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Background: Mitral valve (MV) repair with MitraClip system is a safe treatment option for high‐risk patients with significant mitral regurgitation (MR). We aimed to characterize, by three‐dimensional echocardiography (3D‐E), changes occurring in MV after implantation of third generation MitraClip XTR device, with specific reference to the underlying MR mechanism (functional vs degenerative, FMR vs DMR). Methods: We prospectively enrolled 59 patients, who underwent intra‐procedural 3D‐E before and after device deployment. Three‐D datasets were analyzed off‐line, using a dedicated semiautomatic software, to obtain parametric quantification of mitral anatomy. Results: Post‐procedural MR of mild or lesser degree was achieved in 40 patients (68%), with no differences between FMR and DMR (p 0.9). After MitraClip XTR implantation, the FMR group experienced an immediate annular resizing, with reduction of antero‐posterior diameter (p 0.024) and sphericity index (p 0.017), next to a recovery of physiological saddle‐shape, defined by lower non‐planar angle (p ≤0.001) and higher annulus height to commissural width ratio (p ≤0.001). On the opposite, the DMR group revealed a significant decrease of maximum annular velocity (p 0.027), addressing a mechanic effect of the device deployment. Finally, baseline anterior mitral leaflet angle was found as an independent predictor of acute procedural result (OR 6.7, [CI 1.01–44.33], p 0.049). Conclusions: MitraClip XTR implantation acts in restoring the original mitral geometry, with distinctive effects according to MR mechanism. Three‐D parametric quantification of MV sheds new light on changes occurring in the valvular apparatus, and helps identifying possible new predictors of acute procedural success. [ABSTRACT FROM AUTHOR]

Abstract Background Real time three dimensional (RT3D) echocardiography is an accurate and reproducible method for assessing left ventricular shape and function. Aim assess the feasibility and reproducibility of RT3D stress echocardiography (SE) (exercise and pharmacological) in the evaluation of left ventricular function compared to 2D. Methods and results One hundred eleven patients with known or suspected coronary artery disease underwent 2D and RT3DSE. The agreement in WMSI, EDV, ESV measurements was made off-line. The feasibility of RT-3DSE was 67%. The inter-observer variability for WMSI by RT3D echo was higher during exercise and with suboptimal quality images (good: k = 0.88; bad: k = 0.69); and with high heart rate both for pharmacological (HR < 100 bpm, k = 0.83; HR ≥ 100 bpm, k = 0.49) and exercise SE (HR < 120 bpm, k = 0.88; HR ≥ 120 bpm, k = 0.78). The RT3D reproducibility was high for ESV volumes (0.3 ± 14 ml; CI 95%: -27 to 27 ml; p = n.s.). Conclusions RT3DSE is more vulnerable than 2D due to tachycardia, signal quality, patient decubitus and suboptimal resting image quality, making exercise RT3DSE less attractive than pharmacological stress.

Primary tissue failure of bioprosthetic mitral valves due to cusp perforations or ruptures is an unusual complication on short-term follow-up. An 88-year-old male with a known history of mitral regurgitation (MR) treated with bioprosthetic valve replacement in 2016 was referred to our center for recurrent heart failure. The two-dimensional (2D) transthoracic echocardiography documented an intraprosthetic jet of regurgitation without identifying a clear morphological mechanism, nor quantifying precisely the mitral insufficiency. 3D transesophageal echocardiography (TOE) with the tool FlexiSlice added relevant information by providing insights into the pathophysiological mechanisms of MR. The present case emphasizes the importance of 3D TOE as a fundamental tool for the diagnostic algorithm of bioprosthetic valves failure, even in the more demanding cases. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to evaluate the acute effects of participation in an Ironman distance triathlon competition on arterial function by ultrasound, in relation to cardiac function and body water content. Methods: Twenty‐eight male triathletes participating in an Ironman distance competition underwent carotid, femoral, and cardiac ultrasound examinations. Moreover, the presence of extravascular lung water was identified by lung echo B‐lines (echogenic coherent wedge‐shaped signal with a narrow origin from the hyperechoic pleural line) at rest and within 20 minutes of arrival. Results: At the end of the competition, athletes showed an increased heart rate (mean ± SD, from 60.2 ± 13.1 to 82.8 ± 15.6 beats/min; P < .0001) and unchanged mean blood pressure (from 93 ± 14 to 91 ± 10 mm Hg; P > .05) in the presence of negligible dehydration (total body water from 48.0 ± 4.0 to 46.5 ± 3.9 kg; P > .05). Cardiac output increased (from 5.5 ± 1.2 to 6.7 ± 2.4 L/min; P < .05) in the presence of an unchanged stroke volume (from 64 ± 14 to 59 ± 16 mL; P > .05) and unchanged left ventricular elastance (from 1.52 ± 0.48 to 1.39 ± 0.48 mm Hg/mL/m2; P > .05). The mean carotid diameter increased (from 7.19 ± 0.65 to 7.61 ± 0.76 mm; P < .05), whereas the mean femoral diameter was unchanged at the end of the competition (from 10.41 ± 0.83 to 10.49 ± 0.82 mm; P > .05). Carotid intima‐media thickness was significantly reduced (from 537 ± 70 to 495 ± 70 μm; P < .05), whereas B‐lines increased significantly after the competition (from 1 [0–4] to 12 [5–23]; P < .0001). Conclusions: These data suggest different acute functional adaptation in central arteries with respect to peripheral leg vessels. [ABSTRACT FROM AUTHOR]

Background: The Cardiology Complex Structure of the Azienda Socio Sanitaria Territoriale (ASST) of Lodi, Italy, assists patients with clinical conditions ranging from emergency to chronicity. The model of Homogeneous Waiting Groups should guide the appropriateness of prescriptions categorized as U (urgent), B (brief), D (deferrable), and P (programmable). This study aims to describe and analyze the characteristics of prescription and delivery of clinical and instrumental cardiology outpatient services with U and B priority during the November 2023-January 2024 quarter, paying particular attention to the clinical appropriateness of prescribing., Methods: A prospective observational study was conducted. Computerized data were anonymously extracted from the company's Management Control and provided with the authorization of the Data Protection Officer., Results: During the observed quarter, the Cardiology Complex Structure provided 7379 services for outpatients. Out of 123 U services, 94 (76.4%) were managed through SBC (Single Booking Center) and 29 (23.6%) were managed outside the SBC. From 529 services with B priority, 504 (95%) were managed through SBC and 25 (5%) outside the SBC. Requests with U priority mainly referred to ECG (n = 50; 40.6%) and first cardiological visit (n = 46; 37.4%). Fifty percent of U and B requests were prescribed by 4% and 8% of general practitioners, respectively. The prescribed priority was correct for 13% of requests (n = 64)., Conclusions: This study shows a vastly inappropriate use of resources allocated to urgent outpatient cardiological services. Actions aimed at promoting the adherence to the Homogeneous Waiting Groups Manual and enhancing telemedicine services, currently limited to heart failure, are necessary for resource optimization in cardiology within the ASST of Lodi.

We describe the case of a patient with a congenital long QT syndrome (LQTS) who showed signs of cardiac memory associated with early afterdepolarizations and ventricular arrhythmias, after a change in the pacing mode from VVI to AAI. Cardiac memory, further altering the potassium ion channel function, may have pro-arrhythmic potential in patients with LQTS.

Clinical and experimental studies identified several similarities between calcific aortic stenosis and atherosclerosis, suggesting the involvement of similar pathogenic pathways in both conditions.There are several molecules involved in regulating the development, progression and calcification of the valve sclerosis and in growth and complications of atherosclerotic plaque. Among these molecules, the receptor of advanced glycation end-products, a multi-ligand receptor involved in the pathogenesis of several degenerative, inflammatory and immune diseases, could have an important regulatory role in both diseases and therefore worthy of study as a potential target therapeutic for both conditions.