in automatic way with a reduced testing time.

Thermography represents an important tool to study fatigue behaviour of materials. In this work, the fatigue limit of martensitic and precipitation hardening stainless steels has been determined with thermographic methods. Despite their use in corrosive and cryogenic environments, there is a data lack in literature concerning the study of fatigue behaviour. The peculiarity of these materials is the brittle behaviour: therefore, during fatigue tests the characteristic small deformations determine small changes of temperature. Thus, to properly determine the fatigue limit of aforementioned stainless steels, a more accurate setup is necessary in order to correctly detect surface temperature of specimens due to dissipation heat sources. In literature, different procedures have already been proposed to evaluate the fatigue limit from thermal data but very few works lead to an early detection of dissipation process which can obtain a further reduction of overall testing time. The aim of the paper is to propose a new robust thermal data analysis procedure for estimating fatigue limit of stainless steels in automatable way.

Fatigue behavior is a discriminating feature in choice of steels for extreme conditions such as high or low temperatures and corrosive environments. This is the case of martensitic steels considered in this work, ASTM A182 grade F6NM, and VIRGO 39. These kind of steels are characterized by temperature changes of material related to fatigue damage very low. The fatigue behavior of these steels was investigated with two thermal methods based on temperature surface monitoring and phase variation of thermoelastic signal (TPA method). Two procedures were developed to process thermographic data and to assess fatigue limit of materials.