A Score to Assess Mortality After Percutaneous Mitral Valve Repair.

BACKGROUND: Risk stratification for transcatheter edge-to-edge mitral valve repair (TEER) is paramount in the decision-making process for treating severe mitral regurgitation (MR). OBJECTIVES: This study sought to create and validate a user-friendly score (MitraScore) to predict the risk of mortality in patients undergoing TEER. METHODS: The derivation cohort was based on a multicentric international registry that included 1,119 patients referred for TEER between 2012 and 2020. Score discrimination was assessed using Harrell's c-statistic, and the calibration was evaluated with the Gronnesby and Borgan goodness-of-fit test. An external validation was carried out in 725 patients from the GIOTTO registry. RESULTS: After multivariate analysis, we identified 8 independent predictors of mortality during the follow-up (2.1 ± 1.8 years): age ≥75 years, anemia, glomerular filtrate rate <60 mL/min/1.73 m2, left ventricular ejection fraction <40%, peripheral artery disease, chronic obstructive pulmonary disease, high diuretic dose, and no therapy with renin-angiotensin system inhibitors. The MitraScore was derived by assigning 1 point to each independent predictor. The c-statistic was 0.70. Per each point of the MitraScore, the relative risk of mortality increased by 55% (HR: 1.55; 95% CI: 1.44-1.67; P < 0.001). The discrimination and calibration for mortality prediction was better than those of EuroSCORE II (c-statistic 0.61) or Society of Thoracic Surgeons score (c-statistic 0.57). The MitraScore maintained adequate performance in the validation cohort (c-statistic 0.66). The score was also predictive for heart failure rehospitalization and was correlated with the probability of clinical improvement. CONCLUSIONS: The MitraScore is a simple prediction algorithm for the prediction of follow-up mortality in patients treated with TEER.

Procedural and clinical outcomes after repeat edge-to-edge transcatheter mitral valve repair.

BACKGROUND AND OBJECTIVES: Evidence regarding redo percutaneous interventions for recurrent mitral regurgitation is scarce. We ought to evaluate procedural and clinical outcomes of repeated edge-to-edge transcatheter mitral valve repair (TMVR) interventions. METHODS: This multicenter study collected individual data from eight high-volume TMVR Centers in Spain. Between 2012 and 2020, all patients undergoing a second edge-to-edge TMVR intervention (Redo) were included in the study. RESULTS: Among a total of 1028 procedures, 31 patients (3%) with residual MR ≥ 3 at follow-up underwent a second procedure (Redo). Redo intervention was mainly conducted between the first and second year after the first procedure. The most common cause of MR progression was partial detachment (46.7%) followed by LV remodeling (35.5%). Procedural success was achieved in 87% of cases. After a mean follow-up of 1.75 ± 1.54 years, all-cause and cardiovascular mortality were 48.1% and 25%, respectively. Nearly half of the patients (48.1%) required at least one hospital admission for CHF within the follow-up period. However, most of the patients presented symptomatic improvement as depicted by an NYHA class ≤2. Elective mitral surgery was conducted in only one patient at follow-up due to insufficient MR reduction. CONCLUSIONS: According to our findings, redo edge-to-edge TMVR interventions were feasible and safe with a high procedural success rate. Clinical and echocardiographic follow-up showed however modest long-term results in this specific setting.

Percutaneous Mitral Valve Repair: Outcome Improvement with Operator Experience and a Second-Generation Device.

BACKGROUND AND AIM: Recent randomized data comparing percutaneous mitral valve repair (PMVR) versus optimal medical treatment in patients with functional MR (FMR) seemed to highlight the importance of the learning curve not only for procedural outcomes but also for patient selection. The aim of the study was to compare a contemporary series of patients undergoing PMVR using a second-generation Mitraclip device (Mitraclip NT) with previous cohorts treated with a first-generation system. METHODS: This multicenter study collected individual data from 18 centers between 2012 and 2017. The cohort was divided into three groups according to the use of the first-generation Mitraclip during the first (control-1) or second half (control-2) or the Mitraclip NT system. RESULTS: A total of 545 consecutive patients were included in the study. Among all, 182 (33.3%), 183 (33.3%), and 180 (33.3%) patients underwent mitral repair in the control-1, control-2, and NT cohorts, respectively. Procedural success was achieved in 93.3% of patients without differences between groups. Major adverse events did not statistically differ among groups, but there was a higher rate of pericardial effusion in the control-1 group (4.3%, 0.6%, and 2.6%, respectively; p = 0.025). The composite endpoint of death, surgery, and admission for congestive heart failure (CHF) at 12 months was lower in the NT group (23.5% in control-1, 22.5% in control-2, and 8.3% in the NT group; p = 0.032). CONCLUSIONS: The present paper shows that contemporary clinical outcomes of patients undergoing PMVR with the Mitraclip system have improved over time.

An update on sparring taekwondo's internal logic / Uma atualização da lógica interna de competição do combate no taekwondo / Una actualización de la lógica interna de la competición del combate en el taekwondo

Abstract: This manuscript addresses the internal logic of sparring taekwondo, regulated by the World Taekwondo Federation, to explain motor actions used in competitions. A narrative review was conducted on Google Scholar, Scopus, Web of Science, Ebsco, PubMed, ProQuest, and Dialnet databases, guided by structural and functional taekwondo parameters with no limits as to year of publication or language used. The authors describe the various elements that make up the sport's internal logic such as regulation, space, time, motor communication, roles and sub-roles in addition to the techniques or execution models that explain their special characteristics. This could assist in further examining the characteristics of that sport, defining combat actions, and contextualizing the real competitive situation by adapting tactical taekwondo sequences. Being aware of this sport's unique characteristics will enable creating the necessary framework to continue research on Olympic-level taekwondo.

Resumo: O objetivo do manuscrito é abordar a lógica interna do taekwondo competição regulamentada pela Federação Mundial do Taekwondo para explicar a ação motora na competição. Uma revisão narrativa foi realizada com base nos parâmetros estruturais e funcionais do taekwondo nos bancos de dados do Google Scholar, Scopus, Web of Science, Ebsco, PubMed, ProQuest e Dialnet, sem limitar o ano de publicação nem o idioma utilizado. Os autores se referem aos diversos elementos que compõem a lógica interna mencionada, como regulação, espaço, tempo, comunicação motora, papéis e subfunções, além dos modelos de técnica ou execução, explicando suas particularidades. Isso poderia nos ajudar a aprofundar as características desse esporte, definir a ação de combate e contextualizar a situação real da competição, adaptando as sequências táticas do taekwondo. O conhecimento das particularidades desse esporte permite criar uma estrutura necessária para continuar o trabalho da pesquisa no taekwondo olímpico .

Resumen: El objetivo de este manuscrito es abordar la lógica interna del taekwondo de competición regulado por la Federación Mundial de Taekwondo para explicar la acción motriz en la competición. Se realizó una revisión narrativa basada en los parámetros estructurales y funcionales del taekwondo en las bases de datos del Google Scholar, Scopus, Web of Science, Ebsco, PubMed, ProQuest y Dialnet sin limitar el año de publicación ni el idioma. Los autores se refieren a los diversos elementos que componen la lógica interna mencionada, como reglamento, espacio, tiempo, comunicación motriz, roles y subfunciones, además de los modelos de técnica o ejecución, explicando sus particularidades. Esto podría ayudarnos a profundizar en las características del taekwondo, a definir la acción de combate y a contextualizar la situación real de la competición, adaptando las secuencias tácticas del taekwondo. El conocimiento de las particularidades de este deporte permite crear un marco necesario para continuar el trabajo de investigación en el taekwondo olímpico.

A actividad física representada en los libros de texto de Educación Física en Educación Primaria / A atividade física representada nos livros didáticos da Educação Física na educação primária / Physical activity represented in Physical Education textbooks for Elementary Education

El objetivo de este estudio es analizar la representación de la actividad física que aparece en los libros de texto de Educación Física y su relación con los diferentes bloques de contenidos del área, en Educación Primaria. La muestra estuvo formada por un total de 3.836 imágenes publicadas en 34 libros de texto pertenecientes a seis editoriales españolas, entre 2006 y 2013. La técnica de investigación fue el análisis de contenido mediante la herramienta SAIMEF. Para el análisis estadístico se utilizó el software SPSS 22.0. Los resultados muestran un claro predominio del bloque de contenidos de los "juegos y actividades deportivas". Este desequilibrio en la representación de los bloques no responde a las enseñanzas mínimas que marca el Real Decreto 1513/2006 en el currículo de Primaria en el ámbito español, por lo que se hace necesaria una reflexión sobre la visión tradicional de la actividad física en este material curricular

O objetivo deste estudo foi analisar a representação da atividade física que aparece nos livros didáticos de Educação Física e sua relação com os diferentes blocos de conteúdos da área, no Ensino Fundamental. A amostra foi composta por um total de 3836 imagens publicadas em 34 livros didáticos pertencentes a seis editoras espanholas, entre 2006 e 2013. A técnica de pesquisa foi a análise de conteúdo utilizando a ferramenta SAIMEF. O software SPSS 22.0 foi utilizado para a análise estatística. Os resultados mostram uma clara predominância do bloco de conteúdo dos "jogos e atividades esportivas". Esse desequilíbrio na representação dos blocos não responde aos ensinamentos mínimos que o Real Decreto 1513/2006 estabelece no currículo primário no contexto espanhol, motivo pelo qual é necessário refletir sobre a visão tradicional da atividade física nesse material curricular

This study looks into the representation of physical activity in Physical Education textbooks for Elementary Education and its relationship with the various content blocks in the area. The sample consisted of 3,836 images published in 34 textbooks by six Spanish publishers between 2006 and 2013. The research technique was content analysis using the SAIMEF tool. The SPSS 22.0 software was used for statistical analysis. The results show a clear predominance of the content block 'games and sports'. This imbalance in representation of the blocks does not respond to the minimum teachings established by Royal Decree 1513/2006 in the Elementary Education curriculum for the Spanish context. Therefore, it is necessary to reflect on the traditional vision of physical activity in this curricular material

MitraClip® Repair in Cardiogenic Shock Due to Acute Mitral Regurgitation: From Near-Death to Walking.

A patient with ischemic myocardiopathy who had undergone resynchronization therapy was admitted to the authors' institution with progressive dyspnea. Echocardiography demonstrated a left ventricular ejection fraction (LVEF) of 25%, with a massive mitral regurgitation (MR) secondary to anterior leaflet prolapse and posterior leaflet restriction. Despite intensive medical treatment, the patient developed cardiogenic shock and required mechanical ventilation, inotropic support and intra-aortic balloon pumping. The patient was rejected for surgery due to the high operative risk, but subsequently underwent a successful percutaneous repair with two MitraClip® devices. Immediately after the intervention there was a progressive improvement that allowed the patient to be discharged, such that the clinical outcome was favorable at the six-month follow up (NYHA class II/IV). This case report describes the benefits of minimally invasive therapy in selected patients who are at very high surgical risk and who, despite being in a critical condition and with low LVEF, experience an outstanding clinical improvement following the resolution of a massive MR.

Overview of mitral regurgitation in Europe: results from the European Registry of mitral regurgitation (EuMiClip).

Aims: To determine the prevalence of mitral regurgitation (MR) in a large cohort of consecutive patients undergoing clinically indicated echocardiography and to examine the distribution of primary and secondary MR. Methods and results: All patients undergoing an echocardiographic study in 19 European centres within a 3-month period were prospectively included. MR assessment was performed as recommended by the European Association of Cardiovascular Imaging (EACVI). MR was classified according to mechanism as primary or secondary and aetiologies were reported. A total of 63 463 consecutive echocardiographic studies were reviewed. Any degree of MR was described in 15 501 patients. Concomitant valve disease of at least moderate grade was present in 28.5% of patients, being tricuspid regurgitation the most prevalent. In the subgroup of moderate and severe MR (n = 3309), 55% of patients had primary MR and 30% secondary MR. Both mechanisms were described in 14% of the studies. According to Carpentier's classification, 26.7% of MR were classified as I, 19.9% of MR as II, 22.4% of MR as IIIa, and 31.1% of MR as IIIb. Conclusion: To date, this is the largest echocardiography-based study to analyse the prevalence and aetiology distribution of MR in Europe. The burden of secondary MR was higher than previously described, representing 30% of patients with significant MR. In our environment, degenerative disease is the most common aetiology of primary MR (60%), whereas ischaemic is the most common aetiology of secondary MR (51%). Up to 70% of patients with severe primary MR may have a Class I indication for surgery. However, the optimal therapeutic approach for secondary MR remains uncertain.

Minimally Invasive Transradial Percutaneous Closure of Aortic Paravalvular Leaks: Following the Steps of Percutaneous Coronary Intervention.

Two patients with severe aortic paravalvular leaks (PVLs) in a mechanical prosthesis were percutaneously treated. Procedures were performed with mild sedation, angiographic guidance, and a 6-French right radial artery approach with good final results. Percutaneous PVL treatment is routinely performed with general anaesthesia, transesophageal echocardiographic guidance, and femoral access. Although another case of radial aortic PVL closure has been previously reported, it was performed with an 8-French radial sheath, transesophageal echocardiographic guidance, and general anaesthesia. According to our initial experience, aortic PVLs could be treated in a minimally invasive way. Larger studies should be conducted to confirm these observations.

Cardiovascular Imaging in the Electrophysiology Laboratory.

In recent years, rapid technological advances have allowed the development of new electrophysiological procedures that would not have been possible without the parallel development of imaging techniques used to plan and guide these procedures and monitor their outcomes. Ablation of atrial fibrillation is among the interventions with the greatest need for imaging support. Echocardiography allows the appropriate selection of patients and the detection of thrombi that would contraindicate the intervention; cardiac magnetic resonance imaging and computed tomography are also essential in planning this procedure, by allowing a detailed anatomical study of the pulmonary veins. In addition, in cardiac resynchronization therapy, echocardiography plays a central role in both patient selection and, later, in device adjustment and in assessing the effectiveness of the technique. More recently, ablation of ventricular tachycardias has been established as a treatment option; this would not be possible without planning using an imaging study such as cardiac magnetic resonance imaging of myocardial scarring.