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Background: Interventricular interactions may be responsible for the decline in ventricular performance observed in various disease states that primarily affect the contralateral ventricle., Objectives: This study sought to quantify the impact of such interactions on right ventricular (RV) size and function using clinically stable individuals with left ventricular assist devices (LVADs) as a model for assessing RV hemodynamics while LV loading conditions were acutely manipulated by changing device speed during hemodynamic optimization studies (ie, ramp tests)., Methods: The investigators recorded RV pressure-volume loops with a conductance catheter at various speeds during ramp tests in 20 clinically stable HeartMate3 recipients., Results: With faster LVAD speeds and greater LV unloading, indexed RV end-diastolic volume increased (72.28 ± 15.07 mL at low speed vs 75.95 ± 16.90 at high speed; P = 0.04) whereas indexed end-systolic volumes remained neutral. This resulted in larger RV stroke volumes and shallower end-diastolic pressure-volume relationships. Concurrently, RV end-systolic pressure decreased (31.58 ± 9.75 mL at low speed vs 29.58 ± 9.41 mL at high speed; P = 0.02), but contractility, as measured by end-systolic elastance, did not change significantly. The reduction in RV end-systolic pressure was associated with a reduction in effective arterial elastance from 0.65 ± 0.43 mm Hg/mL at low speed to 0.54 ± 0.33 mm Hg/mL at high speed (P = 0.02)., Conclusions: Interventricular interactions resulted in improved RV compliance, diminished afterload, and did not reduce RV contractility. These data challenge the prevailing view that interventricular interactions compromise RV function, which has important implications for the understanding of RV-LV interactions in various disease states, including post-LVAD RV dysfunction., Competing Interests: Funding Support and Author Disclosures This project was supported, in part, by the American College of Cardiology and Merck Research Fellowship Award. Dr Brener has received consulting fees from Artract Medical and Osprey Medical. Dr Kanwar has served on the Medical Advisory Boards of Abiomed, CareDx, and CorWave. Dr Lander has served on the Medical Advisory Board of Abiomed. Dr Raina has received research support from United Therapeutics and Merck. Dr Sethi has received honoraria from Janssen and Chiessi; and has received institutional grant support from the American Heart Association’s COVID-19 Rapid Response Award. Dr Maurer has received funding from the National Institutes of Health (HL139671-01AL1 and AG K24AG036778); AD consulting income from Ionis, Alnylam, Eidos Therapeutics, Pfizer, Intellia, and Prothena; and his institution has also received funding for clinical trials for Ionis, Alnylam, Eidos Therapeutics, Pfizer, and Attralus. Dr Sayer has received consulting fees from Abbott. Dr Burkhoff has received an unrestricted institutional educational grant from Abiomed. Dr Uriel has received grant support from Abbott, Abiomed, and Fire1; and has served on the Medical Advisory Boards of Leviticus and Revamp. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Aims: Characterize the impact of residual tricuspid regurgitation (TR) on right ventricle (RV) remodeling and clinical outcomes after transcatheter tricuspid valve intervention., Methods: We performed a single-center retrospective analysis of transcatheter tricuspid valve repair (TTVr) or replacement (TTVR) patients. The primary outcomes were longitudinal tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), pulmonary artery systolic pressure (PASP), and RV dimensions (RVd). We used multivariable linear mixed models to evaluate association with replacement versus repair and degree of TR reduction with changes in these echo measures over time. Multivariable Cox regression was used to identify associations between changes in these echo measures and a composite clinical outcome of death, heart failure hospitalization, or re-do tricuspid valve intervention., Results: We included a total of 61 patients; mean age was 77.5 ± 11.7 and 62% were female. TTVR was performed in 25 (41%) and TTVr in 36 (59%). Initially, 72% (n = 44) had ≤ severe TR and 28% (n = 17) had massive or torrential TR. The median number of follow up echos was 2: time to 1st follow-up was 50 days (interquartile range [IQR]: 20, 91) and last follow-up was 147 (IQR: 90, 327). Median TR reduction was 1 (IQR: 0, 2) versus 4 (IQR: 3, 6) grades in TTVr versus TTVR (p < 0.0001). In linear mixed modeling, TTVR was associated with decline in TAPSE and PASP, and TR reduction was associated with decreased RVd. In multivariable Cox regression, greater RVd was associated with the clinical outcome (hazard ratio: 9.27, 95% confidence interval: 1.23-69.88, p = 0.03)., Conclusion: Greater TR reduction is achieved by TTVR versus TTVr, which is in turn associated with RV reverse remodeling. RV dimension in follow-up is associated with increased risk of a composite outcome of death, heart failure hospitalization, or re-do tricuspid valve intervention., (© 2023 Wiley Periodicals LLC.)

Background: Left ventricular (LV) volume reshaping reduces myocardial wall stress and may induce reverse remodeling in patients with heart failure with reduced ejection fraction. The AccuCinch Transcatheter Left Ventricular Restoration system consists of a series of anchors connected by a cable implanted along the LV base that is cinched to the basal free wall radius. We evaluated the echocardiographic and clinical outcomes following transcatheter left ventricular restoration., Methods and Results: We analyzed 51 heart failure patients with a left ventricular ejection fraction between 20% and 40%, with no more than 2+ mitral regurgitation treated with optimal medical therapy, who subsequently underwent transcatheter left ventricular restoration. Serial echocardiograms, Kansas City Cardiomyopathy Questionnaire scores, and 6-minute walk test distances were measured at baseline through 12 months. Primary analysis end point was change in end-diastolic volume at 12 months compared with baseline. Patients (n = 51) were predominantly male (86%) with a mean age of 56.3 ± 13.1 years. Fluoroscopy showed LV free wall radius decreased by a median of 9.2 mm amounting to a 29.6% decrease in the free wall arc length. At 12 months, the LV end-diastolic volume decreased by 33.6 ± 34.8 mL (P < .01), with comparable decreases in the LV end-systolic volume. These decreases were associated with significant improvements in the overall Kansas City Cardiomyopathy Questionnaire score (16.4 ± 18.7 points; P < .01) and 6-minute hall walk test distance (45.9 ± 83.9 m; P < .01). There were no periprocedural deaths; through the 1-year follow-up, 1 patient died (day 280) and 1 patient received a left ventricular assist device (day 13)., Conclusions: In patients with heart failure with reduced ejection fraction without significant mitral regurgitation receiving optimal medical therapy, the AccuCinch System resulted in decreases of LV volume, as well as improved quality of life and exercise endurance. A randomized trial is ongoing (NCT04331769)., Competing Interests: Conflicts of Interest Nadira Hamid reports Institutional grant support. Ulrich Jorde reports travel support from Ancora Heart. Mark Reisman reports travel support from Ancora Heart. Azeem Latib has nothing to declare. D. Scott Lim has nothing to declare. Susan Joseph has nothing to declare. Alena Kurlianskaya has nothing to declare. Oleg Polonetsky, MD, reports consultancy fees from Ancora Heart, and consultancy or proctoring fees from Edwards Lifesciences and Medtronic. Petr Neuzil has nothing to declare. Vivek Reddy has nothing to declare. Jason Foerst has nothing to declare. Hemal Gada has nothing to declare. Kendra J. Grubb reports advisory board and consulting fees for Medtronic, Boston Scientific, Abbott, Ancora, 4C Medical, and honorarium for Edwards Lifesciences. Guilherme Silva has nothing to declare. Dean Kereiakes has nothing to declare. Satya Shreenivas has nothing to declare. Sean Pinney reports consulting fees from Abbott, CareDx, Medtronic, Procyrion, and Transmedics. Giedrius Davidavicius is a consultant to Ancora Heart. Paul Sorajja has nothing to declare. John Boehmer has nothing to declare. Franz X. Kleber is a consultant to Ancora Heart. Patrick Perier has nothing to declare. Nicolas M. Van Mieghem reports research grant support from Abbott, Boston Scientific, Edwards Lifesciences, Medtronic, PulseCath BV, Abiomed, Siemens, and Daiichi Sankyo. Nicolas Dumonteil reports consultancy fees from Ancora Heart, is the co-PI of the CorCinch European study; and reports consultancy and proctoring fees from Abbott Vascular, Boston Scientific, Edwards Lifesciences, and Medtronic. Martin B. Leon reports institutional clinical research grants from Abbott, Abiomed, Ancora, Boston Scientific, Edwards, and Medtronic. Daniel Burkhoff reports institutional grant support from Ancora Heart to the Cardiovascular Research Foundation., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Interventricular interaction, which refers to the impact of left ventricular (LV) function on right ventricular (RV) function and vice versa, has been implicated in the pathogenesis of RV failure in LV assist device (LVAD) recipients. We sought to understand more about interventricular interaction by quantifying changes in the RV systolic and diastolic function with varying LVAD speeds., Methods and Results: Four patients (ages 22-69 years, 75% male, and 25% with ischemic cardiomyopathy) underwent a protocolized hemodynamic ramp test within 12 months of LVAD implantation where RV pressure-volume loops were recorded with a conductance catheter. The end-systolic PV relationship and end-diastolic PV relationship were compared using the V 20 and V 10 indices (volumes at which end-systolic PV relationship and end-diastolic PV relationship reach a pressure of 20 and 10 mm Hg, respectively). The ∆V 20 and ∆V 10 refer to the change in V 20 and V 10 from the minimum to maximum LVAD speeds. RV PV loops demonstrated variable changes in systolic and diastolic function with increasing LVAD speed. The end-systolic PV relationship changed in 1 patient (patient 2, ∆V 20  = 23.5 mL), reflecting a decrease in systolic function with increased speed, and was unchanged in 3 patients (average ∆V 20  = 7.4 mL). The end-diastolic PV relationship changed with increasing speed in 3 of 4 patients (average ∆V 10  = 12.5 mL), indicating an increase in ventricular compliance, and remained unchanged in one participant (patient 1; ∆V 10  = 4.0 mL)., Conclusions: Interventricular interaction can improve RV compliance and impair systolic function, but the overall effect on RV performance in this pilot investigation is heterogeneous. Further research is required to understand which patient characteristics and hemodynamic parameters influence the net impact of interventricular interaction., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Aims: Advances in diagnostic imaging have increased the recognition of coexisting transthyretin cardiac amyloidosis (ATTR-CA) and severe aortic stenosis (AS), with a reported prevalence between 8-16%. In this prospective study, we aimed to evaluate the implications of ATTR-CA on outcomes after transcatheter aortic valve replacement (TAVR)., Methods and Results: At two academic centres, we screened patients with severe AS undergoing TAVR for ATTR-CA. Using Kaplan-Meier analysis, we compared survival free from death and a combined endpoint of death and first heart failure hospitalization between patients with and without ATTR-CA. Cox proportional-hazards models were used to determine the association of ATTR-CA with these endpoints. The rate of heart failure hospitalization was compared amongst those with and without ATTR-CA. Overall, 204 patients (83 years, 65% male, Society of Thoracic Surgeons score 6.6%, 72% New York Heart Association class III/IV) were included, 27 (13%) with ATTR-CA. Over a median follow-up of 2.04 years, there was no difference in mortality (log rank, P = 0.99) or the combined endpoint (log rank, P = 0.79) between patients with and without ATTR-CA. In Cox proportional-hazards models, the presence of ATTR-CA was not associated with death. However, patients with ATTR-CA had increased rates of heart failure hospitalization at 1 year (0.372 vs. 0.114 events/person-year, P < 0.004) and 3 years (0.199 vs. 0.111 events/person-year, P = 0.087) following TAVR., Conclusion: In moderate-risk patients with severe AS undergoing TAVR, there was a 13% prevalence of ATTR-CA, which did not affect mortality. The observed increase in heart failure hospitalization following TAVR in those with ATTR-CA suggests the consequences of the underlying infiltrative myopathy., (© 2020 European Society of Cardiology.)

• Atria make both active and passive contributions throughout the cardiac cycle. • Atrial cardiomyopathy is gaining recognition in various cardiac conditions and is associated with worse prognosis. • Alterations in atrial mechanics are associated with incident heart failure and atrial fibrillation. • Atrial interventions may have adverse subclinical effects on atrial mechanics, which could ultimately result in overt clinical symptoms. • Standardized assessment of atrial mechanics following atrial interventions might allow early detection and prevention of irreversible atrial remodeling. Our comprehension of atrial mechanics, atrial cardiomyopathy and their clinical implications across various cardiovascular conditions has advanced significantly. Atrial interventions can have differing effects on atrial mechanics. With the rapid increase in the use of atrial interventions, it is crucial for investigators and clinicians to acknowledge the potential adverse effects of these interventions on atrial mechanics that might not be clinically significant at the time of interventions. Recognizing the preclinical stage of atrial maladaptation might enable early interventions before the development of irreversible atrial remodeling and clinical manifestation. We review normal atrial function and mechanics, and atrial cardiomyopathy in select cardiovascular conditions. We also summarize and discuss the current evidence of the impact of various atrial interventions on atrial function and mechanics. [Display omitted] [ABSTRACT FROM AUTHOR]

BACKGROUND Severe tricuspid regurgitation is a debilitating condition that is associated with substantial morbidity and often with poor quality of life. Decreasing tricuspid. Inregurgitation may reduce symptoms and improve clinical outcomes in patients with this disease. We conducted a prospective randomized trial of percutaneous tricuspid transcath-We conducted a prospective randomized trial of percutaneous tricuspid transcath-symptomatic severe tricuspid regurgitation were enrolled at 65 centers in the United States, Canada, and Europe and were randomly assigned in a 1:1 ratio to receive either TEER or medical therapy (control). The primary end point was a hierarchical composite that included death from any cause or tricuspid-valve surgery; hospitalization for heart failure; and an improvement in quality of life as measured with the Kansas City Cardiomyopathy Questionnaire (KCCQ), with an improvement defined as an increase of at least 15 points in the KCCQ score (range, to 100, with higher scores indicating better quality of life) at the 1-year follow-Benup. The severity of tricuspid regurgitation and safety were also assessed. RESULTS A total of 350 patients were enrolled; 175 were assigned to each group. The mean age of the patients was 78 years, and 54.9% were women. The results for the primary end point favored the TEER group (win ratio, 1.48; 95% confidence interval, 1.06 to 2.13; P=0.02). The incidence of death or tricuspid-valve surgery and the rate of hospitalization for heart failure did not appear to differ between the groups. The KCCQ quality-of-life score changed by a mean (+SD) of 12.311.8 points in the TEER group, as compared with 0.611.8 points in the control group (P<0.001). At 30 days, 8ZO°6 of the patients in the TEER group and 4.8% of those Appenin the control group had tricuspid regurgitation of no greater than moderate severity (P<0.001). TEER was found to be safe; 98.3% of the patients who underwent the procedure were free from major adverse events at 30 days. CONCLUSIONS Tricuspid TEER was safe for patients with severe tricuspid regurgitation, reduced the severity of tricuspid regurgitation, and was associated with an improvement quality of life. (Funded by Abbott; TRILUMINATE Pivotal ClinicalTrials.gov number, NCT03904147.). [ABSTRACT FROM AUTHOR]