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Background Transient ST-segment elevation or coronary artery spasm during transseptal catheterization has been previously described. Most cases were either reversible or asymptomatic. Case summary We present a case of severe multiple coronary artery spasms with advanced atrioventricular block and ventricular fibrillation during compression of the fossa ovalis by a sheath catheter, before the performance of the transseptal puncture procedure for mitral transcatheter edge-to-edge-repair. Discussion The mechanical effects of forward tension from transseptal puncture on the interatrial vagal network could be the most possible explanation for the occurrence of this phenomenon.

Objective Emerging evidence suggests that systemic inflammation is a predictor of poor prognosis in acute myocardial infarction (AMI). In this study, we sought to assess whether inflammation-based prognostic scores are associated with in-hospital outcomes in elderly patients with AMI. Methods In this retrospective study, patients who were over 75-years-old and met the diagnostic criteria for AMI were consecutively recruited from January 1, 2016, to March 31, 2019. Logistic regression and receiver-operating characteristic (ROC) analyses were performed to evaluate the predictive value of the inflammation-based Glasgow Prognostic Score (GPS), Prognostic Index (PI) and Prognostic Nutritional Index (PNI). Results A total of 273 patients were enrolled. The incidence of major cardiovascular adverse events (MACEs) and mortality during hospitalization increased significantly with increasing GPS and PI scores. Multiple logistic regression showed that the GPS was independently associated with MACEs (score 1, RR: 6.711, 95% CI: 1.409-31.968; score 2, RR: 14.063, 95% CI: 3.018-65.535) and mortality (score 1, RR: 8.656, 95% CI: 1.068-70.126; score 2, RR: 10.549, 95% CI: 1.317-84.465). The PI was also independently predictive of MACEs (score 2, RR: 5.132, 95% CI: 1.451-18.148). No significant difference was observed in the PNI between patients with different in-hospital outcomes. When in-hospital MACEs were used as an endpoint, the area under the curve (AUC) of the GPS was 0.740 (95% CI 0.678-0.802), and the AUC of the PI was 0.703 (95% CI 0.634-0.773). When mortality was used as an endpoint, the AUC of the GPS was 0.677 (95% CI 0.602-0.753), and the AUC of the PI was 0.667 (95% CI 0.577-0.757). Conclusion The severity of systemic inflammation is a strong predictor of poor prognosis in elderly patients with AMI. Among these three inflammation-based prognostic scores, the GPS has a better predictive value than the PI and PNI for in-hospital MACEs and mortality.

Background: The consequence of valve malposition (VM) during transcatheter aortic valve replacement (TAVR) can be severe, but the determinants of VM with self-expandable TAVR have not been thoroughly evaluated. We aimed to investigate the anatomical predictors of VM during self-expandable TAVR.Methods: In this multicenter retrospective study, TAVR was performed using the Venus A-Valve. The baseline, computed tomography, and procedural characteristics along with clinical outcomes were collected. Multivariate logistic regression model and receiver operating characteristic (ROC) curve analyses were performed.Results: A total of 84 consecutive patients (23 with VM) were included. Stepwise regression showed that annulus perimeter/left ventricular outflow tract perimeter (AL ratio) and sinotubular junction (STJ) height were predictors of VM. The ROC curve indicated a moderate strength of AL ratio [area under the curve (AUC) 0.71, cutoff 0.96] and a weak strength of STJ height (AUC 0.69, cutoff 23.8 mm) to predict VM. The combination of both predictors revealed a higher predictive value of VM (AUC 0.77). In multivariate analysis, AL ratio p = 0.015] and STJ height ≥23.8 mm (OR 4.63, p = 0.008) were strong independent predictors of VM. The presence of both predictors was associated with a very high risk of VM (OR 10.67, p = 0.002). The rate of moderate-to-severe paravalvular regurgitation was higher in patients with VM at 30 days (26.1 vs. 4.9%, p = 0.011).Conclusions: A conical left ventricular outflow tract and tall aortic sinuses were strong anatomical predictors of VM during self-expandable TAVR.

Background Clinical impact of the minimally invasive surgical mitral valve annuloplasty (MVA) of functional mitral regurgitation (FMR) in systolic heart failure on top of the state-of-the-art standards of care remains controversial. Therefore, we aimed to compare clinical outcomes of isolated MVA using the mini-invasive videothoracoscopic approach versus the state-of-the-art (CON = conservative) treatment in patients with chronic systolic heart failure and symptomatic FMR. Methods The study population consisted of 379 patients (age 68.9 ± 11.0 years, 62.8% males) with left ventricular (LV) systolic dysfunction, symptomatic FMR and previous heart failure hospitalization. A total of 167 patients underwent undersized MVA and 212 patients were treated conservatively. A concomitant MAZE was performed in 53 (31.7%) patients. Results In the MVA group, the periprocedural and the 30-day mortality were 1.2% and 4.8%, respectively. During the median follow-up of 7.1 years (IQR 3.5–9.8 years) a total of 74 (44.3%) and 138 (65.1%) died in the MVA and the CON group, respectively (p

Objective Emerging evidence suggests that systemic inflammation is a predictor of poor prognosis in acute myocardial infarction (AMI). In this study, we sought to assess whether inflammation-based prognostic scores are associated with in-hospital outcomes in elderly patients with AMI. Methods In this retrospective study, patients who were over 75-years-old and met the diagnostic criteria for AMI were consecutively recruited from January 1, 2016, to March 31, 2019. Logistic regression and receiver-operating characteristic (ROC) analyses were performed to evaluate the predictive value of the inflammation-based Glasgow Prognostic Score (GPS), Prognostic Index (PI) and Prognostic Nutritional Index (PNI). Results A total of 273 patients were enrolled. The incidence of major cardiovascular adverse events (MACEs) and mortality during hospitalization increased significantly with increasing GPS and PI scores. Multiple logistic regression showed that the GPS was independently associated with MACEs (score 1, RR: 6.711, 95% CI: 1.409–31.968; score 2, RR: 14.063, 95% CI: 3.018–65.535) and mortality (score 1, RR: 8.656, 95% CI: 1.068–70.126; score 2, RR: 10.549, 95% CI: 1.317–84.465). The PI was also independently predictive of MACEs (score 2, RR: 5.132, 95% CI: 1.451–18.148). No significant difference was observed in the PNI between patients with different in-hospital outcomes. When in-hospital MACEs were used as an endpoint, the area under the curve (AUC) of the GPS was 0.740 (95% CI 0.678–0.802), and the AUC of the PI was 0.703 (95% CI 0.634–0.773). When mortality was used as an endpoint, the AUC of the GPS was 0.677 (95% CI 0.602–0.753), and the AUC of the PI was 0.667 (95% CI 0.577–0.757). Conclusion The severity of systemic inflammation is a strong predictor of poor prognosis in elderly patients with AMI. Among these three inflammation-based prognostic scores, the GPS has a better predictive value than the PI and PNI for in-hospital MACEs and mortality.

The aim of this study is to evaluate the relationship of miR155 with office and ambulatory blood pressure (BP) parameters and left ventricular hypertrophy (LVH) in patients with hypertension and healthy controls.We assessed the expression level of the miR155 in 50 patients with essential hypertension and 30 healthy individuals. All patients underwent two-dimensional echocardiography, office BP monitoring and ambulatory blood pressure monitoring (ABPM). Quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) was used to evaluate the expression of selected miR155. The miR155 correlations between BP parameters and left ventricular mass index (LVMI) were assessed using the Spearman correlation coefficient.We observed higher expression level of miR155 (33.22 ± 2.59 vs. 27.30 ± 1.76; p0.001) in hypertensive patients compared with healthy control individuals, as well as in LVH to nLVH group (33.00 ± 2.78 vs. 27.28 ± 1.76; p0.001). MiR155 expression level showed significant positive correlations with office measurement of systolic blood pressure (SBP) (r = 0.634, p0.001), diastolic blood pressure (DBP) (r = 0.222, p0.05), pulse pressure (PP) (r = 0.564, p0.001), respectively. And explored miR155 expression level in relation to 24-h ABPM parameters showed significant positive correlation with 24 h mean SBP (r = 0.67, p0.001), 24 h mean DBP (r = 0.257, p0.05), 24 h mean PP (r = 0.597, p0.001), respectively, as well as with LVMI (r = 0.591, p0.001).Circulating miR155 may possibly represent potential non-invasive marker of hypertension and target organ damage (TOD) in essential hypertensive patients.

OBJECTIVES The aim of this study was to compare the volumetric response and the long- term survival after cardiac resynchronization therapy (CRT) in patients with intrinsic left bundle branch block (LBBB) versus chronic right ventricular pacing (RVP) with respect to the presence of mechanical dyssynchrony (MD). BACKGROUND Chronic RVP induces an iatrogenic LBBB and asynchronous left ventricular contraction that is potentially reversible by upgrading to CRT. METHODS A total of 914 patients eligible for CRT (117 with conventional pacemakers and 797 with intrinsic LBBB) were included in the study. MD was visually assessed before CRT and was defined as the presence of either apical rocking and/or septal flash on baseline echocardiograms. Patients with a left ventricular end-systolic volume decrease of >= 15% during the follow-up were considered responders. Patients were followed for all-cause mortality during the median follow-up of 48 months (interquartile range: 29 to 66 months). RESULTS MDwas observed in 51% of patientswithRVP versus 77% in patients with intrinsic LBBB( p< 0.001). Patients with RVP and MD had a similar likelihood of volumetric response as did patients with intrinsic LBBB and MD (adjusted odds ratio: 0.71; 95% confidence interval: 0.33 to 1.53; p - 0.385). There was no significant difference in long-term survival between patients with RVP and intrinsic LBBB (adjusted hazard ratio: 1.101; 95% confidence interval: 0.658 to 1.842; p = 0.714). Patients with visual MD and either intrinsic LBBB or RVP had a more favorable survival than those without MD (p < 0.001). CONCLUSIONS The likelihood of volumetric response and a favorable long-term survival of patients with RVP was similar to those of patients with intrinsic LBBB and were mainly determined by the presence of MD and not by the nature of LBBB. (C) 2017 by the American College of Cardiology Foundation.

To investigate whether and in which patients with catheter-derived low pressure gradient (PG, < 40 mmHg) severe (aortic valve area a parts per thousand 1 cm(2)) aortic stenosis and preserved left ventricular ejection fraction, early aortic valve replacement (AVR) might improve survival. We investigated a total of 506 consecutive patients (age 75 +/- 9 years, 58% men) with either moderate aortic stenosis (MAS) or severe aortic stenosis (SAS) and preserved left ventricular ejection fraction (a parts per thousand50%) as defined at catheterization. Propensity score matching was used to select matched pairs of patients with and without AVR in each group. A 100% complete follow-up of all cause death was obtained after a median of 6.6 years (interquartile range 3.4-8.8 years). There were 62 (12%) patients with MAS, 119 (24%) patients with SAS and low (< 40 mmHg) PG and 325 (64%) patients with SAS and high PG. Significantly less patients with MAS and low-gradient SAS underwent AVR compared to patients with high gradient SAS (58% vs 60% vs 83%, P < 0.001). In propensity score-matched patients, AVR was independently associated with a decrease in all-cause mortality in all groups (P < 0.05) regardless of the PG, stroke volume or aortic valve area. The present data indicate a that AVR improves survival in SAS regardless of the gradient and flow. This advocates an 'early-AVR' rather than a 'watchful waiting' strategy.

Background— During thermodilution-based assessment of volumetric coronary blood flow, we observed that intracoronary infusion of saline increased coronary flow. This study aims to quantify the extent and unravel the mechanisms of saline-induced hyperemia. Methods and Results— Thirty-three patients were studied; in 24 patients, intracoronary Doppler flow velocity measurements were performed at rest, after intracoronary adenosine, and during increasing infusion rates of saline at room temperature through a dedicated catheter with 4 lateral side holes. In 9 patients, global longitudinal strain and flow propagation velocity were assessed by transthoracic echocardiography during a prolonged intracoronary saline infusion. Taking adenosine-induced maximal hyperemia as reference, intracoronary infusion of saline at rates of 5, 10, 15, and 20 mL/min induced 6%, 46%, 111%, and 112% of maximal hyperemia, respectively. There was a close agreement of maximal saline- and adenosine-induced coronary flow reserve (intraclass correlation coefficient, 0.922; P P =0.021). Conclusions— Intracoronary infusion of saline at room temperature through a dedicated catheter for coronary thermodilution induces steady-state maximal hyperemia at a flow rate ≥15 mL/min. These findings open new possibilities to measure maximal absolute coronary blood flow and minimal microcirculatory resistance.

OBJECTIVES To compare the outcomes of MitraClip versus minimally invasive surgical mitral valve repair in high-risk patients with significant functional mitral regurgitation (FMR) and severe heart failure in a centre having pilot versus extensive experience with the MitraClip and the minimally invasive surgical approach, respectively. METHODS The MitraClip group consisted of 24 high-surgical-risk patients [age 75 ± 9 years, 75% males, NYHA III/IV 88%, left ventricular (LV) ejection fraction 31 ± 9%, EuroSCORE II 18 ± 14%], while the surgical group consisted of 48 patients matched for age, NYHA class and LV ejection fraction. RESULTS Patients undergoing MitraClip versus those undergoing surgical repair showed higher prevalence of ischaemic LV dysfunction and larger LV end-diastolic diameter (both P < 0.05). Both the MitraClip and the surgical repair groups had similar 30-day mortality rates (4 vs 13%, P = 0.41) and prevalence of serious adverse events (25 vs 38%, P = 0.43). The median follow-up was 1028 days (IQR: 272-1564 days) in the MitraClip group and 890 days (IQR: 436-1381 days) in the surgical group (P = 0.95). Total all-cause mortality (54 vs 60%, log-rank P = 0.64) and rates of rehospitalizations for heart failure (42 vs 29%, log-rank P = 0.68) did not differ significantly between groups. Both techniques were associated with significant decrease in NYHA class and severity of FMR (P < 0.001 for all) and with a similar degree of stabilization of LV remodelling (P = NS). CONCLUSION Despite the significant baseline differences in accumulated expertise and risk profile between the surgical and the MitraClip groups, both minimally invasive techniques were associated with similar 30-day and long-term outcomes.

To investigate the impact of simultaneous percutaneous transluminal renal artery stenting (PTRAS) and percutaneous coronary artery interventions (PCI) on cardiac and renal function in patients with renal artery stenosis (RAS) and coronary artery disease (CAD), and explore the factors affecting the long-term prognosis.This retrospective cohort study enrolled 169 patients with RAS and CAD from January 2006 to January 2010, 149 patients were intervened with PTRAS and PCI simultaneously (combined group) and the remaining 20 patients were treated with PCI (PCI group). All patients were followed up for at least 2 years. Clinical data including blood pressure, estimated glomerular filtration rate (eGFR), echocardiography and major adverse events were obtained.The average stenotic ratio of the left and right renal artery in PCI group were significantly lower than those in combined group (both P0.01). After 2 years, there was a significant decrease in systolic blood pressure compared to baseline level in the combined group (P0.01). In the PCI group, both systolic blood pressure and diastolic blood pressure were significantly lower during follow-up than at the baseline level (both P0.01) . Echocardiography examination showed that left ventricular mass index (LVMI) during follow up was significantly lower than the baseline value in both groups, and the reduction extent in the combined group was larger than in PCI group (-55.6 g/m(2) vs.-12.8 g/m(2), P0.01) . In the combined group, the eGFR value decreased from (44.7 ± 17.4) ml×min(-1)×1.73 m(-2) to (41.7 ± 18.9) ml×min(-1)×1.73 m(-2) (P0.01). eGFR level remained unchanged in PCI group (P0.05). Multivariate Cox regression analysis demonstrated that baseline renal dysfunction was not significantly related to the long-term adverse prognosis in combined group (HR = 0.986, P0.05).Simultaneous PTRAS and PCI are safe and effective for treating patients with RAS and CAD. Simultaneous PTRAS and PCI are beneficial on controlling blood pressure and reducing left ventricular mass index but has no impact on renal function change.