Transcatheter Mitral Valve Repair in Cardiogenic Shock and Mitral Regurgitation: A Patient-Level, Multicenter Analysis.

OBJECTIVES: The aim of this study was to evaluate the outcome of transcatheter mitral valve repair (TMVr) in patients with cardiogenic shock and significant mitral regurgitation (MR). BACKGROUND: Patients in cardiogenic shock with severe MR have a poor prognosis in the setting of conventional medical therapy. Because of its favorable safety profile, TMVr is being increasingly used as an acute therapy in this population, though its efficacy remains unknown. METHODS: A multicenter, collaborative, patient-level analysis was conducted. Patients with cardiogenic shock and moderate to severe (3+) or severe (4+) MR who were not surgical candidates were treated with TMVr. The primary outcome was in-hospital mortality. Secondary outcomes included 90-day mortality, heart failure (HF) hospitalization, and the combined event rate of 90-day mortality and HF hospitalization following dichotomization by TMVr device success. RESULTS: Between January 2011 and February 2019, 141 patients across 14 institutions met the inclusion criteria. In-hospital mortality occurred in 22 patients (15.6%), at 90 days in 38 patients (29.5%), and at one year in 55 patients (42.6%). Median length of hospital stay following TMVr was 10 days (interquartile range: 6 to 20 days). HF hospitalization occurred in 26 patients (18.4%) at a median of 73 days (interquartile range: 26 to 546 days). When stratified by TMVr procedural results, successful TMVr reduced rates of in-hospital mortality (hazard ratio [HR]: 0.36; 95% confidence interval [CI]: 0.13 to 0.98; p = 0.04), 90-day mortality (HR: 0.36; 95% CI: 0.16 to 0.78; p = 0.01), and the composite of 90-day mortality and HF hospitalization (HR: 0.41; 95% CI: 0.19 to 0.90; p = 0.03). CONCLUSIONS: TMVr may improve short- and intermediate-term mortality in high-risk patients with cardiogenic shock and moderate to severe MR. Randomized studies are needed to definitively establish MR as a therapeutic target in patients with cardiogenic shock.

Risk predictors in a Spanish cohort with cardiac laminopathies. The REDLAMINA registry.

INTRODUCTION AND OBJECTIVES: According to sudden cardiac death guidelines, an implantable cardioverter-defibrillator (ICD) should be considered in patients with LMNA-related dilated cardiomyopathy (DCM) and ≥ 2 risk factors: male sex, left ventricular ejection fraction (LVEF) <45%, nonsustained ventricular tachycardia (NSVT), and nonmissense genetic variants. In this study we aimed to describe the clinical characteristics of carriers of LMNA genetic variants among individuals from a Spanish cardiac-laminopathies cohort (REDLAMINA registry) and to assess previously reported risk criteria. METHODS: The relationship between risk factors and cardiovascular events was evaluated in a cohort of 140 carriers (age ≥ 16 years) of pathogenic LMNA variants (54 probands, 86 relatives). We considered: a) major arrhythmic events (MAE) if there was appropriate ICD discharge or sudden cardiac death; b) heart failure death if there was heart transplant or death due to heart failure. RESULTS: We identified 11 novel and 21 previously reported LMNA-related DCM variants. LVEF <45% (P=.001) and NSVT (P <.001) were related to MAE, but not sex or type of genetic variant. The only factor independently related to heart failure death was LVEF <45% (P <.001). CONCLUSIONS: In the REDLAMINA registry cohort, the only predictors independently associated with MAE were NSVT and LVEF <45%. Therefore, female carriers of missense variants with either NSVT or LVEF <45% should not be considered a low-risk group. It is important to individualize risk stratification in carriers of LMNA missense variants, because not all have the same prognosis.

Complicación infrecuente tras implante percutáneo de válvula aórtica / Rare complication after transaortic percutaneous valve implantation

No disponible

Electrical and mechanical cardiac resynchronisation by novel direct his-bundle pacing in a heart failure patient.

Efficacy of standard cardiac resynchronisation therapy (CRT) by biventricular pacing via coronary sinus depends on the target site for left ventricular (LV) pacing, which in a not insignificant number of patients is limited by anatomical constraints. Direct His-bundle pacing (DHBP) is considered an alternative method of pacing for patients requiring cardiac stimulation in order to obviate detrimental effects of right ventricular pacing on LV function. However, its role in CRT has not been investigated, with scarce number of cases recently reported. We present a case of a heart failure patient in whom CRT was considered and treated by DHBP. In addition to electrical resynchronisation and optimal clinical response, echocardiography showed successful ventricular mechanical synchrony. To our knowledge, these latter findings are for the first time described in the setting of CRT by DHBP.

Assessment of left ventricular function by different speckle-tracking software.

AIMS: Two-dimensional (2D) speckle echocardiography enables objective assessment of left ventricular function through the analysis of myocardial strain, which can be measured by different speckle-tracking software. The aim of this study was to compare two different commercially available cardiac ultrasound systems and their manufacturer-specific speckle-tacking software for the quantification of global myocardial strain in a healthy population. METHODS AND RESULTS: Twenty-eight healthy subjects (age: 38 +/- 12, 64% males) underwent two 2D echocardiograms within the same day using different cardiac ultrasound systems: Vivid 7 (GE Ultrasound, Horten, Norway) and Artida 4D (Toshiba Medical Systems). Standard apical and short-axis views of the left ventricle were obtained in each subject with a frame-rate range of 60 +/- 20 frames/s. Global longitudinal, radial, and circumferential strain values were analysed using their respective speckle-tracking software for Vivid (2D-strain EchoPac PC v.7.0.1, GE Healthcare, Horten, Norway) and Toshiba systems (2D Wall Motion Tracking, Toshiba Medical Systems). Global strain values were estimated from the average of regional left ventricular strain values. Agreement between the two systems and software was assessed by Bland-Altman method. Mean left ventricular ejection fraction was 59 +/- 7%. Global longitudinal, radial, and circumferential strain values were, respectively, -21.95 +/- 1.8, 46.97 +/- 5.5, and -23.18 +/- 3.3% when using 2D-strain EchoPac and -22.28 +/- 2.1, 40.74 +/- 4.3, and -27.17 +/- 4.7% when 2D Wall Motion Tracking was used (P = NS). Limits of agreement between both speckle-tracking software were narrower for global longitudinal strain (-2.25 to 3.65) than for radial and circumferential strain (-2.23 to 12.44 and -1.36 to 10.54, respectively). CONCLUSION: Two commercially available speckle-tracking software appear to be comparable when quantifying left ventricular function in a healthy population. Global longitudinal strain is a more robust parameter than radial and circumferential strain for the assessment of myocardial function when different cardiac ultrasound systems are used for analysis.