Quality of life in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: tools and evidence.

Aortic stenosis is the most prevalent valvular heart disease requiring intervention, especially in the elderly population. Surgical aortic valve replacement and transcatheter aortic valve implantation (TAVI) are well established treatment options for symptomatic patients with severe aortic stenosis, as they provide a significant survival benefit. Aortic stenosis may have an important impact on patients' quality of life (QoL). However, advanced age, comorbidities and frailty may limit the beneficial effect of aortic stenosis interventions in terms of QoL. Current guidelines mention the importance of frailty and avoiding the futility of interventions, but lack specific indications about decision-making. Also, there are limited data on how to specifically assess QoL in aortic stenosis patients since the most used questionnaires are validated in different populations (i.e. heart failure). The aim of this review is to summarize all the available tools for QoL assessment in patients with aortic stenosis; to report current evidence on the impact of TAVI on QoL; and to discuss the role of frailty and comorbidities in this setting.

Right ventricle assessment before tricuspid valve interventions.

In the latest ESC/EACTS Guidelines for the Management of Valvular Heart Disease, right ventricular dilatation and dysfunction, severe pulmonary hypertension and tricuspid annulus dilatation were reported to be the most important parameters to consider in patient selection for tricuspid valve interventions. Indeed, comprehensive right ventricular assessment is crucial in patients with severe tricuspid regurgitation who may benefit from transcatheter or surgical procedures. However, the only guideline parameter considered for intervention has been tricuspid annular dilatation in the presence of at least mild to moderate tricuspid regurgitation, with no other right ventricular markers used in the decision-making process for invasive treatment. Notably, challenges in the assessment of right ventricular function may limit establishing thresholds for defining right ventricular dysfunction. The aim of this review is to summarize current evidence on the prognostic significance of right ventricular function in patients with tricuspid regurgitation undergoing percutaneous or surgical interventions.

Heart failure with mildly reduced ejection fraction: from diagnosis to treatment. Gaps and dilemmas in current clinical practice.

Heart failure (HF) with mildly reduced ejection fraction (HFmrEF) was recently recognised as a distinct clinical entity. Although guideline diagnostic criteria for HFmrEF are well defined, there is substantial variation in clinical characteristics, pathophysiology and prognosis of this group of patients. The heterogeneity in clinical presentations of HFmrEF arises from diverse patients' risk factors, coexisting comorbidities, which modify clinical signs and symptoms, and stage of the disease. On the other hand, HFmrEF shares common clinical features with other HF subgroups. However, the knowledge about the mechanisms and therapeutic approaches in HFmrEF is far from being completely understood. Therefore, HFmrEF represents one of the most intriguing areas of heart failure research. The aim of this review is therefore to highlight the diagnostic challenges in HFmrEF and to provide a constructive appraisal on the pathophysiology of HFmrEF, as well as to discuss the role of pharmacological and nonpharmacological treatment options in patients with HFmrEF.