Abstract
Aims
To evaluate the burden of tricuspid regurgitation (TR) in a large cohort, determine the right ventricle involvement of patients with TR and determine the characteristics of isolated TR.
...Methods and results
Prospective study where consecutive patients undergoing an echocardiographic study in 10 centres were included. All studies with significant TR (at least moderate) were selected. We considered that patients with one of pulmonary systolic hypertension >50 mmHg, left ventricular ejection fraction <35%, New York Heart Association III–IV, or older than 85 years, had a high surgical risk. A total of 35 088 echocardiograms were performed. Significant TR was detected in 6% of studies. Moderate TR was found in 69.6%, severe in 25.5%, massive in 3.9%, and torrential in 1.0% of patients. Right ventricle was dilated in 81.7% of patients with massive/torrential TR, in 55.9% with severe TR, and in 29.3% with moderate TR (P < 0.001). Primary TR was present in 7.4% of patients whereas secondary TR was present in 92.6%. Mitral or aortic valve disease was the most common aetiology (54.6%), following by isolated TR (16%). Up to 51.9% of patients with severe, massive, or torrential primary TR and 57% of patients with severe, massive, or torrential secondary TR had a high surgical risk.
Conclusion
Significant TR is a prevalent condition and a high proportion of these patients have an indication for valve intervention. More than a half of patients with severe, massive, or torrential TR had a high surgical risk. Massive/torrential TR may have implications regarding selection and monitoring patients for percutaneous treatment.
The use of mitral transcatheter edge-to-edge repair (TEER) is rapidly increasing. Anatomical changes have been described after TEER with the MitraClip system in patients with functional mitral ...regurgitation (MR), although no study has yet evaluated such anatomical impacts in patients treated with the G4 MitraClip generation.
This research constituted a prospective, single-center, observational study including consecutive patients with functional MR. Mitral three-dimensional images were obtained transesophageally with echocardiography before and immediately after TEER. Patients receiving the late-generation (G4) system were compared to those receiving early-generation systems.
A total of 116 functional MR patients were evaluated, and 40 (34.5%) and 76 (65.5%) received a late-generation (G4) or early-generation device system, respectively. The baseline clinical and echocardiographic features were well-balanced between the groups. Overall, there was a significant reduction in mitral annular size after the intervention, and greater reductions in the anteroposterior diameter (4 mm vs. 3.54 mm,
= 0.03), annular perimeter (11.07 mm vs. 5.29 mm for 3D-perimeter,
= 0.001), and annular area (1.29 cm
vs. 1.03 cm
,
= 0.002) were found for patients receiving the late G4 device generation compared to the early-generation systems.
In patients with functional MR, we observed significant changes in mitral valve anatomy with a reduction in anteroposterior diameter, valve perimeter, and area. In our cohort, the extent of those changes was greater with the use of the new-generation G4 MitraClip system compared to prior device generations.
The timing and selection of optimal candidates for mitral transcatheter edge-to-edge valve repair remains to be fully determined, especially in cases with severely depressed left ventricular ejection ...fraction (LVEF). The objective of this study is to evaluate the prognostic value of myocardial strain (LVGLS) in this setting.
Retrospectively, 172 consecutive patients with LVEF ≤40% and severe MR treated with MitraClip were included. Four groups were generated according to the LVEF (<30% or
30%) and median LVGLS. The primary end-point was cardiovascular mortality.
Procedural success was high (96.5%) and complications were rare. At one-year follow-up, 82.5% of patients maintained MR grade ≤2, 79.2% were at a NYHA class ≤II and a reduction of 80% in heart failure admissions was observed in all groups. Interestingly, among patients with a more depressed LVEF, LVGLS was found to be an independent predictor for cardiovascular mortality (HR: 3.3; 95% CI: 1.1-10,
= 0.023).
Mitral valve repair with MitraClip is safe and it improves the mid-term functional class of patients regardless of LVEF. LVGLS can help in the selection of optimal candidates and timing for this procedure, as well as in the recognition of those patients with worse prognoses.
Objetivo: Determinar la percepción de los médicos internos residentes (MIR) de cardiología de España sobre el efecto de la pandemia por COVID-19 en su formación y la adaptación realizada por sus ...servicios. Métodos: Estudio de corte transversal a través de una plataforma de encuesta digital con el objetivo de conocer la opinión individual de los MIR de cardiología sobre la influencia de la pandemia en su formación. Se realiza un análisis estadístico para determinar los factores que influyeron en la percepción de la formación afectada. Resultados: Participó un total de 180 MIR de las 17 comunidades autónomas (CA). Los MIR de tercer año fueron los más afectados, junto con los que rotaban en imagen cardíaca. Los residentes de las CA con una prevalencia >5 casos/1,000 habitantes fueron los que mayor probabilidad tuvieron de ser desplazados de sus servicios. Conclusiones: Según la opinión de los participantes, el efecto de la pandemia por COVID-19 en su formación fue más negativa en los residentes de tercer año y los que rotaban en imagen cardíaca.
Sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors) are new glucose-lowering drugs (GLDs) with demonstrated cardiovascular benefits in patients with heart disease and type-2 diabetes ...mellitus (T2DM). However, their safety and efficacy when prescribed at hospital discharge are unexplored. This prospective, observational, longitudinal cohort study included 104 consecutive T2DM patients discharged from the cardiology department between April 2018 and February 2019. Patients were classified based on SGLT-2 inhibitor prescription and adjusted by propensity-score matching. The safety outcomes included discontinuation of GLDs; worsening renal function; and renal, hepatic, or metabolic hospitalization. The efficacy outcomes were death from any cause, cardiovascular death, cardiovascular readmission, and combined clinical outcome (cardiovascular death or readmission). The results showed that, the incidence rates of safety outcomes were similar in the SGLT-2 inhibitor or non-SGLT-2 inhibitor groups. Regarding efficacy, the SGLT-2 inhibitors group resulted in a lower rate of combined clinical outcomes (18% vs. 42%; hazard ratio (HR), 0.35; p = 0.02), any cause death (0% vs. 24%; HR, 0.79; p = 0.001) and cardiovascular death (0% vs. 17%; HR, 0.83; p = 0.005). No significant differences were found in cardiovascular readmissions. SGLT-2 inhibitor prescription at hospital discharge in patients with heart disease and T2DM was safe, well tolerated, and associated with a reduction in all-cause and cardiovascular deaths.
Tricuspid regurgitation (TR) is associated with an increased mortality. Previous studies have analyzed predictors of TR progression and the clinical impact of baseline TR. However, there is a lack of ...evidence regarding the natural history of TR: the pattern of change and clinical impact of progression.
The authors sought to evaluate predictors of TR progression and assess the prognostic impact of TR progression.
A total of 1,843 patients with at least moderate TR were prospectively followed up with consecutive echocardiographic studies and/or clinical evaluation. All patients with less than a 2-year follow-up were excluded. Clinical and echocardiographic features, hospitalizations for heart failure, and cardiovascular death and interventions were recorded to assess their impact in TR progression.
At a median 2.3-year follow-up, 19% of patients experienced progression. Patients with baseline moderate TR presented a rate progression of 4.9%, 10.1%, and 24.8% 1 year, 2 years, and 3 years, respectively. Older age (HR: 1.03), lower body mass index (HR: 0.95), chronic kidney disease (HR: 1.55), worse NYHA functional class (HR: 1.52), and right ventricle dilation (HR: 1.33) were independently associated with TR progression. TR progression was associated with an increase in chamber dilation as well as a decrease in ventriculoarterial coupling and in left ventricle ejection fraction (P < 0.001). TR progression was associated with an increased cardiovascular mortality and hospitalizations for heart failure (P < 0.001).
Marked individual variability in TR progression hindered accurate follow-up. In addition, TR progression was a determinant for survival regardless of initial TR severity.
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El tratamiento médico y las medidas de prevención secundaria en el infarto agudo de miocardio con elevación del segmento ST (IAMCEST) han experimentado una mejora progresiva en las últimas décadas. A ...pesar de ello, los pacientes> 65 años presentan un mayor riesgo de muerte tras un evento coronario. Nuestro objetivo fue evaluar si los pacientes <y ≥ 65 años pueden recuperar una esperanza de vida similar a la de la población general de la misma edad, sexo y área geográfica.
Todos los pacientes que sufrieron un IAMCEST en los últimos 6 años en nuestro centro fueron incluidos en un estudio observacional (SurviSTEMI: survival in STEMI). Se calculo la supervivencia observada, la supervivencia esperada y el exceso de mortalidad. Se repitieron todos los análisis estratificando por grupo etario <y ≥ 65 años.
Para los pacientes <65 años, la supervivencia observada a los 3 y 5 años fue del 97,68% (IC95%, 96,05-98,64%) y 94,14% (IC95%, 90,89-96,25%), respectivamente. La supervivencia observada a los 3 y 5 años fue del 98,12% y 96,61%. Para los pacientes ≥ 65 años, la supervivencia esperada a los 3 y 5 años fue del 85,52% (IC95%, 82,23-88,24%) y 75,43% (IC95%, 70,26-79,83%), respectivamente. La supervivencia esperada a los 3 y 5 años fue del 86,48 y 76,56%.
Los supervivientes del IAMCEST presentan una esperanza de vida similar a la de la población general de la misma edad, sexo y área geográfica.
In the last few decades, there has been a continuous process of improvement in medical treatment and secondary prevention measures after ST-segment elevation myocardial infarction (STEMI). Patients older than 65 years are at increased risk of death due to this event. Our aim was to determine whether patients aged less than 65 years and 65 years and older experiencing a STEMI can recover a life expectancy similar to that of the general population of the same age, sex, and geographical region.
We included all patients experiencing a STEMI at our institution during a 6-year period in an observational-study (SurviSTEMI: survival in STEMI). We calculated their observed survival, expected survival, and excess mortality. We repeated all analyses for survivors of the acute event stratifying by 65 years.
For patients aged <65 years who survived the STEMI, observed survival at 3 and 5 years of follow-up was 97.68% (95%CI, 96.05%-98.64%) and 94.14% (95%CI, 90.89%-96.25%), respectively. Expected survival at 3 and 5 years was 98.12% and 96.61%. For patients ≥ 65 years who survived the STEMI, observed survival at 3 and 5 years was 85.52% (95%CI, 82.23%-88.24%) and 75.43% (95%CI, 70.26%-79.83%), respectively. Expected survival at 3 and 5 years was 86.48% and 76.56%, respectively.
For survivors of the acute event, life expectancy is fairly similar to that of the general population of the same age, sex, and geographical region.
A 31-year-old woman with previous diagnosis of Turner syndrome and desire of pregnancy was submitted for further evaluation for aortic valvulopathy. She was finally diagnosed of unicuspid aortic ...valve with severe regurgitation and an aortic ascending aneurysm.
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