Search

Background: The timing and selection of optimal candidates for mitral transcatheter edge-to-edge valve repair remains to be fully determined, especially in cases with severely depressed left ventricular ejection fraction (LVEF). The objective of this study is to evaluate the prognostic value of myocardial strain (LVGLS) in this setting. Methods: Retrospectively, 172 consecutive patients with LVEF ≤40% and severe MR treated with MitraClip were included. Four groups were generated according to the LVEF (

Introduction and objectives The advantages of sedation in patients undergoing transesophageal echocardiography (TEE) are well established, but the increasing number of TEE studies may limit the capacity of anesthesiology services. In this study we analyze the effectiveness and safety of a moderate sedation program carried out by non-anesthesiology professionals (NAP). Methods Descriptive and prospective study that included all consecutive patients undergoing a TEE procedure under moderate sedation by NAP and by anesthesiology professionals (AP) from September 2018 to September 2019. Patients were selected according to a specific algorithm agreed upon with the Anesthesiology Department. We analyze current indications for TEE, complication rates, and recovery times associated with sedation. Results We performed 267 procedures in 252 patients (54% male, 69 years). Main indications were screening or monitoring of surgical and percutaneous cardiac interventions (47.9%), endocarditis (28.5%) and stroke (20.6%). Patients in the NAP group were younger (59 vs 71 years), less hypertensive (43% vs 61%), with less lung disease (4% vs 24%), lower risk of difficult airway (1% vs 22%) and lower comorbidity (ASA scale ≥ III 13% vs 77%). Complications were more frequent in the AP group (26% vs 9%), mainly mild respiratory (19% vs 9%). Events were associated with the presence of lung disease and higher ASA degree. Recovery time was longer in the AP sedation group (20 min vs 15 min). Conclusions TEE indications are changing and involve larger and more complex studies. Moderate sedation with propofol performed by NAP is safe in selected patients, with adequate recovery times.

BACKGROUND: Cardiac computed tomography angiography (CCTA) appears to be an appropriate imaging technique for device surveillance after left atrial appendage occlusion (LAAO). However, the available experience is limited. AIMS: The aim of this study was to determine the prevalence, mechanisms and clinical impact of left atrial appendage (LAA) patency and device-related thrombosis (DRT) following LAAO utilising a novel CCTA-based classification. METHODS: Consecutively enrolled patients who underwent LAAO with an AMPLATZER device were followed up with CCTA. Mechanisms and frequency of residual patency were evaluated and correlated with clinical events. Atrial-side device thrombus, device positioning and presence of signs of device stability were also analysed. RESULTS: A total of 137 patients were included. LAA patency was observed in 56.9% (n=78). Mechanisms and frequency of patency were: malapposition of proximal segment of the device lobe (55.1%), peri-device leak (PDL, 34.6%) and fabric permeability (5.8%). Lobe-LAA axis misalignment was the only independent predictor of device patency after LAAO (HR 38.3, 95% CI: 13.6-107.0; p

RESUMEN Introducción y objetivos: El cierre de la orejuela izquierda (COI) puede ser una alternativa de tratamiento eficaz para prevenir eventos cardiovasculares en pacientes con fibrilación auricular, en especial en aquellos con alto riesgo de sangrado. Sin embargo, algunos de estos pacientes en los que se realiza COI desarrollan trombosis relacionada con el dispositivo (TRD). Este estudio presenta las características del flujo sanguíneo que son clave en la formación de TDR, a partir de simulaciones personalizadas para cada paciente. Métodos: Para crear las simulaciones personalizadas se incluyeron en el estudio pacientes intervenidos de COI entre 2014 y 2019 en un único centro, de quienes se disponía de imágenes de tomografía computarizada previas al procedimiento y de seguimiento, así como de control ecocardiográfico. Para el COI se utilizaron los dispositivos Amulet. Las simulaciones se analizaron de forma ciega al diagnóstico de TRD. Resultados: En total se estudiaron 6 pacientes, de los que la mitad presentaban TRD según las imágenes del seguimiento clínico. Tras analizar los resultados de las simulaciones, los índices hemodinámicos asociados con TRD fueron la presencia de flujo estancado, las recirculaciones de sangre a velocidades bajas (< 0,20 m/s) cerca de la superficie del dispositivo y las regiones con alta complejidad de flujo y baja tensión de cizallamiento en la pared. Conclusiones: Las simulaciones de flujo personalizadas en pacientes con COI predijeron correctamente el diagnóstico clínico de TRD en todos los casos analizados. Los resultados obtenidos demuestran el potencial de los modelos personalizados para recomendar configuraciones óptimas del dispositivo y minimizar el riesgo de TRD.

Introduction and objectives: Left atrial appendage occlusion (LAAO) can be an efficient treatment to prevent strokes in patients who suffer from atrial fibrillation, especially those at risk of bleeding. A non-negligible number of patients treated with LAAO develop device-related thrombosis (DRT) after device implantation. Our study aimed to identify the key blood flow characteristics leading to DRT using patient-specific flow simulations. Methods: Patients treated with LAAO between 2014 and 2019 at a single center with preoperative and follow-up computerized tomography images and ultrasound imaging (US) were used to create patient-specific flow simulations. Amulet LAAO devices were implanted in the study patients. Flow simulations were blindly assessed to discard the presence of DRT in the follow-up imaging. Results: A total of 6 patients were processed in this pivotal study, half of them with DRT at the follow-up according to the imaging analysis. After a comprehensive analysis of the simulations, the most relevant in silico indices associated with DRT were the presence of stagnant blood flow, recirculation with low flow velocities (< 0.20 m/s) next to the device surface, and regions with high flow complexity combined with low wall shear stress. Conclusions: Patient-specific flow simulations of LAAO were successfully used to predict blood flow patterns with different device configurations. The results show the potential of the present modelling and simulation approach to recommend optimal settings capable of minimizing the risk of DRT. Introducción y objetivos: El cierre de la orejuela izquierda (COI) puede ser una alternativa de tratamiento eficaz para prevenir eventos cardiovasculares en pacientes con fibrilación auricular, en especial en aquellos con alto riesgo de sangrado. Sin embargo, algunos de estos pacientes en los que se realiza COI desarrollan trombosis relacionada con el dispositivo (TRD). Este estudio presenta las características del flujo sanguíneo que son clave en la formación de TDR, a partir de simulaciones personalizadas para cada paciente. Métodos: Para crear las simulaciones personalizadas se incluyeron en el estudio pacientes intervenidos de COI entre 2014 y 2019 en un único centro, de quienes se disponía de imágenes de tomografía computarizada previas al procedimiento y de seguimiento, así como de control ecocardiográfico. Para el COI se utilizaron los dispositivos Amulet. Las simulaciones se analizaron de forma ciega al diagnóstico de TRD. Resultados: En total se estudiaron 6 pacientes, de los que la mitad presentaban TRD según las imágenes del seguimiento clínico. Tras analizar los resultados de las simulaciones, los índices hemodinámicos asociados con TRD fueron la presencia de flujo estancado, las recirculaciones de sangre a velocidades bajas (< 0,20 m/s) cerca de la superficie del dispositivo y las regiones con alta complejidad de flujo y baja tensión de cizallamiento en la pared. Conclusiones: Las simulaciones de flujo personalizadas en pacientes con COI predijeron correctamente el diagnóstico clínico de TRD en todos los casos analizados. Los resultados obtenidos demuestran el potencial de los modelos personalizados para recomendar configuraciones óptimas del dispositivo y minimizar el riesgo de TRD. This work was supported by the Spanish Ministry of Science, Innovation and Universities under the Retos I+D (RTI2018-101193-B-I00), the Maria de Maeztu Units of Excellence (MDM-2015-0502), the Formation of Doctors (PRE2018-084062) and the Recruitment of Talents (RYC-2015-18888) programmes.

Resumen Introduccion y objetivos Algunos estudios indican que los parametros de strain por speckle-tracking pueden ser una alternativa no invasiva a la biopsia endomiocardica para excluir el rechazo celular agudo (RCA) moderado o grave (≥ 2 R) tras el trasplante cardiaco (TxC). En una cohorte inicial, unos puntos de corte del 15,5% para el strain longitudinal global del ventriculo izquierdo (SLGVI) y el 17% para el strain de pared libre del ventriculo derecho mostraron un valor predictivo negativo del 100% para excluir RCA ≥ 2 R. Nuestro objetivo es analizar la utilidad del strain y validar estos puntos de corte en una cohorte multicentrica prospectiva externa. Metodos Estudio multicentrico y prospectivo que incluyo a pacientes con seguimiento el primer ano tras el TC. Se compararon los resultados de biopsias electivas con ecocardiogramas realizados el mismo dia. Resultados Se incluyo a 99 pacientes y 501 pares de biopsias-ecocardiogramas. El RCA ≥ 2 R en las biopsias fue del 7,4%. El SLGVI y el strain longitudinal de pared libre del ventriculo derecho fueron menores durante los RCA ≥ 2 R en el analisis univariante. En el analisis multivariante, el SLGVI se asocio de manera independiente con el RCA ≥ 2 R. Los puntos de corte originales mostraron un valor predictivo negativo del 94,3% el RCA ≥ 2 R. Conclusiones Este estudio mantiene un alto valor predictivo negativo para excluir RCA ≥ 2 R tras el TxC y el SLGVI se asocio de manera independiente con el RCA ≥ 2 R. El strain y, principalmente, el SLGVI pueden ser de utilidad en el diagnostico y el tratamiento no invasivo del RCA.

Background: Left atrial appendage occlusion (LAAO) is an accepted strategy for cardioembolic events prevention in patients with non-valvular atrial fibrillation (AF) unsuitable for anticoagulation. However, uncertainties persist regarding the benefit of LAAO in highly-comorbid patients. The aim of this study was to assess the impact of the CHA(2)DS(2)-VASc score beyond thromboembolic risk in predicting clinical outcomes in patients undergoing LAAO. Methods: 160 patients who underwent LAAO were included and categorized into two groups according to their stroke risk (89 with CHA(2)DS(2)-VASc >4 vs. 71 with lower risk). The coprimary endpoints were death and stroke at follow-up. Thromboembolic and bleeding events were compared to those predicted from CHA(2)DS(2)-VASc and HAS-BLED scores. Results: Over a median follow-up of 679 days, CHA(2)DS(2)-VASc >4 was associated with increased all-cause mortality compared with patients with lower thromboembolic risk (HR: 3.23; 95% CI: 1.28-8.19; p < 0.001). However, the rates of stroke after LAAO were not significantly different between risk groups. The observed annual rates of stroke and major bleeding were lower than predicted. Conclusions: Despite increased long-term mortality in patients with CHA(2)DS(2)-VASc >4, LAAO remains beneficial in reducing stroke and bleeding events in high-risk AF patients unsuitable for anticoagulation. (C) 2020 Elsevier B.V. All rights reserved.

Resumen Introduccion y objetivos La reparacion de la valvula mitral transcateter (RVMT) con el sistema MitraClip es un tratamiento para los pacientes con insuficiencia mitral (IM) grave de alto riesgo quirurgico. El objetivo principal fue analizar los resultados del RVMT en pacientes con IM grave, segun la etiologia. Metodos Estudio observacional, prospectivo y multicentrico con inclusion de pacientes consecutivos. El objetivo primario fue el combinado de mortalidad por todas las causas y reingresos hospitalarios por insuficiencia cardiaca al ano. Se compararon las caracteristicas clinicas y del procedimiento y los eventos para cada grupo de IM. Se realizo un analisis multivariable para determinar las variables asociadas con el objetivo primario. Resultados Se incluyo a 558 pacientes; 364 (65,2%) tenian etiologia funcional; 111 (19,9%), degenerativa, y 83 (14,9%), mixta. La media de edad fue 72,8 ± 11,1 anos y eran varones el 70,3%. Respecto al objetivo primario, hubo 95 (17%) eventos en toda la serie. No hubo diferencias significativas entre los 3 grupos en el numero de eventos del objetivo primario: 11 (11,3%) en la IM degenerativa, 71 (21,3%) en la funcional y 13 (18,1%) en la mixta (p = 0,101). Los predictores independientes fueron la clase funcional (p = 0,029), la revascularizacion quirurgica previa (p = 0,031), el EuroSCORE II (p = 0,003), la diabetes mellitus (p = 0,037) y la fraccion de eyeccion del ventriculo izquierdo (p = 0,015). Conclusiones Este trabajo confirma con datos de la practica clinica la seguridad y la eficacia de la RVMT independientemente de la etiologia de la IM y se documentan los principales factores asociados con el pronostico durante el primer ano de seguimiento.

Resumen La imagen cardiovascular es uno de los grandes pilares en el diagnostico y el seguimiento de la cardiologia moderna. Los diferentes avances tecnicos ofrecen una mejora en este proceso, aunque con una exactitud y una eficacia dependientes de multiples factores, incluidos la disponibilidad y la experiencia acumulada. Resulta dificil seleccionar «lo mejor del 2019» por la cantidad de publicaciones donde participa la imagen cardiovascular. Hemos realizado un pequeno muestreo de articulos destacados en las diferentes tecnicas diagnosticas (ecocardiografia, resonancia cardiaca, tomografia computarizada y cardiologia nuclear) con un foco especial en tres campos de mayor interes actual: la inteligencia artificial, la cardio-onco-hematologia y el campo del intervencionismo en patologia estructural.

Sr. Editor: Se presenta el caso de una mujer de 63 años con hipertensión arterial, obesidad mórbida (122 kg, índice de masa corporal de 44) y edemas crónicos en los miembros inferiores, con infecciones cutáneas de repetición por microorganismos multirresistentes. Presentaba una regurgitación mitral degenerativa importante, con hipertensión pulmonar moderada y disnea, en clase funcional III. A pesar de tener un riesgo quirúrgico bajo, con una puntuación de la Society of Thoracic Surgeons del 1,5% y EuroSCORE II del 1,29%, fue rechazada para cirugía mitral por su obesidad y por el riesgo infeccioso perioperatorio. Se discutió el caso por el equipo multidisciplinario y se decidió realizar tratamiento percutáneo de la insuficiencia mitral, con menor riesgo global. Se obtuvo el consentimiento informado de la paciente para la publicación de los ...

Background: Isolated atrial fibrillation can cause mitral regurgitation (MR) in patients with normal left ventricular systolic function and no organic disease of the mitral valve. Little information is available regarding outcomes of Mitraclip in patients with atrial functional mitral regurgitation (AFMR). We aimed to evaluate 12-month clinical and echocardiographic outcomes of transcatheter mitral valve repair (TMVR) with MitraClip in patients with AFMR compared to those with ventricular functional or degenerative/mixed MR. Methods: Registry-based analysis of all consecutive patients who underwent TMVR and were included in the Spanish Registry of Mitraclip. Changes in MR and NYHA functional class, and a combined endpoint including all-cause mortality and hospitalizations due to heart failure were the main outcomes. Results: Overall, 1074 (69.1% male, 73.3 +/- 10.2 years-old) patients were analyzed in this report. 48 patients (4.5%) presented AFMR. AFMR was significantly reduced after TMVR, with a procedural success rate of 91.7%, and this reduction persisted at 12-month (p < 0.001). Patients with AFMR showed a significant functional improvement at 6- and 12-month follow-up in our series (baseline: NYHA III 70.8% IV 18.8% vs. 1-year: NYHA III 21.7% IV 0%; p < 0.001). The probability of survival free of readmission for heart failure and all-cause mortality within the first year after TMVR was 74.9%. Procedural and clinical outcomes, as well as recurrent rates of MR were similar acutely and at 1-year compared to other etiologies. Conclusion: TMVR in patients with AFMR showed no significant differences compared to ventricular functional or degenerative/mixed MR regarding MR reduction or clinical outcomes.

Producción Científica, Background: Transcatheter mitral valve repair (TMVR) is an effective therapy for high-risk patients with severe mitral regurgitation (MR) but heart failure (HF) readmissions and death remain substantial on mid-term follow-up. Recently, right ventricular (RV) to pulmonary arterial (PA) coupling has emerged as a relevant prognostic predictor in HF. In this study, we aimed to assess the prognostic value of tricuspid annular plane systolic excursion (TAPSE) to PA systolic pressure (PASP) ratio as a non-invasive measure of RV-to-PA coupling in patients undergoing TMVR with MitraClip (Abbott, CA, USA). Methods: Multicentre registry including 228 consecutive patients that underwent successful TMVR with MitraClip. The sample was divided in two groups according to TAPSE/PASP median value: 0.35. The primary combined endpoint encompassed HF readmissions and all-cause mortality. Results: Mean age was 72.5 ± 11.5 years and 154 (67.5%) patients were male. HF readmissions and all-cause mortality were more frequent in patients with TAPSE/PASP ≤ 0.35: Log-Rank 8.844, p = 0.003. On Cox regression, TAPSE/PASP emerged as a prognostic predictor of the primary combined endpoint, together with STS-Score. TAPSE/PASP was a better prognostic predictor than either TAPSE or PASP separately. Conclusions: TAPSE/PASP ratio appears as a novel prognostic predictor in patients undergoing MitraClip implantation that might improve risk stratification and candidate selection.

Background and aim: Recent randomized data comparing percutaneous mitral valve repair (PMVR) versus optimal medical treatment in patients with functional MR (FMR) seemed to highlight the importance of the learning curve not only for procedural outcomes but also for patient selection. The aim of the study was to compare a contemporary series of patients undergoing PMVR using a second-generation Mitraclip device (Mitraclip NT) with previous cohorts treated with a first-generation system. Methods: This multicenter study collected individual data from 18 centers between 2012 and 2017. The cohort was divided into three groups according to the use of the first-generation Mitraclip during the first (control-1) or second half (control-2) or the Mitraclip NT system. Results: A total of 545 consecutive patients were included in the study. Among all, 182 (33.3%), 183 (33.3%), and 180 (33.3%) patients underwent mitral repair in the control-1, control-2, and NT cohorts, respectively. Procedural success was achieved in 93.3% of patients without differences between groups. Major adverse events did not statistically differ among groups, but there was a higher rate of pericardial effusion in the control-1 group (4.3%, 0.6%, and 2.6%, respectively, p = 0.025). The composite endpoint of death, surgery, and admission for congestive heart failure (CHF) at 12 months was lower in the NT group (23.5% in control-1, 22.5% in control-2, and 8.3% in the NT group, p = 0.032). Conclusions: The present paper shows that contemporary clinical outcomes of patients undergoing PMVR with the Mitraclip system have improved over time.

Introduction and objectives The advantages of sedation in patients undergoing transesophageal echocardiography (TEE) are well established, but the increasing number of TEE studies may limit the capacity of Anesthesiology services. In this study we analyze the effectiveness and safety of a moderate sedation program carried out by non-anesthesiologist professionals (NAP). Methods Descriptive and prospective study that included all consecutive patients undergoing a TEE procedure under moderate sedation by NAP and by anesthesiologists (AP) from September 2018 to September 2019. Patients were selected according to a specific algorithm agreed upon with the Anesthesiology department. We analyze current indications for TEE, complication rates, and recovery times associated with sedation. Results We performed 267 procedures in 252 patients (54% male, 69yo). Main indications were screening or monitoring of surgical and percutaneous cardiac interventions (47.9%), endocarditis (28.5%) and stroke (20.6%). Patients in the NAP group were younger (59 vs 71 yo), less hypertensive (43% vs 61%), with less lung disease (4% vs 24%), lower risk of difficult airway (1% vs 22%) and lower comorbidity (ASA scale ≥III 13% vs 77%). Complications were more frequent in the AP group (26% vs 9%), mainly mild respiratory (19% vs 9%). Multivariate adjustment showed events were associated with the presence of lung disease and higher ASA degree. Recovery time was longer in the AP sedation group (20min vs 15min). Conclusions TEE indications are changing and involve larger and more complex studies. Moderate sedation with propofol performed by NAP is safe in selected patients, with adequate recovery times.

Tricuspid regurgitation is a highly prevalent condition, with detrimental effects on long-term survival. However, it has been historically neglected, and only surgically addressed when symptomatic diuretic agents proved insufficient to alleviate congestion. Besides, mortality rates of isolated tricuspid regurgitation surgery have been persistently high, even in contemporary series. This has led to the advent of a myriad of transcatheter tricuspid valve interventions mimicking current surgical technologies, for which a comprehensive imaging work-up holds the key for proper patient selection and intraprocedural monitoring. Although initially designed for compassionate use patients, growing experience and encouraging results of these less-invasive technologies are broadening the spectrum of beneficiaries. In this review, we will focus on the current picture of transcatheter tricuspid valve interventions, with special interest on the current understanding of pathoanatomic tricuspid regurgitation progression, preprocedural multimodality imaging and the latest experience on the different transcatheter devices.

Background: Transcatheter mitral valve repair (TMVR) could improve survival in functional mitral regurgitation (FMR), but it is necessary to consider the influence of left ventricular ejection fraction (LVEF). Therefore, we compare the outcomes after TMVR with Mitraclip&reg, between two groups according to LVEF. Methods: In an observational registry study, we compared the outcomes in patients with FMR who underwent TMVR with and without LVEF &lt, 30%. The primary endpoint was the combined one-year all-cause mortality and unplanned hospital readmissions due to HF. The secondary end-points were New York Heart Association (NYHA) functional class and mitral regurgitation (MR) severity. Propensity-score matching was used to create two groups with the same baseline characteristics, except for baseline LVEF. Results: Among 535 FMR eligible patients, 144 patients with LVEF &lt, 30% (group 1) and 144 with LVEF &gt, 30% (group 2) had similar propensity scores and were included in the analyses. The primary study endpoint was significantlly higher in group 1 (33.3% vs. 9.4%, p = 0.002). There was a maintained improvement in secondary endpoints without significant differences among groups. Conclusion: FMR patients with LVEF &lt, 30% treated with MitraClip&reg, had higher mortality and readmissions than patients with LVEF &ge, 30% treated with the same device. However, both groups improved the NYHA functional class and MR severity.

BACKGROUND In catheter-based procedures, acute kidney injury (AKI) is a frequent, serious complication ranging from 10% to 30%. In MitraClip (Abbott Vascular, Santa Clara, California), a usually contrast-free procedure, there is scarce data about its real incidence and impact. OBJECTIVES This study aimed to evaluate incidence, predictive factors, and midterm outcomes of AKI in patients with significant mitral regurgitation (MR) undergoing transcatheter valve repair with MitraClip. METHODS A total of 721 patients undergoing MitraClip were included. AKI was defined as an absolute or a relative increase in serum creatinine of >0.3 mg/dl or >= 50%, respectively, or the need for hemodialysis during index hospitalization. RESULTS The mean age of the patients was 72 +/- 11 years (28.3% women). Median estimated glomerular filtration rate (eGFR) was 43.7 ml/min/1.73 m(2) (interquartile range: 30.9 to 60.1 ml/min/1.73 m(2)), and was

Introduction and objectives: Transcatheter mitral valve repair (TMVR) with MitraClip is a therapeutic option for high surgical risk patients with severe mitral regurgitation (MR). The main objective of this study was to analyze differences in outcomes in patients with severe MR according to the cause of MR. Methods: Observational, multicenter, and prospective study with consecutive patient inclusion. The primary endpoint was the combination of all-cause mortality and new readmissions due to heart failure after 1 year. We compared clinical and procedural characteristics and the event rate for each MR group. We performed a multivariate analysis to identify predictive variables for the primary endpoint. Results: A total of 558 patients were included: 364 (65.2%) with functional etiology, 111 (19.9%) degenerative and 83 (14.9%) mixed. The mean age was 72.8 +/- 11.1 years and 70.3% of the sample were men. There were 95 (17%) events in the overall sample. No significant differences were found in the 3 groups in the number of primary outcome events: 11 (11.3%) in degenerative MR, 71 (21.3%) in functional MR, and 13 (18.1%) in mixed MR (P=.101). Independent predictors were functional class (P=.029), previous surgical revascularization (P=.031), EuroSCORE II (P=.003), diabetes mellitus (P=.037), and left ventricular ejection fraction (P=.015). Conclusions: This study confirms the safety and efficacy of TMVR with MitraClip irrespective of MR etiology in real-life data and shows the main factors related to prognosis during the first year of follow up. (C) 2019 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.

Multicenter study [Abstract] Introduction and objectives: Two-dimensional speckle-tracking echocardiography has emerged as a promising alternative to endomyocardial biopsy to rule out acute cellular rejection after orthotopic heart transplantation (OHT) in single center studies. In an original cohort, 15.5% and 17% of cutoff points for left ventricular global longitudinal strain (LVGLS) and free-wall right ventricular longitudinal strain, respectively, achieved 100% negative predictive value to exclude moderate or severe acute cellular rejection (ACR ≥ 2R). Our objective was to demonstrate the usefulness of speckle-tracking and validate these cutoff points in an external cohort. Methods: A prospective, multicenter study that included patients who were monitored during their first year after OHT was conducted. Echocardiographic studies analyzed by local investigators were compared with simultaneous paired endomyocardial biopsies samples. Results: A total of 501 endomyocardial biopsy-echocardiographic studies were included in 99 patients. ACR≥2R was present in 7.4% of samples. LVGLS and free-wall right ventricular longitudinal strain were significantly reduced during ACR≥2R on univariate analysis. On multivariate analysis, LVGLS was independently associated with the presence of ACR≥2R. The original cutoff points demonstrated a negative predictive value of 94.3% to exclude ACR≥2R. Conclusions: This study maintained a strong negative predictive value to exclude ACR≥2R after OHT and LVGLS was independently associated with the presence of ACR≥2R. We propose the use of speckle-tracking, especially LVGLS, as part of the noninvasive diagnosis and management of ACR. [Resumen] Introducción y objetivos. Algunos estudios indican que los parámetros de strain por speckle-tracking pueden ser una alternativa no invasiva a la biopsia endomiocárdica para excluir el rechazo celular agudo (RCA) moderado o grave (≥ 2 R) tras el trasplante cardiaco (TxC). En una cohorte inicial, unos puntos de corte del 15,5% para el strain longitudinal global del ventrículo izquierdo (SLGVI) y el 17% para el strain de pared libre del ventrículo derecho mostraron un valor predictivo negativo del 100% para excluir RCA ≥ 2 R. Nuestro objetivo es analizar la utilidad del strain y validar estos puntos de corte en una cohorte multicéntrica prospectiva externa. Métodos. Estudio multicéntrico y prospectivo que incluyó a pacientes con seguimiento el primer año tras el TC. Se compararon los resultados de biopsias electivas con ecocardiogramas realizados el mismo día. Resultados. Se incluyó a 99 pacientes y 501 pares de biopsias-ecocardiogramas. El RCA ≥ 2 R en las biopsias fue del 7,4%. El SLGVI y el strain longitudinal de pared libre del ventrículo derecho fueron menores durante los RCA ≥ 2 R en el análisis univariante. En el análisis multivariante, el SLGVI se asoció de manera independiente con el RCA ≥ 2 R. Los puntos de corte originales mostraron un valor predictivo negativo del 94,3% el RCA ≥ 2 R. Conclusiones. Este estudio mantiene un alto valor predictivo negativo para excluir RCA ≥ 2 R tras el TxC y el SLGVI se asoció de manera independiente con el RCA ≥ 2 R. El strain y, principalmente, el SLGVI pueden ser de utilidad en el diagnóstico y el tratamiento no invasivo del RCA.

Resumen La insuficiencia mitral es la valvulopatia mas prevalente en Estados Unidos y la segunda en Europa. Una vez se establecen los sintomas o produce una repercusion significativa en la funcion cardiaca, la insuficiencia mitral grave tiene un pronostico adverso con tratamiento medico. A pesar de ello, no se opera hasta la mitad de los pacientes con insuficiencia mitral grave sintomatica por edad avanzada, disfuncion ventricular y otras comorbilidades. Se ha demostrado que la cirugia obtiene mayor supervivencia a las insuficiencias mitrales organicas por prolapso, pero no se ha podido demostrar un beneficio clinico de intervenir insuficiencias mitrales funcionales. En este escenario, la reparacion percutanea de la insuficiencia mitral nativa permite intervenir la valvulopatia en pacientes con alto riesgo quirurgico. La reparacion percutanea de la insuficiencia mitral es un campo en expansion con gran dependencia de las tecnicas de imagen tanto para el diagnostico de la anatomia funcional que reparar como para guiar el procedimiento.