Effects of Transcatheter Mitral Valve Repair Using MitraClip® Device on Sleep Disordered Breathing in Patients with Mitral Valve Regurgitation.

Sleep disordered breathing (SDB) is common among patients with valvular heart disease, and successful valve surgery could reduce SDB severity. However, data about the effects of transcatheter mitral valve repair on SDB are scarce. Therefore, mitral regurgitation (MR) patients undergoing MitraClip-placement were prospectively enrolled. Before MitraClip-placement, daytime sleepiness and sleep quality were assessed using the Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI), respectively; and all patients underwent SDB screening using five-channel respiratory polygraphy. After 3-6 months, patients had a similar reassessment including: ESS, PSQI, and respiratory polygraphy. 67 patients were included (77 ± 8years). Despite normal sleepiness scores, 41 patients (61%) had SDB with apnea-hypopnea-index (AHI) ≥ 15 h before MitraClip-placement, of whom only three patients had known SDB previously. Compared to patients without SDB, patients with SDB had similar sleepiness scores but higher NT-proBNP values at baseline (4325 vs. 1520 pg/mL, p < 0.001). At follow-up, there were significant AHI improvements among patients with SDB (p = 0.013). However, there were no significant sleepiness score changes. In conclusion, the prevalence of SDB among MitraClip candidates is very high even in those without daytime sleepiness. MR patients with SDB have higher NT-proBNP values, which may reflect a worse prognosis. MitraClip-placement may improve the underlying SDB, which could be an additional benefit of the procedure.

Post-cardiac injury syndrome after transcatheter mitral valve repair using MitraClip system: a case report.

BACKGROUND: Post-cardiac injury syndrome (PCIS) is an inflammatory process that may occur after myocardial infarction, cardiac surgery, percutaneous cardiac interventions or chest trauma. To our knowledge, PCIS following transcatheter mitral valve repair (TMVr) using the MitraClip system has not been reported. CASE SUMMARY: A 79-year-old female with chronic heart failure and severe mitral regurgitation received TMVr using the MitraClip system. After the procedure she developed elevated inflammatory markers, pericardial and pleural effusion. Cardiac magnetic resonance provided signs of pericardial and pleural inflammation. After initiating an anti-inflammatory therapy with Aspirin and Colchicine, inflammatory markers decreased markedly, pleural and pericardial effusions were regressive, and the patient showed rapid clinical improvement. DISCUSSION: Post-cardiac injury syndrome may occur after TMVr and should be considered as a differential diagnosis in patients developing chest pain, signs of pericarditis with or without pericardial effusion and elevated inflammatory markers.

Detection of Acute Changes in Left Ventricular Function by Myocardial Deformation Analysis after Excessive Alcohol Ingestion.

BACKGROUND: The effects of acute excessive alcohol ingestion on echocardiographic parameters of left ventricular (LV) function are unclear. METHODS: One hundred ninety-nine healthy subjects (44 ± 5 years, 71% male) were prospectively examined within 6 hours after excessive alcohol ingestion as well as after 4 weeks with strict alcohol abstinence. Echocardiography was performed at baseline and follow-up for conventional parameters (left ventricular ejection fraction [LVEF], transmitral E and A Doppler flow velocities, E/A ratio, tissue Doppler velocity lateral and septal (é), E/é ratio, deceleration time of E, and isovolumic relaxation time) and myocardial deformation data (such as global radial and global and layer-specific circumferential [endo and epi global CS] and longitudinal [endo and epi global LS] strain). Multivariate regression was used to assess the impact of independent variables on echocardiographic parameters. RESULTS: Alcohol levels were 1.2 ± 0.3 g/L at the time of drinking cessation. After alcohol ingestion endo CS (30% ± 2% vs 37% ± 3%, P = .008) and endo LS (27% ± 4% vs 33% ± 3%, P = .002) were significantly lower at baseline versus follow-up. Blood pressure, LVEF and heart rate, and other echocardiographic parameters did not differ between the two examinations. Alcohol levels were modestly, negatively associated with change in endo CS and endo LS (r = -0.54, 95% CI, -0.63 to -0.43, P < .001; and r = -0.26, 95% CI, -0.39 to -0.14; P < .003, respectively). Alcohol levels were the strongest predictor for endo CS (ß = -4.84; 95% CI, -6.31 to -3.37) and endo LS (ß = -2.50; 95% CI, -4.32 to -0.68). CONCLUSIONS: Acute alcohol ingestion effects endocardial CS and LS, suggesting an acute and transient toxic effect on myocardial deformation, an effect that remains undetected by conventional echocardiographic parameters. The current findings may help clinicians to gain more understanding into the mechanism of developing an alcohol cardiomyopathy and to detect early persistent alcohol-induced myocardial disturbances for an effective therapy in time to prevent harm.

Long-term outcome after angiographically proven coronary stent thrombosis.

The long-term outcomes of patients with angiographically proved stent thrombosis (ST) are insufficiently known. The aim of this study was to evaluate the presentation and in-hospital and long-term outcomes of patients with angiographically proved ST as well as predictors of unfavorable clinical outcomes. One hundred six consecutive patients (mean age 69 ± 12 years, 85 men) presenting from 2003 to 2011 with 117 angiographically proved STs were included in the analysis. The time interval from initial stent implantation to ST, antiplatelet therapy at presentation, and the frequency and predictors of adverse events (death, myocardial infarction, and recurrent ST) during long-term follow-up (mean 65 ± 30 months) were evaluated. Eighty-six patients (80.9%) had early ST, 7 patients (6.6%) had late ST, and 13 patients (12.2%) had very late ST. Eighty-three patients (78.3%) were receiving dual-antiplatelet therapy at the time of ST. Eighty-three patients (78.3%) presented with ST-segment elevation myocardial infarctions, and 23 patients (21.6%) presented with other forms of acute coronary syndromes. Death rates during hospitalization, at 1 year, and at long-term follow-up were 17.9%, 23.8%, and 35.6%, respectively. The rates of recurrent definite ST during hospitalization, at 1 year, and at long-term follow-up were 7.5%, 9.9%, and 10.9%, respectively. Univariate predictors of the combined end point of death rate and definite recurrent ST were presentation with cardiogenic shock, left ventricular ejection fraction <30% at presentation, renal failure, discontinuation of clopidogrel administration at presentation, maximal creatine phosphokinase after ST, and Thrombolysis In Myocardial Infarction (TIMI) flow grade after intervention. Independent predictors of the primary end point at long-term follow-up remained cardiogenic shock (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.08 to 1.63, p = 0.0069), renal failure (OR 1.26, 95% CI 1.01 to 1.57, p = 0.0425), and TIMI flow grade after intervention (OR 0.85, 95% CI 0.74 to 0.98, p = 0.0315). Current cigarette smoking was an independent predictor of repeat definite ST at long-term follow-up (OR 1.12, 95% CI 1.01 to 1.27, p = 0.0321). In conclusion, ST was associated with detrimental outcomes in the acute phase as well as the long-term phase. Recurrent ST was not infrequent.