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Aims: The impact of malnutrition in patients with tricuspid regurgitation (TR) undergoing tricuspid transcatheter edge-to-edge repair (T-TEER) is not well established. We evaluated the impact of malnutrition among patients with symptomatic TR undergoing T-TEER., Methods and Results: Baseline nutritional status was evaluated using the geriatric nutritional risk index (GNRI), based on serum albumin concentrations and body weight to ideal body weight ratio, among patients with symptomatic TR undergoing T-TEER, enrolled in the multicentre EuroTR registry between March 2016 and February 2024. Malnutrition was defined as GNRI ≤98. The primary outcome of interest was all-cause mortality. A total of 1034 patients were included (mean age 78.4 ± 7.3 years, 47.7% male). Among them, GNRI ≤98 (i.e. malnutrition) was observed in 211 patients (20.4%). Estimated rates of all-cause death at 2 years were 45.9% and 28.2% in patients with and without malnutrition, respectively (log-rank p < 0.001). After multivariable adjustment, malnutrition was independently associated with an increased risk of mortality (adjusted hazard ratio 1.53, 95% confidence interval 1.11-2.10, p = 0.009), also confirmed at inverse probability of treatment weighting-adjusted analysis. As compared to post-procedural residual TR ≥3+, residual TR ≤2+ was associated with a similar lower risk of mortality in patients with and without malnutrition (interaction p = 0.947)., Conclusion: In the large, real-world, multicentre EuroTR registry, malnutrition was present in one out of five patients with symptomatic TR undergoing T-TEER and was independently associated with increased mortality. The prognostic benefit of successful T-TEER in reducing mortality was consistently observed in patients with and without malnutrition., (© 2025 European Society of Cardiology.)

Background: Data regarding the association of pulmonary hypertension (PH) and outcomes in patients undergoing transcatheter tricuspid valve edge-to-edge repair (T-TEER) are scarce., Objectives: The aims of this study were: 1) to investigate the impact of PH on outcomes after T-TEER; and 2) to shed further light on the role of precapillary- and postcapillary PH in patients undergoing T-TEER for relevant tricuspid regurgitation (TR)., Methods: The study included patients from EuroTR (European Registry of Transcatheter Repair for Tricuspid Regurgitation; NCT06307262) who underwent T-TEER for relevant TR from 2016 until 2023 with available invasive evaluation of systolic pulmonary artery pressure (sPAP) using right heart catheterization. Study endpoints were procedural TR reduction, improvement in NYHA function class, and a combined endpoint of death or heart failure hospitalization (HFH) at 2 years., Results: Among a total of 1,230 patients (mean age 78.6 ± 7.0 years, 51.4% women), increasing sPAP was independently associated with increasing rates of 2-year death or HFH (HR: 1.027; 95% CI: 1.003-1.052; P = 0.030; median survival follow-up 343 days [Q1-Q3: 114-645 days]). No significant survival differences were observed for patients with pre- vs postcapillary PH. Sensitivity analysis revealed an sPAP value of 46 mm Hg as the optimized threshold for the prediction of death or HFH. Being observed in 526 patients (42.8%), elevated sPAP (>46 mm Hg) was associated with more severe heart failure symptoms at baseline and follow-up. Importantly, NYHA functional class significantly improved and TR severity was significantly reduced irrespective of PH., Conclusions: PH is an important outcome predictor in patients undergoing T-TEER for relevant TR. In contrast to previous studies, no significant differences were observed for patients with precapillary and postcapillary PH in terms of survival free from HFH., Competing Interests: Funding Support and Author Disclosures Dr Stolz has received speaker honoraria from Edwards Lifesciences. Dr Kresoja has received travel expenses from Edwards Lifesciences. Dr von Stein has received lecture honoraria from Edwards Lifesciences. Dr Rottbauer has received speaker honoraria from Edwards Lifesciences and Abbott. Dr Denti has served as a consultant for InnovHeart, Picardia, HVR, and Approxima; and has received speaker honoraria from Abbott and Edwards Lifesciences. Dr Rassaf has received speaker honoraria and consulting fees from AstraZeneca, Bayer, Pfizer, and Daiichi-Sankyo. Dr Barreiro-Perez has received speaker fees from Abbott Vascular, Edwards Lifesciences, and Venus Medtech. Dr Adamo has received consulting fees in the past 3 years from Abbott Structural Heart and Edwards Lifesciences. Dr von Bardeleben has received institutional grants from and has served as a speaker for Abbott Vascular and Edwards Lifesciences. Dr Toggweiler has received personal honoraria from Medtronic, Boston Scientific, Biosensors, Abbott Vascular, Medira, Shockwave Medical, Teleflex, atHeart Medical, Cardiac Dimensions, Polares Medical, Amarin, Sanofi, AstraZeneca, ReCor Medical, and Daiichi-Sankyo; has received institutional research grants from Edwards Lifesciences, Boston Scientific, Fumedica, Novartis, and Boehringer Ingelheim; and holds equity in Hi-D Imaging. Dr Metra has received consulting fees in the past 3 years from Abbott Structural Heart, AstraZeneca, Bayer, Boehringer Ingelheim, Edwards Lifesciences, and Roche Diagnostics. Dr Geisler has received speaker honoraria and research grants from AstraZeneca, Bayer, Bristol Myers Squibb/Pfizer, Ferrer/Chiesi, Medtronic, and Edwards Lifesciences (all unrelated to this study). Dr Estévez-Loureiro has received speaker fees from Abbott Vascular, Edwards Lifesciences, Boston Scientific, and Venus Medtech. Dr Lüdike has received speaker honoraria and consulting fees from AstraZeneca, Bayer, Pfizer, and Edwards Lifesciences; and has received research honoraria from Edwards Lifesciences. Dr Maisano has received grant and/or research institutional support from Abbott, Medtronic, Edwards Lifesciences, Biotronik, Boston Scientific, NVT, Terumo, and Venus Medtech; has received consulting fees and personal and institutional honoraria from Abbott, Medtronic, Edwards Lifesciences, Xeltis, Cardiovalve, Occlufit, Simulands, Mtex, Venus Medtech, Squadra, and Valgen; has received royalty income from and holds intellectual property rights with Edwards Lifesciences; and is a shareholder (including share options) in Magenta, Transseptal Solutions, and 4Tech. Dr Praz has received travel expenses from Edwards Lifesciences, Abbott Vascular, Polares Medical, Medira, and Siemens Healthineers. Dr Kessler has received speaker honoraria from Edwards Lifesciences and Abbott. Dr Kalbacher has received personal fees from Abbott Medical, Edwards Lifesciences, Pi-Cardia, and Medtronic. Dr Rudolph has received research grants from Abbott Medical, Boston Scientific, and Edwards Lifesciences. Dr Iliadis has received consultant fees and travel expenses from Abbott Medical and Edwards Lifesciences. Dr Lurz has received institutional grants from Edwards Lifesciences and honoraria from Innoventrics. Dr Hausleiter has received research grant support and speaker honoraria from Edwards Lifesciences. Dr Sticchi has served on an advisory board for Edwards Lifesciences. Dr Tarantini has received speaker fees for Abbott Vascular and Edwards Lifesciences. Dr Karam has received consultant fees from Edwards Lifesciences, Boston Scientific, and Medtronic; and has received proctor fees from Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: Complete resection of the affected tissue remains the best curative treatment option for liver-derived tumors and colorectal liver metastases. In addition to preoperative cross-sectional imaging, contrast-enhanced intraoperative ultrasound (CE-IOUS) plays a crucial role in the detection and localization of all liver lesions. However, its exact role is unclear. This study was designed to evaluate the clinical and oncological impact of using CE-IOUS in the surgical treatment of these diseases., Materials and Methods: Over the three-year study period, 206 patients with primary liver tumors and hepatic metastases were enrolled in this prospective, monocentric study to evaluate the impact of CE-IOUS in liver surgery. Secondary outcomes included comparing the sensitivity and specificity of CE-IOUS with existing preoperative imaging modalities and identifying preoperative parameters that could predict a strategic impact of CE-IOUS. In addition, the oncological significance of CE-IOUS was evaluated using a case-cohort design with a minimum follow-up of 18 months., Results: CE-IOUS findings led to a change in surgical strategy in 34% of cases (n=70/206). The accuracy in cases with a major change could be confirmed histopathologically in 71.4% of cases (n=25/35). The impact could not be predicted using parameters assumed to be clinically relevant. An oncological benefit of a CE-IOUS adapted surgical approach was demonstrated in patients suffering from HCC and colorectal liver metastases., Conclusion: CE-IOUS may significantly increase R0 resection rates and should therefore be used routinely as an additional staging method, especially in complex liver surgery., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

The most common functional challenge after Ivor-Lewis esophagectomy is delayed emptying of the gastric conduit. One of the primary endoscopic treatment strategies is performing a pyloric dilatation. However, the effects of dilation have never been scientifically proven. A novel method to detect pyloric distensibility (DI) is the endoluminal functional lumen imaging probe (EndoFlip™). The purpose of this study is to analyze the effects of pyloric dilatation using an EndoFlip™ measurement. Forty-nine patients after Ivor-Lewis esophagectomy were included retrospectively from June 2021 to August 2023 at University Hospital Cologne, Germany. All patients suffered from early delayed emptying of the gastric conduit (DGCE). DI was measured before and after endoscopic dilatation using EndoFlip™ at 40, 45, and 50 mL balloon filling. The Student's t-test and Chi-Squared test were used. All tests were two-sided, with statistical significance set at P ≤ 0.05. EndoFlip™ measurement and pyloric dilatation were feasible in all patients and no adverse events were recorded. DI proved to be smaller in patients before dilatation compared to patients after dilatation. For 40, 45, and 50 mL balloon filling, the mean DI was 5.0 versus 10.0, 4.5 versus 9.1, and 4.0 and 7.5 mm2/mmHg before versus after dilatation. The differences were significant in all balloon fillings. Endoscopic dilatation of the pylorus is the primary endoscopic treatment strategy in patients suffering from DGCE. Currently, the success of dilatation can only be measured with clinical data. This study could demonstrate that EndoFlip™ can be used as an additional diagnostic tool to rate the success of pyloric dilatation., (© The Author(s) 2024. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Cold-induced lipolysis is widely studied as a potential therapeutic strategy to combat metabolic disease, but its effect on lipid homeostasis in humans remains largely unclear. Blood plasma comprises an enormous repertoire in lipids allowing insights into whole body lipid homeostasis. So far, reported results originate from studies carried out with small numbers of male participants. Here, the blood plasma's lipidome of 78 male and 93 female volunteers, who were exposed to cold below the shivering threshold for 2 h, was quantified by comprehensive lipidomics using high-resolution mass spectrometry. Short-term cold exposure increased the concentrations in 147 of 177 quantified circulating lipids and the response of the plasma's lipidome was sex-specific. In particular, the amounts of generated glycerophospholipid and sphingolipid species differed between the sexes. In women, the BMI could be related with the lipidome's response. A logistic regression model predicted with high sensitivity and specificity whether plasma samples were from male or female subjects based on the cold-induced response of phosphatidylcholine (PC), lysophosphatidylcholine (LPC), and sphingomyelin (SM) species. In summary, cold exposure promotes lipid synthesis by supplying fatty acids generated after lipolysis for all lipid classes. The plasma lipidome, i.e. PC, LPC and SM, shows a sex-specific response, indicating a different regulation of its metabolism in men and women. This supports the need for sex-specific research and avoidance of sex bias in clinical trials., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: In patients undergoing transcatheter aortic valve replacement (TAVR), elevated pre-procedural C-reactive protein (CRP) levels are frequently observed. Its impact on long-term results of TAVR is unclear. The aim of the study was to investigate the long-term (up to six years) clinical outcomes of TAVR patients with normal compared to elevated CRP levels before TAVR., Methods: Consecutive patients undergoing TAVR between August 2012 and January 2023 at a tertiary cardiology facility were included. Patients were divided into two cohorts based on the baseline CRP levels: normal CRP (≤ 5 mg/l) and elevated CRP (>5 mg/l). The cohorts were followed clinically for up to six years after TAVR., Results: From a total of 1000 TAVR patients (mean age 81 ± 6 years), 268 patients (27 %) were found to have elevated baseline CRP (>5 mg/l). Such patients had significantly more co-morbidities (e.g. chronic obstructive pulmonary disease, atrial fibrillation, heart failure, concomitant valvopathies). They also developed periprocedural infections more frequently (3 % vs. 1 %, p = 0.007) and required more commonly repeat hospitalizations for infections during follow-up (HR 1.97, CI 1.47-2.64, p < 0.001). All-cause mortality and development of valve dysfunction did not significantly differ between patients with elevated and normal baseline CRP levels., Conclusion: Albeit long-term results of TAVR patients with elevated pre-procedural CRP levels seem favorable in terms of survival and development of valve dysfunction, they have an increased risk for periprocedural infections and re-admissions due to infections of any type during the follow-up period., Competing Interests: Declaration of competing interest S. Toggweiler serves as a consultant and proctor for Medtronic, Boston Scientific, Edwards Lifesciences and Biosensors, as a proctor for Edwards Lifesciences and Abbott Vascular, as a consultant for Medira, Shockwave, Teleflex, atHeart Medical, Veosource, Cardiac Dimensions, ReCor Medical and Polares Medical, has received institutional research grants from Boston Scientific, Fumedica and Novartis and holds equity in Hi-D Imaging. M. Bossard received speaker and consulting fees from Abbott Vascular, Abiomed and SIS Medical. A. Attinger-Toller serves as a consultant for Boston Scientific and received speaker fees from Abbott. M. Wolfrum serves as a proctor and consultant for Biosensors., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: To develop an intervention enhancing hospitalized older adults' nutrition., Methods: For the first time, a mixed-methods design with data triangulation was applied according to the six-step model of Corry et al. to elaborate on a complex nursing intervention in the form of a logic model. Patients who were aged ≥80 years and hospitalized for at least 5 days were included. Sample size for quantitative practice analysis was 135 older adults, whereas 22 older inpatients participated in interviews and observations for needs analysis and generated data for key principles., Findings: The intervention "Eat Enough" encompasses nursing team culture and comprises six actionable targets to deliver needs-based support and reach required protein and energy intake for hospitalized older adults by sensitizing nurses and the interprofessional team. Facilitating nutritional intake would be supported by an advanced practice nurse who considers the medical and nursing care plan and therapy., Conclusions: The intervention "Eat Enough" demonstrates that nurses play a key role in interprofessional teams to enhance older adults' nutrition in hospital. The pipeline model displays how the actionable targets can be achieved, and how awareness raising can influence the context-leading to raised calories and protein requirement coverages and shorter length of stay., Implications for Clinical Practice: By identifying risk factors of malnutrition and strengthening nurses' responsibilities, the intervention "Eat Enough" could significantly enhance nutrition among hospitalized older adults. However, the logic model should be tested and implemented in future research., (© 2023 The Authors. International Journal of Nursing Knowledge published by Wiley Periodicals LLC on behalf of NANDA International.)

As the survival prognosis of cancer patients continues to improve, the improvement in quality of life during and after cancer treatment is becoming increasingly important 1. Exercise therapy has a positive effect on so-called "patient-reported outcomes" 2. The combination of endurance training and individualized strength training plays a particularly important role here. There is therefore a need for consistent and comprehensive implementation of quality-assured exercise therapy in everyday clinical practice., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Increasing energy expenditure in brown adipose (BAT) tissue by cold-induced lipolysis is discussed as a potential strategy to counteract imbalanced lipid homeostasis caused through unhealthy lifestyle and cardiometabolic disease. Yet, it is largely unclear how liberated fatty acids (FA) are metabolized. We investigated the liver and BAT lipidome of mice housed for 1 week at thermoneutrality, 23 °C and 4 °C using quantitative mass spectrometry-based lipidomics. Housing at temperatures below thermoneutrality triggered the generation of phosphatidylethanolamine (PE) in both tissues. Particularly, the concentrations of PE containing polyunsaturated fatty acids (PUFA) in their acyl chains like PE 18:0&#95;20:4 were increased at cold. Investigation of the plasma's FA profile using gas chromatography coupled to mass spectrometry revealed a negative correlation of PUFA with unsaturated PE in liver and BAT indicating a flux of FA from the circulation into these tissues. Beta-adrenergic stimulation elevated intracellular levels of PE 38:4 and PE 40:6 in beige wildtype adipocytes, but not in adipose triglyceride lipase (ATGL)-deficient cells. These results imply an induction of PE synthesis in liver, BAT and thermogenic adipocytes after activation of the beta-adrenergic signaling cascade., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)