Acta cardiologica最新文献

Background: Right heart haemodynamics, including right ventricular function and pulmonary arterial capacitance (PAC), are important prognostic determinants in cardiovascular disease. However, their combined role in patients undergoing transcatheter aortic valve implantation (TAVI) remains unclear. This study aimed to determine whether the combined assessment using pulmonary artery pulsatility index (PAPi) and PAC can stratify clinical outcomes in patients with aortic stenosis (AS) undergoing TAVI.

Methods: This retrospective single-centre study included 77 patients with severe AS who underwent right heart catheterisation within 3 months before TAVI. Patients were stratified into four groups based on the median values of PAPi and PAC. The primary endpoint was a composite of all-cause death or heart failure-related hospitalisation.

Results: During a median follow-up of 3.60 years (interquartile range: 1.89-4.62), 15 patients experienced the primary endpoint. Kaplan-Meier's analysis showed significant stratification by PAPi-PAC groups (log-rank p = 0.040). In Cox regression models, the low PAPi/low PAC group was independently associated with adverse outcomes compared with the other groups (hazard ratio (HR): 3.65, 95% confidence interval (CI): 1.28-10.40, p = 0.015 adjusted for age and sex; HR: 3.61, 95% CI: 1.27-10.26, p = 0.016 adjusted for natriuretic peptide levels; HR: 3.07, 95% CI: 1.07-8.81, p = 0.038 adjusted for the Meta-analysis Global Group in Chronic Heart Failure score).

Conclusions: Combined PAPi-PAC assessment identified distinct haemodynamic phenotypes with prognostic significance following TAVI. This approach offers a simple, physiologically grounded framework for postprocedural risk stratification and individualised management.

Background: The predictive role of right ventricular dysfunction (RVD) in patients with functional mitral regurgitation (FMR) undergoing transcatheter edge-to-edge repair (TEER), as well as RV remodelling following the procedure, remains uncertain. We evaluated the prognostic impact of pre-procedural three-dimensional (3D) right ventricular ejection fraction (RVEF) in patients with FMR. Additionally, we assessed the RV reverse remodelling (RVRR) based on 3D volumes and ejection fraction six months after the procedure.

Methods: Data from 74 patients treated with TEER for FMR were prospectively collected. Pre-procedural RVD, defined as 3D RVEF ≤45%, was observed in 47 patients (63.5%). Patients were divided into three groups according to pre-procedural 3D-RVEF: no RVD (No-RVD, RVEF >45%, n = 27), mild-to-moderate RVD (MRVD, RVEF 31-45%, n = 36), and severe RVD (SRVD, RVEF ≤30%, n = 11).

Results: Patients with SRVD demonstrated a significant higher rate of all-cause mortality compared with the other two groups (p = 0.04) and RVEF ≤ 30% was associated with all-cause death, independently of left ventricular ejection fraction (LVEF) and left atrial volume index (LAVi) (HR: 3.72, 95% CI 1.12-12.30, p = 0.03). At 6-month follow-up, only patients with pre-procedural MRVD showed a significant reduction in 3D RV volumes and an improvement in RVEF compared to baseline (p < 0.05).

Conclusions: RVD was common among patients undergoing mitral TEER for FMR. Those with pre-procedural SRVD had worse mid-term survival compared to patients with MRVD and No-RVD. The group with MRVD was the only one to demonstrate an RVRR six months after the procedure.