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Objectives Methods Results Interpretation Many cases of cervical artery dissection are considered “spontaneous.” Recent data suggest that while cervical artery dissection may proportionally explain more strokes in young patients, hospitalization for dissection increases with age, suggesting a potential role of acquired vascular disease. In this study, we hypothesized that traditional vascular risk factors and comorbidities are associated with cervical artery dissection.We performed a retrospective cohort study using administrative claims data from a 5% sample of Medicare beneficiaries. Exposures of interest included traditional vascular risk factors and comorbidities: coronary artery disease, hyperlipidemia, hypertension, diabetes mellitus, heart failure, chronic kidney disease, chronic obstructive pulmonary disease, valvular heart disease, atrial fibrillation, tobacco use, and alcohol abuse. The primary outcome was a new diagnosis of cervical artery dissection. Marginal structural Cox models were used to characterize the association between the exposures and outcomes, adjusted for time‐dependent confounding.Among 2,256,710 eligible Medicare beneficiaries, 730 (0.03%) developed cervical artery dissection. The following exposures were found to be significantly associated with the development of cervical artery dissection: hypertension (HR 1.84 [95% CI: 1.40–2.41]), alcohol use (HR 1.83 [1.52–2.21]), atrial fibrillation (HR 1.80 [1.53–2.11]), tobacco use (HR 1.80 [1.52–2.13]), coronary artery disease (HR 1.56 [1.33–1.82]), and valvular heart disease (HR 1.23 [1.05–1.45]).In a large cohort of older people, several traditional vascular risk factors and comorbidities were associated with subsequent cervical artery dissection. Further studies exploring the role of such factors in the development of cervical artery dissection are warranted. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Global disparities in valvular surgery services exist. Cost‐effectiveness analysis (CEA) and cost‐utility analysis can be used to guide national investment decisions. This scoping review aims to synthesize economic evaluations for valvular surgery by income settings and provide recommendations.A systematic literature review identified primary CEAs or CUAs in English comparing surgical management strategies for valvular heart disease. MEDLINE, Embase, CINAHL, Web of Science, and Business Source Complete were searched using keywords “valvular surgery,” “valve disease,” “cost‐effectiveness,” and “cost‐benefit analysis”. Articles comparing outcomes or costs only were excluded. Search results were uploaded and screened on COVIDENCE. Variables from eligible articles were charted in a spreadsheet.Twenty articles were eligible, six from low‐ and middle‐income countries (LMICs) and 14 from high‐income countries (HICs). In HICs, the top conditions were degenerative aortic valve disease (7/14) and mitral valve disease (4/14) compared to congenital (2/6) and rheumatic heart diseases (2/6) in LMICs. HICs evaluated new technologies and techniques, whereas LMICs compared different valve types or surgery versus no intervention. Most articles used published studies (12/20) or databases (7/20) to conduct their CEA and quality‐adjusted life years was the most common effectiveness measure (12/20). Comparator interventions were cost‐effective in all LMIC articles and in 8/14 for HICs.Economic evaluations are mostly conducted in HICs and for adult conditions. More analyses in LMICs are needed. This can be facilitated by maintaining databases, documenting costs, and implementing quality of life assessments. [ABSTRACT FROM AUTHOR]

Tricuspid regurgitation (TR) is an increasingly prevalent condition, especially in older populations, and presents significant challenges due to its association with right heart failure, hospital admissions, and high mortality rates. The management of TR has evolved, with new percutaneous valve repair and replacement techniques emerging alongside traditional surgical approaches. However, accurately assessing right ventricular (RV) function–a key prognostic factor in TR–remains difficult due to the RV's unique anatomy and sensitivity to loading conditions. Current echocardiographic methods, such as Tricuspid Annular Plane Systolic Excursion (TAPSE), S' wave analysis, and RV fractional area change (FAC), offer valuable insights but have limitations, particularly regarding load dependence and incomplete assessment of RV function. Advances in 3D echocardiography and myocardial strain imaging provide more comprehensive evaluations, yet challenges persist in integrating these measures in routine clinical practice. The review highlights the importance of a multimodal approach to RV assessment in TR patients, considering both the right atrium and pulmonary artery interactions, and explores potential future tools such as myocardial work and dynamic testing to improve prognostic accuracy and patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Current guidelines highlight a paucity of evidence guiding optimal timing for non‐ST‐elevation myocardial infarction (NSTEMI) in high‐risk and non‐high‐risk cases. Aim: We assessed long‐term major adverse cardiovascular events (MACEs) in NSTEMI patients undergoing early (<24 h) versus delayed (>24 h) coronary angiography at 6 years. Secondary end‐points included all‐cause mortality and cumulative MACE outcomes. Methods: Baseline characteristics and clinical outcomes were assessed among 355 patients presenting to a tertiary regional hospital between 2017 and 2018. Cox proportional hazard models were generated for MACE and all‐cause mortality outcomes, adjusting for the Global Registry of Acute Coronary Events (GRACE) score, patient demographics, biomarkers and comorbidities. Results: Two hundred and seventy patients were included; 147 (54.4%) and 123 (45.6%) underwent early and delayed coronary angiography respectively. Median time to coronary angiography was 13.3 and 45.4 h respectively. At 6 years, 103 patients (38.1%) experienced MACE; 41 in the early group and 62 in the delayed group (hazard ratio (HR) = 2.23; 95% confidence interval (CI) = 1.50–3.31). After multivariable adjustment, the delayed group had higher rates of MACE (HR = 1.79; 95% CI = 1.19–2.70), all‐cause mortality (HR = 2.76; 95% CI = 1.36–5.63) and cumulative MACE (incidence rate ratio = 1.54; 95% CI = 1.12–2.11). Subgroup analysis of MACE outcomes in rural and weekend NSTEMI presentations was not significant between early and delayed coronary angiography (HR = 1.49; 95% CI = 0.83–2.62). Conclusion: Higher MACE rates in the delayed intervention group suggest further investigation is needed. Randomised control trials would be well suited to assess the role of early invasive intervention across all NSTEMI risk groups. [ABSTRACT FROM AUTHOR]

Inclusion body myositis (IBM) is an idiopathic inflammatory myopathy, but cardiac involvement has rarely been reported. Although bicuspid aortic valve (BAV) is one of the most common congenital heart diseases, the relationship between IBM and valvular heart disease remains unknown. We herein report the first case of a 68‐year‐old male patient with IBM coexisting with severe aortic stenosis due to BAV that was successfully treated with aortic valve replacement. To date, only 10 cases of IBM with cardiac manifestation, including our case, have been reported, and we review the current literature on cardiac involvement in patients with IBM. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Recurrence of valvular involvement may occur after Libman–Sacks endocarditis surgery, emphasizing the need for frequent multivalvular evaluations with echocardiography or more sensitive methods to optimize surgical outcomes. This report presented a 32‐year‐old woman, complaining of recurrent fever and chills. Physical examination revealed the presence of a third heart sound (S3), a pan‐systolic murmur (III/VI) at mitral and tricuspid foci, tachycardia, and fine pulmonary crackles. Transesophageal echocardiography (TEE) revealed severe mitral regurgitation (MR) and moderate tricuspid regurgitation (TR) with vegetations on the mitral valve. Initially, intravenous antibiotic therapy was started simultaneously with diagnostic studies. Despite a positive TEE, negative blood cultures on three separate occasions precluded meeting the diagnostic criteria outlined in the modified Duke criteria. Moreover, the patient's condition continued to deteriorate after antibiotic therapy, leading to the diagnosis of Libman–Sacks endocarditis. The patient was considered a candidate for mitral valve surgery. All vegetations were completely debrided and then the mitral valve was reconstructed. Follow‐up post‐surgery echocardiography revealed the absence of MR and mitral stenosis (MS). Four months later, the patient presented again complaining of fatigue, dyspnea, lower extremity edema, and ascites with evidence of pulmonary hypertension and right heart failure on physical examination. TEE was performed, which revealed severe MR, severe TR, detached artificial chordae, and blood leak from the perforated pericardial patch. Therefore, she was necessitated for valvular surgery and underwent mitral and tricuspid valve surgery. The mitral ring and perforated pericardial patch were removed, and a mitral prosthetic valve was implanted. In addition, the tricuspid valve was repaired. Follow‐up post‐surgery echocardiography revealed the absence of MR and TR. To our knowledge, this is the first case of LSE recurrence with multi‐valvular involvement. [ABSTRACT FROM AUTHOR]

Background: MRI‐derived left atrial (LA) longitudinal strain has been shown to be a marker for mitral regurgitation, but the utility of LA circumferential strain remains unclear. Purpose: To assess feasibility and reproducibility of LA circumferential strain, identify changes in mitral regurgitation patients compared to healthy volunteers, and determine strain's association with mitral regurgitation severity and cardiac function. Study Type: Retrospective. Population: 52 mitral regurgitation patients, 12 healthy volunteers. Field Strength/Sequence: Steady‐state free precession cine and 2D phase contrast sequences at 1.5T. Assessment: Peak LA circumferential strain was computed in each of three short‐axis slices (superior, mid, and inferior) and longitudinal strain computed from long‐axis slices using MRI feature‐tracking software. Strain test–retest reproducibility was determined from two repeat studies in healthy volunteers. Statistical Tests: LA circumferential strain test–retest reproducibility was assessed by intra‐class correlation coefficient (ICC). Strain was compared between cohorts using Student's t‐test or Mann–Whitney U. Mitral regurgitation severity association with strain and LV function was assessed using Spearman correlation and multivariable regression. Significance was defined as P < 0.05. Results: LA circumferential strain assessment was feasible in all subjects with moderate reproducibility in the superior (ICC = 0.74), mid LA (ICC = 0.71), and inferior LA (ICC = 0.63). In mitral regurgitation patients, LA circumferential strain was significantly lower in the superior (11.86% [6.5%,19.2%] vs. 18.73% ± 6.7%) and mid LA slices (18.41% ± 9.5% vs. 28.7% ± 10.4%) compared to healthy volunteers. Mitral regurgitation severity significantly associated with mid LA circumferential strain (β = −0.03) and LAV significantly associated with superior LA circumferential strain (β = −2.09), both independent of LA longitudinal strain and CO. Data Conclusion: LA circumferential strain assessment is feasible with moderate reproducibility. Compared to healthy volunteers, patients had significantly lower LA circumferential strain. Mitral regurgitation severity and LAV were significantly associated with LA circumferential strain independent of LA longitudinal strain. Evidence Level: 3 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

Purpose: The extraaortic‐valvular cardiac damage (EVCD) Stage has shown potential for risk stratification for patients with aortic stenosis (AS). This study aimed to examine the usefulness of the EVCD Stage in risk stratification of patients with moderate AS and reduced left ventricular ejection fraction (LVEF). Methods: Clinical data from patients with moderate AS (aortic valve area,.60–.85 cm2/m2; peak aortic valve velocity, 2.0–4.0 m/s) and reduced LVEF (LVEF 20%–50%) were analyzed during 2010–2019. Patients were categorized into three groups: EVCD Stages 1 (LV damage), 2 (left atrium and/or mitral valve damage), and 3/4 (pulmonary artery vasculature and/or tricuspid valve damage or right ventricular damage). The primary endpoint included a composite of cardiac death and heart failure hospitalization, with non‐cardiac death as a competing risk. Results: The study included 130 patients (mean age 76.4 ± 6.8 years; 62.3% men). They were categorized into three groups: 26 (20.0%) in EVCD Stage 1, 66 (50.8%) in Stage 2, and 48 (29.2%) in Stage 3/4. The endpoint occurred in 54 (41.5%) patients during a median follow‐up of 3.2 years (interquartile range, 1.4–5.1). Multivariate analysis indicated EVCD Stage 3/4 was significantly associated with the endpoint (hazard ratio 2.784; 95% confidence interval 1.197–6.476; P =.017) compared to Stage 1, while Stage 2 did not (hazard ratio 1.340; 95% confidence interval.577–3.115; P =.500). Conclusion: The EVCD staging system may aid in the risk stratification of patients with moderate AS and reduced LVEF. [ABSTRACT FROM AUTHOR]

This article provides concise summaries of recent studies published in the European Journal of Heart Failure that are relevant to heart failure specialists. The studies cover various topics, including the importance of screening for malnutrition in patients with advanced heart failure, the role of sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes and heart failure, the safety of diuretic use in pregnant women with structural heart disease, and the importance of optimal heart failure management after mitral transcatheter edge-to-edge repair. The findings highlight the poor prognosis for malnourished heart failure patients, the consistent benefits of sodium-glucose cotransporter 2 inhibitors in improving clinical outcomes, the safety of loop diuretic use during pregnancy, and the factors associated with heart failure hospitalization risk after mitral transcatheter edge-to-edge repair. [Extracted from the article]

Aims: Data regarding the characterization and outcomes of patients with heart failure (HF) with mildly reduced ejection fraction (HFmrEF) is scarce. This study investigates the characteristics and prognostic impact of native aortic valve diseases (AVD) in patients with HFmrEF. Methods and results: Consecutive patients hospitalized with HFmrEF (i.e. left ventricular ejection fraction 41–49% and signs and/or symptoms of HF) were retrospectively included at one institution from 2016 to 2022. The prognostic impact of native aortic valve stenosis (AS), aortic valve regurgitation (AR) and mixed AVD (MAVD) was investigated for the primary endpoint of long‐term all‐cause mortality during a median follow‐up of 30 months. Kaplan–Meier, univariable and multivariable Cox proportional analyses were applied. From a total of 2106 patients hospitalized with HFmrEF, the prevalence of AS and AR was 16.5% and 31.2%, respectively (MAVD 7.8%). The presence of moderate/severe AS was associated with a higher risk of long‐term all‐cause mortality (44.8% vs. 28.7%; p = 0.001) and HF‐related rehospitalization (18.6% vs. 12.0%; p = 0.001), even after multivariable adjustment (mortality: hazard ratio [HR] 1.320; 95% confidence interval [CI] 1.035–1.684; p = 0.025; HF‐related rehospitalization: HR 1.570; 95% CI 1.101–2.241; p = 0.013). Interestingly, even mild AS was associated with increased risk of long‐term all‐cause mortality compared to patients without AS (HR 1.477; 95% CI 1.101–1.982; p = 0.009). In contrast, the presence of AR was not associated with long‐term outcomes after multivariable adjustment. Conclusions: The presence of AS, but not AR, was independently associated with increased risk of all‐cause mortality and HF‐related rehospitalization in patients with HFmrEF. Even milder stages of AS were associated with impaired prognosis. [ABSTRACT FROM AUTHOR]

The relationship between sarcopenia and the long‐term risk of atrial fibrillation (AF) remains unclear. This study recruited a large prospective Caucasian cohort from the UK Biobank. Participants were assessed at baseline with handgrip strength and muscle mass and were categorized into groups of non‐sarcopenia, probable sarcopenia, and confirmed sarcopenia. Kaplan–Meier method and Cox proportional hazards model were used to explore the association between sarcopenia and the incidence of AF. The genetic predisposition of AF was assessed by polygenic risk score. Sensitivity analyses were performed to validate the results. A total of 384,433 participants with a median age of 58 years and 54.3% women were enrolled in this study. There were 24,007 cases of new‐onset AF over a median follow‐up of 12.56 years. The groups of non‐sarcopenia, probable sarcopenia, and confirmed sarcopenia accounted for 22,290 (6.1%), 1665 (9.2%), and 52 (11.9%) cases, respectively. Compared with the non‐sarcopenia group, participants with probable sarcopenia or confirmed sarcopenia had an 8% (95% CI, 1.03–1.14) or 61% (95% CI, 1.23–2.12) higher risk of AF incidence. The findings remained robust in multiple sensitivity analyses, such as subgroup analysis and further adjustment of genetic predisposition. Notably, the association between sarcopenia and a high AF risk was more pronounced in younger participants, women, and those with valvular heart disease. In conclusion, sarcopenia was associated with a high long‐term risk of AF in Caucasians, supporting sarcopenia as a new independent risk factor of AF. [ABSTRACT FROM AUTHOR]

Introduction: Rheumatic heart disease with persistent atrial fibrillation (RHD‐AF) is associated with increased morbidity. However, there is no standardized approach for the maintenance of sinus rhythm (SR) in them. We aimed to determine the utility of a stepwise approach to achieve SR in RHD‐AF. Methods: Consecutive patients with RHD‐AF from July 2021 to August 2023 formed the study cohort. The stepwise approach included pharmacological rhythm control and/or electrical cardioversion (Central illustration). In patients with recurrence, additional options included AF ablation or pace and ablate strategy with conduction system pacing or biventricular pacing. Clinical improvement, NT‐proBNP, 6‐Minute Walk Test (6MWT), heart failure (HF) hospitalizations, and thromboembolic complications were documented during follow‐up. Results: Eighty‐three patients with RHD‐AF (mean age 56.13 ± 9.51 years, women 72.28%) were included. Utilizing this approach, 43 (51.81%) achieved and maintained SR during the study period of 11.04 ± 7.14 months. These patients had improved functional class, lower NT‐proBNP, better distance covered for 6MWT, and reduced HF hospitalizations. The duration of AF was shorter in patients who achieved SR, compared to those who remained in AF (3.15 ± 1.29 vs 6.93 ± 5.23, p = 0.041). Thirty‐five percent (29) maintained SR after a single cardioversion over the study period. Only one underwent AF ablation. Of the 24 who underwent pace and ablate strategy, atrial lead was implanted in 22 (hybrid approach), and 50% of these achieved and maintained SR. Among these 24, none had HF hospitalizations, but patients who maintained SR had further improvement in clinical and functional parameters. Conclusions: RHD‐AF patients who could achieve SR with a stepwise approach, had better clinical outcomes and lower HF hospitalizations. [ABSTRACT FROM AUTHOR]

Background: Ventricular tachycardia (VT) remains a risk in repaired Tetralogy of Fallot (rTOF); however, long‐term benefits of VT ablation have not been established. This study compares the outcomes of rTOF patients with and without VT ablation. Methods: We searched multiple databases examining the outcomes of rTOF patients who had undergone VT ablation compared to those without ablation. Primary outcomes were VT recurrence, sudden cardiac death (SCD), and all‐cause mortality. Subgroup analysis was conducted based on the type of ablation (catheter and surgical). Slow‐conducting anatomical isthmus (SCAI)‐based catheter ablation (CA) was also analyzed separately. The secondary outcome was the risk factors for the pre‐ablation history of VT. Results: Fifteen cohort studies with 1459 patients were included, 21.4% exhibited VTs. SCAI was found in 30.4% of the population, with 3.7% of non‐inducible VT. Factors significantly associated with VT before ablation included a history of ventriculostomy, QRS duration ≥180 ms, fragmented QRS, moderate to severe pulmonary regurgitation, high premature ventricular contractions burden, late gadolinium enhancement, and SCAI. Ablation was only beneficial in reducing VTs recurrence in SCAI‐based CA (risk ratio (RR) 0.11; 95% CI 0.03 to 0.33. p < 0.001; I2 = 0%) with no recurrence in patients with preventive ablation (mean follow‐up time 91.14 ± 77.81 months). The outcomes of VT ablation indicated a favorable trend concerning SCD and all‐cause mortality (RR 0.49 and 0.44, respectively); however, they were statistically insignificant. Conclusions: SCAI‐based CA has significant advantages in reducing VT recurrence in rTOF patients. Risk stratification plays a key role in determining the decision to perform ablation. [ABSTRACT FROM AUTHOR]

Aims: This study aims to assess the applicability of the mitral regurgitation (MR) proportionality concept in patients with atrial functional mitral regurgitation (aFMR) treated with transcatheter edge‐to‐edge repair (M‐TEER). We hypothesized that patients with disproportionate MR (higher MR relative to left ventricular size) would exhibit different outcomes compared to those with proportionate MR, despite undergoing M‐TEER. Methods and results: We retrospectively analysed 98 patients with aFMR from the EuroSMR registry who underwent M‐TEER between 2008 and 2019. Patients met criteria for aFMR (normal indexed left ventricular end‐diastolic volume [LVEDV], preserved left ventricular ejection fraction [LVEF] ≥ 50% without regional wall motion abnormalities, and structurally normal mitral valves). We excluded patients with missing effective regurgitant orifice area (EROA) or LVEDV data. The primary endpoint was 2‐year mortality, with an EROA/LVEDV ratio employed to differentiate disproportionate from proportionate MR. Procedural success and baseline characteristics were analysed, and multivariate Cox proportional hazards models were used to identify mortality predictors. The mean patient age was 79 ± 7.3 years, with 68.8% female, and 79% had a history of atrial fibrillation. The mean EROA was 0.27 ± 0.14 cm2, and LVEDV was 95.6 ± 33.7 mL. Disproportionate MR was identified with an EROA/LVEDV ratio >0.339 cm2/100 mL. While procedural success was similar in both groups, disproportionate MR was associated with a numerically higher estimate of systolic pulmonary artery pressures (sPAP) and rates of NYHA ≥III and TR ≥ 3+. Disproportionate MR had a significant association with increased 2‐year mortality (P < 0.001). The EROA/LVEDV ratio and tricuspid annular plane systolic excursion (TAPSE) were independent predictors of 2‐year mortality (EROA/LVEDV: HR: 1.35, P = 0.010; TAPSE: HR: 0.85, P = 0.020). Conclusions: This analysis introduces the MR proportionality concept in aFMR patients and its potential prognostic value. Paradoxically, disproportionate MR in aFMR was linked to a 1.35‐fold increase in 2‐year mortality post‐M‐TEER, emphasizing the importance of accurate preprocedural FMR characterization. Our findings in patients with disproportionate MR indicate that a high degree of aFMR with high regurgitant volumes may lead to aggravated symptoms, which is a known contributor to increased mortality following M‐TEER. These results underline the need for further research into the pathophysiology of aFMR to inform potential preventative and therapeutic strategies, ensuring optimal patient outcomes. [ABSTRACT FROM AUTHOR]

Aims: A considerable proportion of candidates for transcatheter aortic valve implantation (TAVI) have underlying heart failure (HF) with preserved ejection fraction (HFpEF), which can be challenging for diagnosis because significant valvular heart disease should be excluded before diagnosing HFpEF. This study investigated the long‐term prognostic value of the pre‐procedural H2FPEF score in patients with preserved ejection fraction (EF) undergoing TAVI. Methods and results: Patients who underwent TAVI between October 2013 and May 2017 were enrolled from the Optimized CathEter vAlvular iNtervention–Transcatheter Aortic Valve Implantation Japanese multicentre registry. After excluding 914 patients, 1674 patients with preserved EF ≥ 50% (median age: 85 years, 72% female) were selected for calculation of the H2FPEF score and were dichotomized into two groups: the low H2FPEF score [0–5 points; n = 1399 (83.6%)] group and the high H2FPEF score [6–9 points; n = 275 (16.4%)] group. Patients with high H2FPEF scores were associated with a higher prevalence of New York Heart Association Functional Class III/IV (59.3% vs. 43.7%, P < 0.001), diabetes (24.4% vs. 18.5%, P = 0.03), and paradoxical low‐flow, low‐gradient aortic stenosis (15.9% vs. 6.2%, P < 0.001). These patients showed worse prognoses than those with low H2FPEF scores regarding the cumulative 2 year all‐cause mortality (26.3% vs. 15.5%, log‐rank P < 0.001), cardiovascular mortality (10.5% vs. 5.4%, log‐rank P < 0.001), HF hospitalization (16.2% vs. 6.7%, log‐rank P < 0.001), and the composite endpoint of cardiovascular mortality and HF hospitalization (23.8% vs. 10.8%, log‐rank P < 0.001). After adjustment for several confounders, the high H2FPEF scores were independently associated with increased risk for all‐cause mortality [adjusted hazard ratio (HR), 1.48; 95% confidence interval (CI), 1.09–2.00; P = 0.011] and for the composite endpoint of cardiovascular mortality and HF hospitalization (adjusted HR, 1.95; 95% CI, 1.38–2.74; P < 0.001). Subgroup analysis confirmed the excess risk of high H2FPEF scores relative to low H2FPEF scores for the composite endpoint of cardiovascular mortality and HF hospitalization increased with a lower Society of Thoracic Surgeons (STS) score (STS score <8%: adjusted HR, 2.40; 95% CI, 1.50–3.85; P < 0.001; STS score ≥8%: adjusted HR, 1.34; 95% CI, 0.79–2.28; P = 0.28; Pinteraction = 0.030). Conclusions: The H2FPEF score is useful for predicting long‐term adverse outcomes after TAVI, including all‐cause mortality, cardiovascular mortality, and HF hospitalization for patients with preserved EF. More aggressive interventions targeting HFpEF in addition to the TAVI procedure might be relevant in patients with high H2FPEF scores, particularly in those with a lower surgical risk. [ABSTRACT FROM AUTHOR]

Aims: Data on diuretic use in pregnancy are limited and inconsistent, and consequently it remains unclear whether they can be used safely. Our study aims to evaluate the perinatal outcomes after in‐utero diuretic exposure. Methods and results: The Registry Of Pregnancy And Cardiac disease (ROPAC) is a prospective, global registry of pregnancies in women with heart disease. Outcomes were compared between women who used diuretics during pregnancy versus those who did not. Multivariable regression analysis was used to assess the impact of diuretic use on the occurrence of congenital anomalies and foetal growth. Diuretics were used in 382 (6.7%) of the 5739 ROPAC pregnancies, most often furosemide (86%). Age >35 years (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.2–2.0), other cardiac medication use (OR 5.4, 95% CI 4.2–6.9), signs of heart failure (OR 1.7, 95% CI 1.2–2.2), estimated left ventricular ejection fraction <40% (OR 2.9, 95% CI 2.0–4.2), New York Heart Association class >II (OR 3.4, 95% CI 2.3–5.1), valvular heart disease (OR 6.3, 95% CI 4.7–8.3) and cardiomyopathy (OR 3.9, 95% CI 2.6–5.7) were associated with diuretic use during pregnancy. In multivariable analysis, diuretic use during the first trimester was not significantly associated with foetal or neonatal congenital anomalies (OR 1.3, 95% CI 0.7–2.6), and diuretic use during pregnancy was also not significantly associated with small for gestational age (OR 1.4, 95% CI 1.0–1.9). Conclusions: Our study does not conclusively establish an association between diuretic use during pregnancy and adverse foetal outcomes. Given these findings, it is essential to assess the risk–benefit ratio on an individual basis to guide clinical decisions. [ABSTRACT FROM AUTHOR]

Data on retrospective compensation claims for injuries caused by pharmaceutical drugs are prone to selection and reporting biases. Nevertheless, this case study of the antidiabetic drug benfluorex shows that such data can be used to estimate the cumulative incidence of drug‐related injury, and to provide insights into its epidemiology. To this end, we develop a modelling framework for under‐reporting of retrospective claims for compensation arising from drug damage. The model involves a longitudinal component related to attrition of cases over time, and a cross‐sectional component related to incomplete reporting. We apply this model to cardiac valve surgery necessitated by exposure to benfluorex. Benfluorex was marketed in France between 1976 and 2009, when it was withdrawn because it caused valvular heart disease. A scandal erupted in 2010 over the scale of the damage caused by the drug. Since then, no further estimates of cumulative incidence have been published, though thousands of claims for compensation have been processed. The analysis combines compensation claims data and sociological survey data on benfluorex users, together with data on benfluorex sales and duration of treatment. We find a threshold of toxicity at about 6 months' exposure, and that at least 1690 individuals (95% CI 1290 to 2320) needed heart surgery to replace or repair valves damaged by exposure to benfluorex in France: a cumulative incidence of 3.68 per 10,000 (95% CI 2.68 to 5.34) benfluorex users or 3.22 per 10,000 (95% CI 2.48 to 4.39) person‐years at risk above the exposure threshold. While these findings are tentative, they are consistent with those obtained previously using very different methods. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is a chronic and progressive disease that often progresses to an advanced stage where conventional therapy is insufficient to relieve patients' symptoms. Despite the availability of advanced therapies such as mechanical circulatory support or heart transplantation, the complexity of defining advanced HF, which requires multiple parameters and multimodality assessment, often leads to delays in referral to dedicated specialists with the result of a worsening prognosis. In this review, we aim to explore the role of cardiac magnetic resonance (CMR) in advanced HF by showing how CMR is useful at every step in managing these patients: from diagnosis to prognostic stratification, hemodynamic evaluation, follow‐up and advanced therapies such as heart transplantation. The technical challenges of scanning advanced HF patients, which often require troubleshooting of intracardiac devices and dedicated scans, will be also discussed. [ABSTRACT FROM AUTHOR]

Aortic stenosis is a heart valve disease that comprises one of the most common valvular lesions worldwide that can obstruct blood flow from the heart to the rest of the body leading to a significant mortality rate. In the present study, a sophisticated approach concerning the inspection of patient‐specific human heart conditions is proposed utilizing advanced computational and manufacturing methodologies. The suggested method exploits Digital Imaging and Communications in Medicine (DICOM) data that are retrieved via a computerized tomography scan process, and the corresponding 3D digital model of the heart is computed. In the next phase, the design the construction of an appropriate mechanical aortic valve is conducted considering the patient anatomical characteristics, which are derived directly from the heart's 3D model. Hereupon, additive manufacturing technologies are employed to accurately feature the customizable geometry of the native aortic valve. In addition, several experimental tests are performed in order to calculate the optimal process‐related parameters; presenting that way a mechanical behavior that resembles the mechanical properties of commercial artificial heart valves. Both the physical and digital 3D models can be used by healthcare professionals to identify potential defects prior to the cardiovascular operation. Finally, a numerical simulation is developed using computational fluid dynamics (CFD) modeling, which has emerged as an effective tool to explore the heart's hemodynamics pinpointing the efficiency of the aortic valve replacement. [ABSTRACT FROM AUTHOR]

Purpose: Aortic stenosis (AS) is a common valvular heart disease with high morbidity and mortality. Recently, the association between peak atrial longitudinal strain (PALS) and AS clinical outcomes has been identified. This systematic review evaluates the prognostic value of PALS for adverse events in AS. Methods: We performed a systematic literature review to identify clinical studies that evaluated Speckle–Tracking Echocardiography (STE)‐derived PALS to predict adverse outcomes in patients with AS. We excluded studies that compared echocardiography to computed tomography and studies that focused on diseases other than AS. Results: We included 18 studies reporting on 2660 patients. Patients with symptomatic AS had decreased PALS when compared to patients with asymptomatic AS. Patients with AS who had adverse events had decreased PALS when compared to patients with AS with no events. Each unit increase of PALS was independently associated with decreased risk for the primary endpoint. PALS cut‐off values were associated with increased risk for the primary endpoint. Conclusion: This systematic review suggests PALS as an independent predictor for cardiovascular events in patients with AS and highlights the importance of evaluating LA mechanics for AS prognosis. [ABSTRACT FROM AUTHOR]

Background: Mendelian randomization analysis was applied to elucidate the causal relationship between the basal metabolic rate (BMR) and common cardiovascular diseases. Method: We choose BMR as exposure. BMR is the metabolic rate of the body when the basic physiological activities (blood circulation, breathing and constant body temperature) are maintained. The normal BMR is 1507 kcal/day for men and 1276 kcal/day for women. The dataset was drawn from the public GWAS dataset (GWAS ID: ukb‐a‐268), collected and analysed by UK biobank, containing 331,307 European males and females. SNPs independently and strongly associated with BMR were used as instrumental variables in the inverse variance weighted analysis. MR‐Egger, weighted median, MR pleiotropy residual sum, and outlier methods were also performed, and the sensitivity was evaluated using horizontal pleiotropy and heterogeneity analyses to ensure the stability of the results. Results: An increased BMR is associated with a higher risk of cardiomyopathy (odds ratio [OR] = 2.00, 95% confidence interval [CI], 1.57–2.54, p = 1.87 × 10−8), heart failure (OR = 1.39, 95% CI, 1.27–2.51, p = 8.1 × 10−13), and valvular heart disease (OR = 1.18, 95% CI, 1.10–1.27, p =.00001). However, there was no clear association between BMR and the subtypes of other cardiovascular diseases, such as coronary disease (OR =.96, 95% CI,.85–1.08, p =.48651) and atrial fibrillation (AF) (OR = 1.85, 95% CI, 1.70–2.02, p = 6.28 × 10−44). Conclusion: Our study reveals a possible causal effect of BMR on the risk of cardiomyopathy, heart failure and valvular disease, but not for coronary disease and AF. [ABSTRACT FROM AUTHOR]

Aim: To assess cause‐specific death in patients with heart failure with preserved, mildly reduced, and reduced ejection fraction (HFpEF, HFmrEF, and HFrEF). Methods and results: Data were analysed from the Swedish Heart Failure Registry (SwedeHF) and the National Patient Register of patients enrolled in SwedeHF 2000–2021. Cox proportional hazards regression models were performed and adjusted for age, sex and time period. Among 100 584 patients (23% HFpEF, 23% HFmrEF, 53% HFrEF), median age (interquartile range) was 75 (66–82) and 36% were female. Of those who died within 5 years, most deaths were ascribed to cardiovascular (CV) causes across all ejection fraction (EF) categories. Within 5 years, HFpEF had higher adjusted risk of non‐CV death (hazard ratio [HR] 1.33, 95% confidence interval [CI] 1.28–1.38, p < 0.001) and lower adjusted risk of CV death (HR 0.85, 95% CI 0.82–0.88, p < 0.001) compared to HFrEF. Ischaemic heart disease (IHD) and cancer were the most common causes of CV and non‐CV death regardless of EF category. The incidence rate of CV death due to IHD was highest in HFrEF while incidence rates of CV death due to pulmonary vascular disease, stroke, valvular heart disease and atrial fibrillation increased with increasing EF. The incidence rates of non‐CV deaths due to cancer, respiratory disease, and infections increased with increasing EF. Conclusion: Cardiovascular death was more common than non‐CV death across all EF categories although the risk of non‐CV death within 5 years was higher with increasing EF. IHD and cancer were the most common causes of CV and non‐CV deaths, respectively, regardless of EF category. [ABSTRACT FROM AUTHOR]

Tricuspid regurgitation (TR) secondary to cardiac implantable electronic devices (CIEDs) has been well documented and is associated with worse cardiovascular outcomes. A variety of mechanisms have been proposed including lead‐induced mechanical disruption of the tricuspid valvular or subvalvular apparatus and pacing‐induced electrical dyssynchrony. Patient characteristics such as age, sex, baseline atrial fibrillation, and pre‐existing TR have not been consistent predictors of CIED‐induced TR. While two‐ dimensional echocardiography is helpful in assessing the severity of TR, three‐dimensional echocardiography has significantly improved accuracy in identifying the etiology of TR and whether lead position contributes to TR. Three‐dimensional echocardiography may therefore play a future role in optimizing lead positioning during implant to reduce the risk of CIED‐induced TR. Optimal lead management strategies in addition to percutaneous interventions and surgery in alleviating TR are very important. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Besides thromboses, it's crucial to also consider the rare possibility of tumors like papillary fibroelastomas when evaluating worsening cardiopulmonary symptoms in patients with severe rheumatic mitral stenosis and atrial fibrillation. Cardiac papillary fibroelastoma is a rare and benign endocardial tumor typically found on the aortic valve. The simultaneous occurrence of rheumatic heart disease affecting the mitral valve and papillary fibroelastoma on the aortic valve is infrequent, with limited documented instances. This unique case can enhance our understanding of the clinical presentation, diagnostic approaches, management options, and implications for patient outcomes in these two conditions. We present the case of a 47‐year‐old woman who was admitted to the hospital due to worsening dyspnea and fatigue, during which time she discovered an aortic valve papillary fibroelastoma. Further investigations revealed two thrombi in her left atrium and left atrial appendage, along with significant rheumatic mitral valve stenosis. The patient underwent thrombectomy, mitral valve replacement, and valve‐sparing aortic valve tumor resection. Following surgery, the patient's recovery was unremarkable. This case report emphasizes the need for a comprehensive evaluation in patients with rheumatic mitral stenosis, considering all possible etiologies. While thrombi are typical in mitral stenosis and atrial fibrillation, the rare presence of tumors like papillary fibroelastomas should be recognized, underscoring the importance of further assessment when suspicion arises. Importantly, individuals with asymptomatic cardiac papillary fibroelastomas should undergo surgical treatment to minimize the potential risk of tumoral embolization. [ABSTRACT FROM AUTHOR]

Background: According to the current literature, there is no difference between left bundle brunch area pacing (LBBAP) and right ventricular apical pacing in terms of lead dislodgement and capture threshold elevation. However, there are no large‐scale studies reporting the data about long‐term lead stability in patients with severe tricuspid regurgitation. Methods and Results: We present a case of lead dislodgement with possible infective endocarditis six months after implantation in a patient with severe tricuspid regurgitation who underwent LBBAP. Conclusions: We concluded that severe preoperative tricuspid regurgitation may cause lead dislodgement, and infective endocarditis may be a facilitator or main reason of lead dislodgement in cases of LBBAP. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the association between the number of remaining teeth and the incidence of postoperative respiratory complications in patients undergoing heart valve surgery. Methods: We retrospectively enrolled 157 patients who underwent heart valve surgery between April 2010 and March 2019. Data on patient characteristics including systemic and oral conditions were extracted and postoperative respiratory complications were set as outcomes. Patients were divided into two groups according to the number of remaining teeth (≥20, <20). After adjusting for confounding factors with propensity scoring, logistic regression analysis was performed to examine the association of remaining teeth number with the incidence of postoperative respiratory complications. In addition, subgroup analysis was performed by stratifying the data into quintiles based on the propensity score. Results: Univariate analysis showed significant differences between the two groups in factors, including age, past cardiac surgery experience, New York Heart Association functional classification class IV, denture use, tooth extraction before surgery, occlusal support, and periodontitis. Logistic regression analysis showed that patients with <20 remaining teeth had a significantly higher incidence of postoperative respiratory complications than those with ≥20 remaining teeth, with an odds ratio of 29.800 (p = 0.004). Subgroup analysis showed that the odds ratio for the patients with <20 remaining teeth was 9.000 (p = 0.038). Conclusions: The results suggest that heart valve surgery patients shall get attention on oral disease prevention by dental care practitioners to maintain a sufficient number of teeth for the prevention of postoperative respiratory complications. [ABSTRACT FROM AUTHOR]

This document provides a summary of various studies related to cardiovascular diseases. The first study explores the potential of targeting lipolysis in white adipose tissue (WAT) to improve diastolic dysfunction in heart failure with preserved ejection fraction (HFpEF). The second study investigates a new mouse model for arrhythmogenic cardiomyopathy caused by filamin C haploinsufficiency. The third study examines the role of miR-721 in autoimmune myocarditis and its potential as a therapeutic target. These studies contribute to our understanding of the mechanisms and potential treatments for these cardiovascular conditions. [Extracted from the article]

Aims: Tricuspid regurgitation (TR) is commonly observed in patients with severe left‐sided valvular heart disease (VHD). This study sought to assess TR frequency, management and outcome in this population. Methods and results: Among 6883 patients with severe native left‐sided VHD or previous left‐sided valvular intervention enrolled in the EURObservational Research Programme prospective VHD II survey, moderate or severe TR was very frequent in patients with severe mitral VHD (30% when mitral stenosis, 36% when mitral regurgitation [MR]), especially in patients with secondary MR (46%), and rare in patients with severe aortic VHD (4% when aortic stenosis, 3% when aortic regurgitation). An increase in TR grade was associated with a more severe clinical presentation and a poorer 6‐month survival (p < 0.0001). Rates of concomitant tricuspid valve (TV) intervention at the time of left‐sided heart valve surgery were high at the time of mitral valve surgery (50% when mitral stenosis, 41% when MR). Concordance between class I indications (patients with severe TR) for concomitant TV surgery at the time of left‐sided valvular heart surgery according to guidelines and real‐practice decision‐making was very good (88% overall, 95% in patients operated on for MR). Conclusion: In this large international prospective survey among patients with severe left‐sided VHD, moderate/severe TR was frequent in patients with mitral valve disease and was associated with a poorer outcome as TR grade increased. In patients with severe TR, compliance to guidelines for class I indications for concomitant TV surgery at the time of left‐sided heart valve surgery was very good. [ABSTRACT FROM AUTHOR]

Aims: The aim of this analysis was to provide data on the overall comorbidity burden, both cardiovascular (CV) and non‐CV, in a large real‐world heart failure (HF) population across the ejection fraction (EF). Methods and results: Patients with HF from the Swedish HF Registry between 2000 and 2021 were included. Of 91 463 patients (median age 76 years [interquartile range 67–82]), 98% had at least one among the 17 explored comorbidities (94% at least one CV and 85% at least one non‐CV comorbidity). All comorbidities, except for coronary artery disease (CAD), were more frequent in HF with preserved EF (HFpEF). Patients with multiple comorbidities were older, more likely female, inpatients, with HFpEF, worse New York Heart Association class and higher N‐terminal pro‐B‐type natriuretic peptide levels. In a multivariable Cox model, 12 comorbidities were independently associated with a higher risk of death from any cause. The highest risk was associated with dementia (hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.45–1.65), chronic kidney disease (HR 1.37, 95% CI 1.34–1.41), chronic obstructive pulmonary disease (HR 1.32, 95% CI 1.28–1.35). Obesity was associated with a lower risk of all‐cause death (HR 0.81, 95% CI 0.79–0.84). CAD and valvular heart disease were associated with a higher risk of all‐cause and CV mortality, but not non‐CV mortality, whereas cancer and musculo‐skeletal disease increased the risk of non‐CV mortality. A significant interaction with EF was observed for several comorbidities. Occurrence of CV and non‐CV outcomes was related to the number of CV and non‐CV comorbidities, respectively. Conclusion: The burden of both CV and non‐CV comorbidities was high in HF regardless of EF, but overall higher in HFpEF. Multimorbidity was associated with a high risk of death with a different burden on CV or non‐CV outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Pulsed field ablation (PFA) has emerged as an innovative technique for pulmonary vein isolation (PVI). Typically, a transeptal puncture (TSP) with a standard sheath precedes a switch to the larger diameter sheath in the left atrium. This study aimed to describe the safety and feasibility of direct TSP using the large diameter Faradrive sheath before performing PVI with PFA. Methods: We prospectively enrolled 166 consecutive patients with paroxysmal or persistent atrial fibrillation (AF) undergoing PVI with PFA at our institution. TSP was performed in all cases with transesophageal echocardiography guidance, using the Faradrive sheath and a 98 cm matched Brockenbrough needle. The primary endpoint was the occurrence of pericardial tamponade during or within the first 48 h after the procedure. The secondary endpoint was the occurrence of any major complication. Results: All 166 patients were included into the final analysis (44% female): 64% of patients had paroxysmal AF and 36% persistent AF (68 ± 11 years old, median CHA2DS2Vasc Score 3, median left atrial volume index 31). The median duration of the procedure was 60 min, median time to TSP was 15 min, and the median fluoroscopy dose was 595 cGy × cm2. The primary endpoint occurred in one patient: a non‐TSP related pericardial tamponade, which was managed with pericardial puncture. Conclusion: Direct TSP with skipping sheath exchange using the large diameter Faradrive sheath for PVI with PFA was safe, feasible, and reduced costs in all patients. Large scale studies and registries are needed to verify this workflow. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is currently defined as symptomatic by asking patients if they are aware of when they are in AF and if they feel better in sinus rhythm. However, this approach of defining AF as symptomatic and asymptomatic fails to adequately consider the adverse effects of AF in patients who are unaware of their rhythm including progression from paroxysmal to persistent AF, and the development of dementia, stroke, sinus node dysfunction, valvular regurgitation, ventricular dysfunction, and heart failure. Labeling these patients as asymptomatic falsely suggests that their AF requires less intense therapy and puts into question the notion of truly asymptomatic AF. Because focusing on patient awareness ignores other important consequences of AF, clinical endpoints that are independent of symptoms are being developed. The concept of AF burden has more recently been used as a clinical endpoint in clinical trials as a more clinically relevant endpoint compared to AF‐related symptoms or time to first recurrence, but its correlation with symptoms and other clinical outcomes remains unclear. This review will explore the impact of AF on apparently asymptomatic patients, the use of AF burden as an endpoint for AF management, and potential refinements to the AF burden metric. The review is based on a presentation by the senior author during the 2023 16th annual European Cardiac Arrhythmia Society (ECAS) congress in Paris, France. [ABSTRACT FROM AUTHOR]

Aim: The aim was to investigate the prevalence of, and factors related to frailty, together with early clinical outcomes, in hospitalized older patients with valvular heart disease (VHD) in China. Design: A prospective observational cohort study was conducted. Methods: A validated prospective survey was conducted to assess the prevalence of frailty, factors associated with it, and early clinical outcomes in hospitalized older patients with VHD, utilizing Fried's criterion. A total of 207 consecutive participants aged 65 years and older who underwent cardiac surgery were included in the study, spanning from September 2021 to December 2021. Results: Frailty was detected in 78 patients (37.7%). Patients with multimorbidity, a New York Heart Association (NYHA) class of III/IV, or masticatory dysfunction had a greater incidence of frailty (p < 0.05). Patients with a normal albumin level and a higher frequency of exercise had a lower incidence of frailty (p < 0.05). Patients with frailty had longer hospital and intensive care unit stays and greater hospitalization costs than did those without frailty (p < 0.05). The 30‐day adverse event rate of the frail group was also greater (11.5% vs. 3.1%). Therefore, early screening for conditions such as multimorbidity, cardiac dysfunction, and hypoalbuminemia is urgently needed to effectively address frailty, as it has been linked to unfavourable early outcomes. Moreover, promoting exercise and improving masticatory function and nutrition are crucial for preventing and managing frailty in older patients with VHD. [ABSTRACT FROM AUTHOR]

The article explores the relationship between heart failure with preserved ejection fraction (HFpEF) and secondary mitral regurgitation (SMR). It highlights a study that reveals the mechanisms behind exercise intolerance in HFpEF patients with SMR, attributing it to left atrial and early left ventricular dysfunction, as well as pulmonary vascular disease. The article emphasizes the need for a better understanding of HFpEF and the development of targeted therapies for specific phenotypes. It also discusses the importance of accurate measurement and management of mitral regurgitation in HFpEF patients, cautioning against misjudging its severity in patients with smaller ventricles and diastolic dysfunction. The study raises questions about the development and treatment of functional MR in HFpEF patients. [Extracted from the article]

The article discusses the relationship between aortic valve disease and heart failure with mildly reduced ejection fraction (HFmrEF). It highlights the importance of left ventricular ejection fraction (LVEF) as a prognostic factor and driver for intervention in valvular disease. The article also emphasizes the role of multimodality imaging in understanding LV remodeling and identifying other causes of LV dysfunction. The study by Schupp et al. provides insights into the risk stratification of HFmrEF patients with aortic valve disease, particularly aortic stenosis (AS). It suggests the need for improved knowledge of the interactions between valvular disease and LV function to optimize patient management. The article cautions against overinterpretation of the association between mild AS and poor outcomes, and highlights the underuse of interventions on the aortic valve in patients with severe AS and HFmrEF. It concludes by calling for further research to elucidate the underlying mechanisms of the association between valvular disease and impaired outcomes in HFmrEF patients. [Extracted from the article]

The article discusses the use of diuretics during pregnancy for women with heart failure and/or congenital heart and/or valvular heart disease. The care of these patients during pregnancy is largely based on expert opinion rather than evidence-based studies. The article presents data from the ESC Registry of Pregnancy and Cardiac Disease, showing that diuretics can be used during pregnancy when clearly indicated based on the mother's disease. The data mainly refer to the loop diuretic furosemide, and other diuretic medications were used less frequently. The article emphasizes the need for an individualized patient-centered approach and collaboration between cardiologists and obstetricians in the care of pregnant women with cardiac diseases. [Extracted from the article]

This article discusses the conflicting results of two clinical trials, MITRA-FR and COAPT, which evaluated the effectiveness of percutaneous repair (PR) for patients with severe secondary mitral regurgitation (SMR). The MITRA-FR trial showed no benefit of PR, while the COAPT trial reported a significant improvement in clinical outcomes. The article reviews the assessment and response to these trials by key stakeholders, including regulators, health technology assessment bodies, and authors of medical journal publications. The main factors contributing to the conflicting results were differences in patient characteristics, control therapy, and procedural success rates. The majority of published documents supported the findings of the COAPT trial, but many authors called for further research and highlighted the need for standardized recommendations. The article also discusses potential explanations for the conflicting results, such as the concept of disproportionate-proportionate mitral regurgitation and the optimization of medical care prior to patient selection. The nature of sponsorship (industrial vs. academic) was also mentioned as a potential factor influencing the findings. The article concludes by emphasizing the clinical and economic impacts of discordant interpretations of clinical evidence and the importance of standardized recommendations in similar circumstances. [Extracted from the article]

Valvular heart diseases (such as stenosis and regurgitation) are recognized as a rapidly growing cause of global deaths and major contributors to disability. The most effective treatment for these pathologies is the replacement of the natural valve with a prosthetic one. Our work considers an innovative design for prosthetic aortic valves that combines the reliability and durability of artificial valves with the flexibility of tissue valves. It consists of a rigid support and three polymer leaflets which can be cut from an extruded flat sheet, and is referred to hereafter as the Wheatley aortic valve (WAV). As a first step towards the understanding of the mechanical behavior of the WAV, we report here on the implementation of a numerical model built with the ICFD multi‐physics solver of the LS‐DYNA software. The model is calibrated and validated using data from a basic pulsatile‐flow experiment in a water‐filled straight tube. Sensitivity to model parameters (contact parameters, mesh size, etc.) and to design parameters (height, material constants) is studied. The numerical data allow us to describe the leaflet motion and the liquid flow in great detail, and to investigate the possible failure modes in cases of unfavorable operational conditions (in particular, if the leaflet height is inadequate). In future work the numerical model developed here will be used to assess the thrombogenic properties of the valve under physiological conditions. [ABSTRACT FROM AUTHOR]

Background: This study aimed to determine how patients trade‐off the benefits and risks of two different types of procedures used to treat heart valve disease (HVD). It also aimed to determine patients' preferences for HVD treatments (predicted uptake) and the relative importance of each treatment attribute. Methods: A discrete choice experiment (DCE) was conducted in Australia and Japan with patients who required a heart valve procedure. Patients were stratified into three categories: no prior procedure experience, minimally invasive procedure experience and invasive procedure experience. DCE attributes included risk of mortality; risk of stroke; needing dialysis; needing a new pacemaker; valve durability; independence 1 month after surgery; and out‐of‐pocket expenses. Participants chose between two hypothetical labelled approaches to therapy ('invasive procedure' and 'minimally invasive procedure'), with a separate opt‐out included. A mixed multinomial logit model was used to analyse preferences. Results: The DCE was completed by 143 Australian and 206 Japanese patients. Both populations demonstrated an overall preference for the minimally invasive procedure over the invasive procedure. All attributes tested significantly predicted choice and were important to patient decision‐making. However, patients' choices were most influenced by the durability of the valve and the likelihood of independence postprocedure, irrespective of their prior procedure experience. Differences in preference were observed between Australian and Japanese patients; valve durability was the most important attribute among Australian patients, while Japanese patients emphasised regaining independence postsurgery. Risk of mortality was less important relative to other key attributes in Japan; however, it remained significant to the model. Conclusions: HVD patients prefer a minimally invasive procedure over an invasive procedure, irrespective of prior treatment experience. Key attributes contributing to treatment preferences are valve durability and faster recovery. These results can be used to help inform healthcare decision‐makers about what features of heart valve procedures patients value most. Patient and Public Contribution: People with lived experience of HVD were included in multiple stages of the design phase of this research. First, patients and doctors were consulted by taking part in qualitative interviews. The qualitative interviews helped inform which treatment attributes to include in the DCE based on what was important to those with lived experience and those who help make treatment decisions on behalf of patients. Qualitative interview participants also assisted with the framing of questions in the online survey to ensure the terminology was patient‐friendly and relevant to those with lived experience. Following qualitative interviews, the DCE attribute list was agreed on in expert consultation with a steering committee, which included patient representatives and treating physicians (interventional cardiologists, cardiothoracic surgeons). The survey was also pilot tested with a small sample of patients and minor adjustments were made to the wording to ensure it was appropriate and meaningful to those with lived experience of HVD. [ABSTRACT FROM AUTHOR]

Background: Electroanatomical mapping is an essential tool in the ablation of typical AFL. Objectives: To identify the existence of voltage patterns in the CTI voltage maps and their relevance for typical AFL ablation. Methods: A voltage map of the CTI was made prior to ablation, identifying the areas of maximum voltage and their location along the CTI, allowing classification into patterns according to their distribution. A stepwise ablation approach targeting the areas of maximum voltage was conducted. The ablation characteristics were compared based on the pattern obtained. Results: Two voltage patterns were identified, with differences in ablation time to bidirectional CTI block. No complications occurred. Conclusions: Voltage mapping identifies patterns in the CTI with implications for typical AFL ablation. [ABSTRACT FROM AUTHOR]

Identifying the underlying cause of unexplained syncope is crucial for appropriate management of recurrent syncopal episodes. Implantable loop recorders (ILRs) have emerged as valuable diagnostic tools for monitoring patients with unexplained syncope. However, the predictors of pacemaker requirement in patients with ILR and unexplained syncope remain unclear. In this study, we shed light on these prognostic factors. PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane CENTRAL were systematically searched until May 04, 2023. Studies that evaluated the predictors of pacemaker requirement in patients with implantable loop recorder and unexplained syncope were included. The "Quality In Prognosis Studies" appraisal tool was used for quality assessment. The pooled odds ratio (OR) with 95% confidence intervals (CIs) was calculated. The publication bias was evaluated using Egger's and Begg's tests. Ten studies (n = 4200) were included. Right bundle branch block (OR: 3.264; 95% CI: 1.907–5.588, p <.0001) and bifascicular block (OR: 2.969; 95% CI: 1.859–4.742, p <.0001) were the strongest predictors for pacemaker implantation. Pacemaker requirement was more than two times in patients with atrial fibrillation, sinus bradycardia and first degree AV block. Valvular heart disease, diabetes mellitus, and hypertension were also significantly more in patients with pacemaker implantation. Age (standardized mean difference [SMD]: 0.560; 95% CI: 0.410/0.710, p <.0001) and PR interval (SMD: 0.351; 95% CI: 0.150/0.553, p =.001) were significantly higher in patients with pacemaker requirement. Heart conduction disorders, atrial arrhythmias and underlying medical conditions are main predictors of pacemaker device implantation following loop recorder installation in unexplained syncopal patients. [ABSTRACT FROM AUTHOR]

Aims: Valvular heart disease (VHD) is one of the leading causes of heart failure. Clinically significant VHD can induce different patterns of cardiac remodelling, and risk stratification is challenging in patients with various degrees of cardiac dysfunction. The study aimed to investigate the prognostic implications of Meta‐Analysis Global Group in Chronic Heart Failure (MAGGIC) score in patients with VHD. Methods and results: This study used data from the China Valvular Heart Disease (China‐VHD) registry, which was a multicentre, prospective, observational cohort study for patients with significant (at least moderate) VHD. In total, 10 446 patients with moderate or greater VHD from the China‐VHD study were included in the present analysis. The primary outcome of interest was all‐cause mortality within 2 years. Among 10 446 patients with VHD, the mean age was 61.98 ± 13.47 years, and 5819 (55.7%) were male. During 2 years of follow‐up, 895 (8.6%) patients died. The MAGGIC score was monotonically and independently associated with mortality in both total cohort [adjusted hazard ratio: 1.095, 95% confidence interval (CI): 1.084–1.107, P < 0.001] and most types of VHD (aortic regurgitation, mitral stenosis, mitral regurgitation, tricuspid regurgitation, mixed aortic stenosis and aortic regurgitation, and multiple VHD). The score was also an independent prognostic factor in patients with or without symptoms or preserved left ventricular ejection fraction (LVEF) and exhibited both satisfactory discrimination and calibration properties in predicting mortality. The prognostic value of MAGGIC score was robust in most quartiles of N‐terminal pro‐brain natriuretic peptide level, with no significant interaction observed (Pinteraction = 0.498). Compared with the EuroSCORE II, the MAGGIC score achieved significantly better predictive performance in overall population [C index: 0.769 vs. 0.727; net reclassification improvement index (95% CI): 0.354 (0.313–0.396), P < 0.001; integrated discrimination improvement index (95% CI): 0.069 (0.052–0.085), P < 0.001] and in subgroups of patients divided by therapeutic strategy, LVEF, symptomatic status, stage of VHD, and aetiology of VHD. Conclusions: The MAGGIC score is a reliable prognostic factor across the range of cardiac dysfunction in VHD and may assist in risk stratification and guide clinical decision‐making. [ABSTRACT FROM AUTHOR]

Background: Ivabradine, a medical treatment for heart failure (HF), reduces heart rate (HR) and prolongs diastolic perfusion time. It is frequently prescribed to patients with HF who have a suboptimal response or intolerance to beta‐blockers. Degenerative mitral regurgitation (MR) is a valvular heart disease often associated with the development of HF and atrial fibrillation (AF). However, studies comparing the effects of ivabradine and beta‐blockers on MR are lacking. Therefore, this study aimed to explore the potential therapeutic effects of ivabradine and carvedilol on MR using a rat model. Methods and results: Using a novel echo‐guided mini‐invasive surgery, MR was created in 12‐weeks‐old Sprague–Dawley rats. After 2 weeks, the rats were randomized to receive either ivabradine or carvedilol for 4 weeks. Echocardiography was performed at baseline and at two‐week intervals. Following haemodynamic studies, postmortem tissues were analysed. Notably, the MR‐induced myocardial dysfunction did not improve considerably after treatment with ivabradine or carvedilol. However, in haemodynamic studies, pharmacological therapies, particularly carvedilol, mitigated MR‐induced chamber dilatation (end‐systolic volume and end‐diastolic volume; MR vs. MR + Carvedilol; P < 0.05) and decreased compliance (end‐systolic pressure–volume relationship; MR vs. MR + Carvedilol; P < 0.05). Compared with ivabradine, a shorter duration (MR vs. MR + Carvedilol; P < 0.05) and reduced inducibility (MR vs. MR + Carvedilol and MR vs. MR + Ivabradine; P < 0.05) of AF were observed in MR rats treated with carvedilol. Similarly, reduced cardiac fibrosis and apoptosis were observed in the MR rat model in the treatment groups, especially in those treated with carvedilol (MR vs. MR + Carvedilol; P < 0.01). Conclusions: Although both ivabradine and carvedilol, at least in part, mitigated MR‐induced chamber dilatation and decreased compliance, carvedilol had a better effect on reversing MR‐induced cardiac fibrosis, apoptosis, and arrhythmogenesis than ivabradine. When compared with Ivabradine, MR rats treated with carvedilol exhibited a shorter duration and reduced inducibility of AF, thus providing more effective suppression of HCN4. Further investigations are required to validate our findings. [ABSTRACT FROM AUTHOR]

Aims: We aim to investigate the correlation between preoperative soluble suppression of tumourigenicity 2 (sST2) and postoperative myocardial remodelling and cardiac function in patients with valvular heart disease. Methods and results: This retrospective study included patients who underwent heart valve surgery at the General Hospital of Northern Theatre Command from July 2019 to June 2020. Preoperative, early postoperative, and 1‐month postoperative cardiac ultrasound data were collected. Multivariable linear regression was used to analyse the factors associated with preoperative sST2 and postoperative cardiac function parameters. A receiver operator characteristic curve analysis was used to analyse the predictive value of sST2 for left ventricular ejection fraction (LVEF) reduction at 1 month after surgery. This study included 156 patients. Left ventricular end‐systolic volume (b = 0.125, P = 0.004), atrial fibrillation (b = 7.933, P = 0.003), and coronary artery disease (b = 5.826, P = 0.043) were correlated with the preoperative sST2 levels. Preoperative sST2 was independently associated with early postoperative left ventricular end‐systolic volume (b = −0.136, P = 0.035), left ventricular end‐diastolic volume (b = −0.225, P = 0.036), and LVEF (b = 0.056, P = 0.008). At 1 month after surgery, LVEF (r = −0.234, P = 0.023) and reduction in LVEF (r = −0.316, P = 0.002) were negatively correlated with preoperative sST2. The area under the receiver operator characteristic curve of preoperative sST2 in predicting LVEF reduction at 1 month was 0.646, with a sensitivity of 0.357 and a specificity of 0.918. Conclusions: Preoperative sST2 levels are related to early postoperative myocardial remodelling and have a predictive value for the improvement of cardiac function 1 month after surgery. [ABSTRACT FROM AUTHOR]

Background & Aims: Objectives of this retrospective cohort study were to assess differences in patient survival between etiologies of cirrhosis while on the waitlist for liver transplantation (LT), and to identify cardiac risk factors that predict survival failure while on the waitlist for LT. Methods: This single‐center retrospective cohort design included adult patients who were listed for LT at a tertiary academic hospital with a high‐volume liver transplant center. Results: Of the 653 patients listed for LT during the study period, 507 (77.6%) survived to transplant and 146 (22.4%) died or clinically deteriorated prior to transplant. Cumulative incidence of death or clinical deterioration did not differ statistically between patient groups (log rank p =.11). In multivariate analysis, compared to patients with NAFLD, there were no significant differences between patients with alcoholic cirrhosis (HR.95, 95%, CI,.62–1.45), cryptogenic cirrhosis (HR 1.31, 95%, CI,.77–2.23), or hepatitis C cirrhosis (HR 1.12, 95%, CI,.66–1.90). However, higher MELD scores (HR = 1.52, 95% CI, 1.12–1.19), severe coronary artery disease (HR = 2.09 95% CI, 1.23–3.55), and tricuspid regurgitation (HR = 2.62, 95% CI, 1.31–5.26) were independently associated with increased risk for survival failure to LT. Conclusions: The presence of severe coronary artery disease and tricuspid regurgitation at the time of listing for transplant are associated with survival failure while on the LT waitlist across etiologies of liver disease. Diagnostic assessment of coronary and valvular disease should be considered in all patients undergoing evaluation for LT, such as cardiac catheterization and/or stress echocardiogram. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of valvular heart diseases remain considerably high in Africa, largely but not solely due to rheumatic heart disease. Valvular heart surgeries have emerged as the cornerstone in their management. While several studies have reported data on outcomes following heart valve surgery in many developed countries, there is a staggering paucity of data and evidence reporting the outcomes in the Africa population. The aim of this study is to report the perioperative outcomes following valvular heart surgery in Africa. Methods: The Preferred Reporting Items for Systematic Reviews and Meta‐analysis guideline was utilized. Electronic searches were performed using PubMed, African journal online, and Research gate from inception to June 2023. The primary endpoints were overall mortality and 30‐day mortality, and secondary endpoints included postoperative complications, length of hospital, and intensive care stays. The outcome data were pooled together and analyzed with the random effect model for proportions and mean for meta‐analysis using the R software. Results: This systematic review identified 31 studies that fulfilled the study eligibility criteria and all were observational studies. The countries in which these studies were carried out include South Africa, Ethiopia, Egypt, Mali, Rwanda, Nigeria, Cameroon, Ghana, Senegal, Tanzania, and Kenya. Statistical analysis reported a pooled overall mortality of 10.48% and a pooled 30‐day mortality of 4.59%. Conclusion: Several obstacles, such as lack of financial resources and inadequate infrastructure, continue to impede valvular heart surgery practice in many parts of Africa. Future studies need to focus on identifying factors associated with this poor early mortality. [ABSTRACT FROM AUTHOR]

Aims: Heart failure is a significant disease, and its high readmission rate is a big concern. We must identify readmission risk factors and optimize outpatient management to prevent them. This study aims to investigate the readmission risk factors, including outpatient management represented by the number of outpatient visits, and to identify the factors related to frequent outpatient visits. Methods and results: We used the diagnosis‐procedure‐combination database between April 2016 and March 2022. Based on the number of outpatient visits within 60 days after discharge, we categorized patients into <1 visits/month, (1<, ≦2) visits/month, and <2 visits/month and observed the occurrence of 60 days readmission. We performed multiple logistic regression analyses to reveal the readmission risk factors and the association between the number of outpatient visits and readmission. As a subgroup analysis, we conducted the same research in the low‐ and high‐readmission risk groups. We compared medical contents between (1<, ≦2) visits/month and <2 visits/month. We analysed 101 239 patients and identified the following factors as a risk of readmission: older age (P < 0.001), female (P = 0.009), longer length‐of‐hospital‐stay (P < 0.001), artificial ventilator (P < 0.001), tolvaptan (P < 0.001), top 50% dosage of loop diuretics (P = 0.036), bottom 50% dosage of class III antiarrhythmic agents (P < 0.001), hypertension (P = 0.005), atrial fibrillation (P < 0.001), dilated cardiomyopathy (P < 0.001), valvular disease (P = 0.021), myocardial infarction (P < 0.001), diabetes (P < 0.001), and renal disease (P < 0.001). We revealed that the risk of readmission increases in <2 visits/month compared to (1<, ≦2) visits/month (P < 0.001), whereas the risk of readmission decreases in ≦1 visits/month compared with (1<, ≦2) visits/month (P < 0.001). In the subgroup analysis, we found the possibility that some risk factors are specific to the subgroup. We identified that the following factors were related to frequent outpatient visits: older age (P < 0.001), home medical care (P = 0.007), tolvaptan (P < 0.001), top 50% dosage of loop diuretics (P < 0.001), diabetes (P < 0.001), renal disease (P = 0.009), 0–2 weeks follow‐up (P < 0.001), 2–4 weeks follow‐up (P < 0.001), cardiac rehabilitation (P < 0.001), and echocardiography (P < 0.001). Conclusions: This study comprehensively identified risk factors for readmission and found outpatient visit is personalized by readmission risk. There is still room to optimize outpatient management. We suggest optimizing outpatient management according to our identified characteristics. [ABSTRACT FROM AUTHOR]

The article delves into the often-overlooked issue of tricuspid valve damage (TVD) following transvenous lead extraction (TLE) procedures, highlighting the variability in incidence rates and exploring factors influencing the worsening or improvement of tricuspid regurgitation (TR) post-procedure. It discusses the implications of TVD on patient outcomes, presenting data on the frequency of deterioration and improvement in tricuspid valve function following TLE.

This article discusses the implications of tricuspid valve regurgitation (TR) in patients with heart failure with preserved ejection fraction (HFpEF). Severe TR is associated with high risks of death and heart failure hospitalization or death. However, medical treatments for TR are limited, and surgical intervention is rarely performed. Tricuspid transcatheter edge-to-edge repair (T-TEER) has shown promise in reducing TR severity, but its effects on HFpEF are unclear. A recent study examined the physiological response to T-TEER in patients with severe TR and HFpEF, finding that T-TEER improved left ventricular filling and right ventricular-left ventricular interactions without adverse changes to end-diastolic pressures. However, there are still questions about the generalizability of these findings and the effects of T-TEER on patients without marked pericardial restraint or typical HFpEF hemodynamics. Further research is needed to understand the long-term effects of TR reduction and the potential benefits of T-TEER in patients with severe TR and HFpEF. [Extracted from the article]

This article discusses the issue of access to transcatheter aortic valve implantation (TAVI) in the Australian healthcare system. TAVI is a less invasive procedure for treating aortic stenosis, a common heart valve disease. The article highlights the challenges of rationing healthcare resources and the role of health technology assessment (HTA) in informing decision-making. It identifies structural problems in Australia's current approach to HTA that hinder equitable access to TAVI. The article suggests the need for a unified national body that can undertake HTA from both state and federal perspectives to ensure equitable access to new technologies. [Extracted from the article]