Transcatheter Mitral Valve Repair via MitraClip in Patients Aged <65 Years: Multicentre 2-year Outcomes.

Background: Transcatheter mitral valve repair (TMVR) using the MitraClip has become a well-established interventional therapy and is usually performed in elderly patients. The objective of this study was to assess 2-year clinical outcomes of TMVR in patients aged <65 years at three heart centres with severe mitral regurgitation (MR) and no surgical options. Methods: A retrospective study analysed data of 36 patients aged <65 years treated with TMVR . All patients were refused surgery by Heart Team decision. Baseline MR was assessed by biplane vena contracta width in two perpendicular views (mean 8.35 ± 1.87 mm). Degenerative MR was detected in 11 patients (30.6%); functional MR was detected in 25 patients (69.4%). Results: Acute procedural success was accomplished in 88.9% of patients. No procedure-related mortality during the first 30 days was detected. Over an average of 2 years of follow-up, all-cause mortality was 19.4% and cardiovascular death was 11.1% owing to advanced heart failure. The average follow-up period was 25.8 months (median was 20 months). Statistically significant difference (p-value <0.01) was detected for N-terminal prohormone of brain natriuretic peptide (pg/ml) at baseline (mean 9,870 ± 10,819; median 7,748) compared to follow-up visits (mean 7,645 ± 11,292; median 3,263). New York Heart Association functional class improvement was achieved in 69% of patients. A second intervention (reclipping) was required in two patients to correct recurrent significant MR. Conclusion: TMVR in patients aged <65 years refused surgical repair provides satisfactory clinical outcomes at 2 years. Future studies should evaluate the outcomes of MitraClip in this population in a larger cohort.

Retinal fluorescein angiography: A sensitive and specific tool to predict coronary slow flow.

BACKGROUND: Obstructive coronary artery disease (OCAD) and coronary slow flow (CSF) are frequent angiographic findings for patients that have chest pain and require frequent hospital admission. The retina provides a window for detecting changes in microvasculature relating to the development of cardiovascular diseases such as arterial hypertension or coronary heart disease. OBJECTIVES: To assess the coronary and ocular circulations in patients with CSF and those with obstructive coronary artery disease. METHODS: A prospective study was conducted over 3.5 years, included a total of 105 subjects classified to 4 groups: Group I (OCAD): Included 30 patients with obstructive coronary artery disease, group II (CSF): Included 30 patients with coronary slow-flow, group III (Control 1): Included 30 healthy control persons and group IV (Control 2): Included 15 patients indicated for coronary angiography that proved normal. All participants were subjected to coronary angiography (except control group 1), ophthalmic artery Doppler for measuring Pulsatility index (PI) and resistivity index (RI) and Fluorescence angiography of retinal vessels. RESULTS: Patients with CSF showed slow flow retinal circulation (microcirculation) evidenced by prolonged fluorescein angiography (Arm-retina time [ART] & Arterio-venous Transit time [AVTT]). Ophthalmic artery Doppler measurements (RI & PI) were significantly delayed in OCAD and CSF patients. There was significant positive correlation between TIMI frame count in all subjects and ART, AVTT, PI, RI and Body Mass Index. Using ART cutoff value of >16 s predicted CSF with sensitivity and specificity of 100%, meanwhile AVTT of >2 s predicted CSF with a sensitivity 96.7% and specificity of 93.3. CONCLUSION: Both delayed arm-retina time and retinal arterio-venous transit times can accurately predict coronary slow-flow.

24-Hour blood pressure variability as a predictor of short-term echocardiographic changes in normotensive women with past history of preeclampsia/eclampsia.

OBJECTIVES: To investigate the association between 24-hr blood pressure variability (BPV) and subclinical echocardiographic changes and microalbuminuria in normotensive women with history of preeclampsia/eclampsia. BACKGROUND: Ambulatory blood pressure monitoring (ABPM) has been used as a valuable method in determining cardiovascular (CV) risk and target organ damage. Although hypertension and proteinuria that define preeclampsia/eclampsia may resolve in the majority of women, a significantly greater risk of CV and renal disease is present in their later life. METHODS: 101 normotensive women with a past history of preeclampsia/eclampsia and 42 age-matched normal volunteers were subjected to 24-hr ABPM, echocardiography for estimation of left ventricular mass (LVM) index and Aortic distensibility/stiffness indices. Urinary albumin/creatinine ratio was also estimated. RESULTS: There was significantly higher standard deviation (SD) and average reading variability (ARV) indices of BPV in the study group compared to controls (p < 0.001 for all). There were significantly higher LVM index, aortic stiffness index and microalbuminuria in the study group (p < 0.001 for all). There was significant positive correlation between all BPV indices and LVM index, aortic stiffness index (except for SD and ARV of diastolic BP for nighttime) and microalbuminuria. Stepwise regression analysis revealed that ARV of systolic BP for daytime can independently predict LVM index (r2 = 0.688, p < 0.001), impaired aortic distensibility (r2 = 0.557, p < 0.001) and microalbuminuria (r2 = 0.696, p < 0.001). CONCLUSIONS: The BPV indices correlated with subclinical echocardiographic changes and microalbuminuria in normotensive women with history of preeclampsia/eclampsia. The ARV of systolic BP for daytime could early predict such changes in those apparently healthy women.