The intricate interplay between mitral regurgitation (MR) and left ventricular outflow tract (LVOT) obstruction may result in two clinical scenarios: prosthesis-related LVOT obstruction after mitral ...valve replacement (TMVR) and systolic anterior motion (SAM)-associated MR. This review provides a comprehensive overview of the pathophysiology, risk assessment, and transcatheter interventions for mitigating the likelihood of LVOT obstruction in patients undergoing TMVR. In addition, it extends its focus to SAM-associated MR, elucidating the different aetiological mechanisms contributing to this phenomenon, beyond hypertrophic cardiomyopathy. Transcatheter treatment options, are explored as potential therapeutic strategies, offering insights into their hemodynamic effectiveness and limitations.
Patients with coronavirus disease 2019 (COVID-19) exhibit high thrombotic risk. The evidence on a potential independent prognostic role of antiplatelet treatment in those patients is limited. The aim ...of the study was to evaluate the prognostic impact of pre-admission low-dose acetylsalicylic acid (ASA) in a wide series of hospitalized patients with COVID-19.
This cohort study included 984 COVID-19 patients stratified according to ASA intake before hospitalization: ASA+ (n = 253) and ASA− (n = 731). Patients were included in ASA+ group if they received it daily in the 7 days before admission. 213 (83%) were on ASA 100 mg daily. Primary endpoint was a composite of in-hospital death and/or need for respiratory support upgrade, secondary endpoints were in-hospital death and need for respiratory support upgrade.
Mean age was 72 62; 81 with 69% of male patients. ASA+ patients were significantly older, with higher prevalence of comorbidities. No significant differences regarding the degree of respiratory dysfunction were observed. At 30-day Kaplan-Meier analysis, ASA+ patients had higher survival free from the primary endpoint and need for respiratory support upgrade, conversely in-hospital death did not significantly differ between groups. At multivariate analysis ASA intake was independently associated with a lower probability of reaching primary endpoint (HR 0.697, 95% C.I. 0.525–0.924; p = 0.012).
In COVID-19 patients undergoing hospitalization, pre-admission treatment with ASA is associated with better in-hospital outcome, mainly driven by less respiratory support upgrade.
•Coronavirus disease 2019 (COVID-19) may predispose patients to thrombosis.•Antiplatelet therapy may represent an effective therapeutic option.•Patients on acetylsalicylic acid therapy suffered less from in-hospital death and/or need for respiratory support upgrade.
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.
Les critères d’admission à l’étude COAPT (CardiovascularOutcomesAssessment of the MitraClipPercutaneousTherapy for Heart Failure Patients With Functional Mitral Regurgitation) sont utiles pour identifier les patients susceptibles d’obtenir de meilleurs résultats après une réparation mitrale percutanée bord à bord (RMPBB). Cependant, en contexte réel, jusqu’à la moitié des patients atteints d'insuffisance mitrale secondaire (IMS) qui subissent une RMPBB ne répondent pas à ces critères hautement sélectifs et aucune étude formelle ne les a formellement étudiés. La présente étude visait à évaluer les prédicteurs d’une issue favorable à la suite d’une RMPBB chez les patients non admissibles selon les critères de l’étude COAPT.
Tous les patients consécutifs atteints d'IMS et d’insuffisance cardiaque (IC) traités au moyen d’un dispositif MitraClip dans trois centres européens ont été choisis de façon rétrospective. La présence d’au moins un critère d’exclusion de l’étude COAPT a été utilisée pour définir un profil non admissible selon les critères COAPT, et admettre les patients dans la population de la présente étude. L’absence de décès toutes causes confondues et d’hospitalisation pour IC a été évaluée après un suivi de deux ans (critère d’évaluation principal).
Au total, 305 patients (47 %) présentaient un profil non admissible selon les critères COAPT. Un taux global de 58 % de décès toutes causes confondues ou d’hospitalisation pour IC a été observé après un suivi de deux ans. Chez les patients présentant un seul critère d’exclusion de l’étude COAPT, la fréquence de manifestations indésirables a été plus faible que chez les patients présentant plus d’un critère d’exclusion (55 % vs 69 %). Dans une analyse de régression de Cox multivariée, la classe II de la classification de la NYHA, un âge moins avancé (< 75 ans), un taux sérique de créatinine faible (< 2 mg/dl), un volume télédiastolique faible dans le ventricule gauche (< 240 ml), et l’absence d’instabilité hémodynamique, de fibrillation auriculaire et de maladie pulmonaire obstructive chronique ont été des variables associées de façon indépendante à une issue favorable.
Chez cette série de patients traités en contexte réel qui étaient atteints d'IMS et qui ont été soumis à une RMPBB, un profil non admissible selon les critères de l’étude COAPT était une ca- ractéristique courante. La présence d’un seul critère d’exclusion de l’étude COAPT ou l’absence d’instabilité hémodynamique ont été associées aux issues les plus favorables.
Pharmacological treatment is the cornerstone therapy of heart failure with reduced ejection fraction (HFrEF). In addition, several percutaneous techniques have been developed to treat symptomatic ...patients, with specific heart failure (HF) phenotypes (e.g., valvular heart disease) that require non-pharmacological treatment. Given their prognostic relevance, it is imperative to deliver high-level patient care. This review provides a clinical overview on the available data regarding transcatheter devices in the armamentarium of contemporary interventional cardiologists, focusing on the clinical and anatomical selection criteria.
Diabetic foot ulcer (DFU) is a severe complication of diabetes mellitus (DM). Patients with DFU have increased mortality and morbidity as well as decreased quality of life (QoL). The present scoping ...review aims to study the social issues of diabetic foot. Following PRISMA guidelines, the review was conducted in two databases (Scopus and Pubmed) with the use of the following keywords: “social aspects and diabetic foot”, “social characteristics and diabetic foot”, “social issues and diabetic foot”, “demographic profiles and diabetic foot”, “social determinants and diabetic foot”, “social capital and diabetic foot”, “social characteristics and gender and diabetic foot”, “social profiles and diabetic foot”, “social relationships and diabetic foot” and “social risk and diabetic foot”, from July to August 2021. Predetermined exclusion and inclusion criteria were selected. Forty-five studies (quantitative and qualitative) were eligible for inclusion in this review. Gender problems, socioeconomic status, social capital, and medical problems were the most important negative variables for diabetic foot. All the included variables reveal that the social impact of diabetic foot is the most important factor for management and prevention, in terms of aggravation and more, of the diabetic foot.
AimsWe aimed at identifying how exercise performance by percent of predicted oxygen uptake defines the exercise gas exchange phenotypes in a population of apparently healthy individuals enrolled in ...the Euro-Ex population-based trial.Methods782 healthy subjects (age 63 ± 12 years; male 45 %; BMI 28.95 ± 5.2 kg/m) enrolled in the EURO-EX prevention trial with at least one major cardiovascular risk factor (hypertension, diabetes, tabagism, dyslipidaemia, body mass index > 25), but no previous CV events, underwent cardiopulmonary exercise test (CPET) with personalized incremental ramp protocol. Peak oxygen consumption (VO2), the percent predicted normal value and other main CPET- derived variables were obtained. The population was divided into tertiles groups based on the VO2 predicted (I tertile 21%-60%), II tertile 60%-75%, III tertile 75%- 164%).ResultsSubjects in the tertile 1 compared to the other two groups were younger (age 60 ± 13 years), more frequently females with a higher BMI (31.12 ± 5.83 kg/m), and smokers in a higher rate (31.89 %). No significant differences in the frequency of diabetes, hypertension and dyslipidemia were observed in the three groups. As reported in the table, the group with lower % predicted peak VO2 showed higher prevalence of exercise oscillatory ventilation, lower exercise tolerance (peak VO2 and VO2 at threshold), peak O2 pulse and VO2/Work slope, higher VE/VCO2 slope. This group showed lower heart rate recovery at first minute and heart rate reserve. Subjects with lower VO2 predicted tertiles had comparatively poorer CPET performance and gas exchange phenotype.ConclusionsThe use of % predicted peak VO2 appears helpful to phenotype gas exchange and identify the progressive level of cardiovascular risk of apparently healthy subjects. These findings broaden the constellation of targets that need to be considered in the preventive strategies of individuals at risk for cardiovascular events.
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