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Background: The purpose of the study was to determine the association between vena contracta area (VCA) and secondary leaflet tethering among mitral valve prolapse (MVP) patients, and thus to further identify and characterize an MVP with pathological leaflet tethering (MVPt+) phenotype. Methods: We prospectively evaluated 94 consecutive MVP patients with significant mitral regurgitation (MR) and 21 healthy controls. MVPt+ group was defined as tenting volume index (TVi) >.7 mL/m2. The three‐dimensional (3D) geometry of mitral valve apparatus and VCA was measured with dedicated quantification software. Results: Of the 94 patients with MVP and significant MR, 31 patients showed a TVi >.7 mL/m2 and entered the MVP with leaflet tethering (MVPt+) group. In stepwise multivariate analysis, only prolapse volume index and TVi were independently associated with 3D VCA. 3D VCA, annular area index, and plasma levels of NT‐proBNP were independently correlated with the severity of leaflet tethering. ROC curve revealed that a 3D VCA ≥.55 cm2 is the optimal cutoff point to predict MVPt+ phenotype. Conclusions: Secondary leaflet tethering is a significant mechanism behind severe degenerative MR, resulting in an MVPt+ phenotype featuring more advanced morphological and hemodynamical characteristics. [ABSTRACT FROM AUTHOR]

Objective To construct a prediction model based on metabolic profiling for predicting the response to cardiac resynchronization therapy (CRT). Methods Peripheral venous (PV) and coronary sinus (CS) blood samples were collected from 25 patients with heart failure (HF) at the time of CRT implantation, and PV blood samples were obtained from ten healthy controls. The serum samples were analyzed by liquid chromatography-mass spectrometry (LC-MS). As per the clinical and echocardiographic assessment at the 6-month follow-up, the HF patients were categorized as CRT responders and non-responders. Results HF patients had altered serum metabolomic profiles that were significantly different from those of the healthy controls. Differential metabolites were also observed between CRT responders and non-responders. A prediction model for CRT response (CRT-Re) was constructed using the concentration levels of the differential metabolites, L-arginine and taurine. The optimal cutoff value of the CRT-Re model was found to be 0.343 by ROC analysis (sensitivity, 88.2%; specificity, 87.5%; Area under curve (AUC) = 0.897, P = 0.002). The concentration levels of the differential metabolites, L-arginine and lysyl-gamma-glutamate, in PV serum were significantly correlated with that in CS serum (r = 0.945 and 0.680, respectively, all P < 0.001). Conclusions Our results suggest that serum-based metabolic profiling may be a potential complementary screening tool for predicting the outcome of CRT. [ABSTRACT FROM AUTHOR]

Backgroud: Left bundle branch pacing (LBBP) is a novel physiological pacing modality. However, whether it delivers comparable efficacy with different capture sites in heart failure (HF) patients remains unclear., Objective: This study aims to assess the association between different pacing sites and the response of LBBP ., Methods: Forty-three consecutive HF patients , referred for successful LBBP implantation, were prospectively recruited in this study. Patients were assigned to 3 subgroups according to the paced QRS complex morphology (left bundle branch trunk pacing (LBTP), left posterior fascicular pacing (LPFP) or left anterior fascicular pacing (LAFP) groups). Echocardiograms, electrocardiograms were recorded and analyzed at baseline and 6-month follow-up., Results: The response rate was 95.0%, 88.2%, 83.3% in LBTP, LPFP and LAFP groups, respectively. All subgroups were efficient in narrowing QRS complex(ΔQRS: 62.4±10.4 ms, 54.7±14.2ms, 58.2±14.5ms) and improving cardiac function (ΔLVEF: 25.7±8.1%, 15.3±8.1%, 18.8±4.4%). Compared with left fascicle pacing(LFP), LBTP resulted in longer LVAT (76.5±10.2ms vs 82.3±6.5ms; P=0.037) , shorter QRSid (128.0±6.0ms vs 113.3±5.2ms; P＜0.0001),along with better improvement in septal systolic longitudinal strain(P=0.007) and lateral-septal myocardial loading inhomogeneity (P=0.036). Linear regression analysis further revealed LBB capture sites was strongly associated with the improvement of peak strain dispersion (PSD) (model R2 = 0.586, P =0.042) and LVEF (model R2 = 0.425, P <0.0001)., Conclusions: Different LBB capture sites led to subtle difference in mechanical synchrony , which may in-turn affect LVEF improvement in HF patients., (Copyright © 2024. Published by Elsevier Inc.)

Objective: To construct a prediction model based on metabolic profiling for predicting the response to cardiac resynchronization therapy (CRT)., Methods: Peripheral venous (PV) and coronary sinus (CS) blood samples were collected from 25 patients with heart failure (HF) at the time of CRT implantation, and PV blood samples were obtained from ten healthy controls. The serum samples were analyzed by liquid chromatography-mass spectrometry (LC-MS). As per the clinical and echocardiographic assessment at the 6-month follow-up, the HF patients were categorized as CRT responders and non-responders., Results: HF patients had altered serum metabolomic profiles that were significantly different from those of the healthy controls. Differential metabolites were also observed between CRT responders and non-responders. A prediction model for CRT response (CRT-Re) was constructed using the concentration levels of the differential metabolites, L-arginine and taurine. The optimal cutoff value of the CRT-Re model was found to be 0.343 by ROC analysis (sensitivity, 88.2%; specificity, 87.5%; Area under curve (AUC) = 0.897, P = 0.002). The concentration levels of the differential metabolites, L-arginine and lysyl-gamma-glutamate, in PV serum were significantly correlated with that in CS serum ( r = 0.945 and 0.680, respectively, all P < 0.001)., Conclusions: Our results suggest that serum-based metabolic profiling may be a potential complementary screening tool for predicting the outcome of CRT.