Future cardiology最新文献

Mitral regurgitation (MR) is among the most common heart conditions. Untreated, severe MR may result in adverse cardiac remodeling, atrial fibrillation (AF), and heart failure. A 45-year-old male with a history of AF presented with heart failure symptoms. Transesophageal echocardiogram revealed a myxomatous mitral valve with anterior leaflet prolapse, severe MR, and massively dilated left atrium (LA). A computerized tomography scan found severe LA dilation up to 17.8 cm. The patient underwent mitral valve replacement, tricuspid valve repair, and LA reduction. MR is known to result in LA dilation due to increased LA volume and pressure. While large LA sizes have been reported, they are often related to congenital conditions and rarely grow to the size identified in this case. AF and LA dilation both predict adverse outcomes, increasing the risk of thrombus formation in such a large chamber.

Tricuspid regurgitation (TR) is a common yet underrecognized valvular disease associated with significant morbidity and mortality. Recent advances in transcatheter therapies, namely transcatheter edge-to-edge repair (T-TEER) with the TriClip device (Abbott) and transcatheter tricuspid valve replacement (TTVR) with the EVOQUE device (Edwards Lifesciences), offer promising alternatives to surgery for severe symptomatic TR. This review compares both approaches with a focus on safety, procedural considerations, and clinical outcomes. Treating TR remains uniquely challenging due to the anatomical complexity of the valve, frequent lead interference, and common coexistence of RV dysfunction, atrial fibrillation, and pulmonary hypertension. Many affected patients are elderly and frail, rendering them poor surgical candidates. Optimal treatment requires individualized decision-making guided by detailed imaging and assessment of RV function and valvular anatomy. Both therapies achieve significant TR reduction, yet each carries distinct risks: TTVR is associated with higher rates of pacemaker implantation, bleeding, and RV failure, while T-TEER may lead to single leaflet device attachment (SLDA), leaflet injury, or residual TR. Careful patient selection is essential. Despite encouraging short-term outcomes, long-term data are needed to determine survival benefit and durability. Further studies are warranted to refine technique and optimize candidate selection.

Cardiac amyloidosis (CA) can result in a restrictive cardiomyopathy, and heart transplantation (HT) remains the gold standard treatment for patients with end-stage heart failure secondary to amyloid cardiomyopathy. Although HT was historically contraindicated due to inferior outcomes, survival following HT in patients with CA has significantly improved over recent decades; and outcomes are now similar to those of patients undergoing HT for non-amyloid indications. This improvement has been driven largely by advances in screening for appropriate patient selection and improvement in therapeutic strategies for both immunoglobulin light-chain (AL) and transthyretin (ATTR) amyloidosis. Future directions in HT for CA will hinge on continued optimization of patient selection and refining post-transplant management of extracardiac manifestations.

Background: Angiotensin receptor - neprilysin inhibitors (ARNI) are well-established for chronic heart failure (HF) with reduced ejection fraction. However, their efficacy and safety after stabilization of acute decompensation (ADHF) remain unclear. This meta-analysis evaluates ARNI versus angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) post-ADHF.

Methods: Meta-analysis of randomized controlled trials (RCTs) from PubMed, Scopus, WOS, Embase, and CENTRAL up to November 2024. Risk ratios (RR) and standardized mean differences (SMD) with 95% confidence intervals (CI) were used.

Results: Three RCTs (1,741 patients) were included. ARNI use after ADHF stabilization significantly reduced HF rehospitalization/all-cause mortality (RR: 0.71; 95% CI: 0.57-0.88; p < 0.01), HF rehospitalization (RR: 0.73; 95% CI: 0.57-0.93; p = 0.01), worsening renal function (RR: 0.80; 95% CI: 0.64-1.00; p = 0.048), and NT-proBNP at 4 weeks (SMD: -0.24; 95% CI: -0.34 to -0.14; p < 0.0001) and 8 weeks (SMD: -0.21; 95% CI: -0.31 to -0.10; p = 0.0001). However, ARNI increased symptomatic hypotension risk (RR: 1.33; 95% CI: 1.04-1.71; p = 0.024).

Conclusion: initiation of ARNI after ADHF stabilization is more effective than ACEIs/ARBs for cardiovascular and renal outcomes, albeit with higher symptomatic hypotension risk.

Protocol registration: PROSPERO: CRD42024618027.

Functional mitral regurgitation (FMR), secondary to left ventricle and mitral annulus dilation, is a frequent and prognostically adverse complication of heart failure. Several different transcatheter approaches were developed as therapeutic options in high-risk patients. Among them, the Carillon® Mitral Contour System, which offers a minimally invasive, trans- coronary-venous approach to indirect annuloplasty that reduces annular dimensions and improves leaflet coaptation without the need for transseptal access or manipulation of the mitral valve apparatus. A key advantage of Carillon lies in its extracardiac, leaflet-sparing mechanism. By acting from the lumen of coronary sinus and great cardiac vein, the device preserves the possibility of future interventions such as transcatheter edge-to-edge repair, direct annuloplasty, or even valve replacement, while still allowing successful placement of left ventricular pacing leads for cardiac resynchronization therapy. The current article provides the Carillon device characteristics and technical aspects of implantation procedure. The paper is an overview of the clinical studies and real-world registries conducted on the Carillon device, and the effectiveness of this treatment for functional mitral regurgitation. We also discuss possible future perspectives of the Carillon device applications like treating patients with mild FMR, in combination with other treatment modalities, approaches or atrial form of FMR.

A 36-year-old man with marked eosinophilia presented with fatigue and dyspnea. Echocardiography revealed biventricular apical thickening and thrombi, confirmed by contrast imaging. Cardiac magnetic resonance demonstrated global systolic dysfunction,myocardial edema, and subendocardial late gadolinium enhancement, consistent with early-thrombotic-stage Loeffler endocarditis. Bone marrow biopsy identified a FIP1L1-PDGFRA fusion, confirming myeloproliferative hypereosinophilic syndrome. High-dose corticosteroids followed by imatinib induced hematologic and cardiac improvement, with complete thrombus resolution at follow-up. Τhis case illustrates that the integration of advanced multimodal imaging with targeted genetic analysis can reliably establish the diagnosis of Loeffler endocarditis, obviating the need for invasive histopathological confirmation in appropriately selected patients.

In patients undergoing mitral valve transcatheter edge-to-edge repair (M-TEER), atrial fibrillation is a common comorbidity. While oral anticoagulation is the mainstay of stroke prevention therapy in most patients with atrial fibrillation, patients undergoing M-TEER might have a unique opportunity to undergo concomitant left atrial appendage occlusion (LAAO). LAAO is an alternative to oral anticoagulation that reduces the long-term risk of stroke and major bleeding, but it comes with upfront peri-procedural risk. M-TEER and LAAO share numerous procedural characteristics including large-bore venous access, transseptal puncture, general anesthesia, and real-time imaging of the left atrium with echocardiography. Therefore, performing concomitant LAAO at the time of M-TEER might be an attractive option for patients to lessen the cumulative peri-procedural risk, repeated anesthetic, and hospital visits from separate procedures. With rapidly evolving device technologies and an increasing evidence base for LAAO use, there is still limited data evaluating the safety and feasibility of concomitant M-TEER and LAAO. This up-to-date narrative review on concomitant M-TEER and LAAO aims to summarize the current body of literature, review practical procedural considerations, and review the unmet research questions limiting the widespread adoption of this concomitant intervention.