المؤلفون: Rodés‐Cabau, Josep, Lindenfeld, JoAnn, Abraham, William T., Zile, Michael R., Kar, Saibal, Bayés‐Genís, Antoni, Eigler, Neal, Holcomb, Richard, Núñez, Julio, Lee, Elizabeth, Perl, Michal Laufer, Moravsky, Gil, Pfeiffer, Michael, Boehmer, John, Gorcsan, John, Bax, Jeroen J., Anker, Stefan, Stone, Gregg W.

المصدر: European Journal of Heart Failure; Apr2024, Vol. 26 Issue 4, p1078-1089, 12p

مصطلحات موضوعية: HEART failure, HEART assist devices, NATRIURETIC peptides, VENTRICULAR ejection fraction

مصطلحات جغرافية: VENTURA (Calif.), KANSAS City (Kan.)

مستخلص: Aims: Heart failure (HF) outcomes remain poor despite optimal guideline‐directed medical therapy (GDMT). We assessed safety, effectiveness, and transthoracic echocardiographic (TTE) outcomes during the 12 months after Ventura shunt implantation in the RELIEVE‐HF open‐label roll‐in cohort. Methods and results: Eligibility required symptomatic HF despite optimal GDMT with ≥1 HF hospitalization in the prior year or elevated natriuretic peptides. The safety endpoint was device‐related major adverse cardiovascular or neurological events at 30 days, compared to a prespecified performance goal. Effectiveness evaluations included the Kansas City Cardiomyopathy Questionnaire (KCCQ) at baseline, 1, 3, 6, and 12 months and TTE at baseline and 12 months. Overall, 97 patients were enrolled and implanted at 64 sites. Average age was 70 ± 11 years, 97% were in New York Heart Association class III, and half had left ventricular ejection fraction (LVEF) ≤40%. The safety endpoint was achieved (event rate 0%, p < 0.001). KCCQ overall summary score was improved by 12–16 points at all follow‐up timepoints (all p < 0.004), with similar outcomes in patients with reduced and preserved LVEF. At 12 months, left ventricular end‐systolic and end‐diastolic volumes were reduced (p = 0.020 and p = 0.038, respectively), LVEF improved (p = 0.009), right ventricular end‐systolic and end‐diastolic areas were reduced (p = 0.001 and p = 0.030, respectively), and right ventricular fractional area change (p < 0.001) and tricuspid annular plane systolic excursion (p < 0.001) improved. Conclusion: Interatrial shunting with the Ventura device was safe and resulted in favourable clinical effects in patients with HF, regardless of LVEF. Improvements of left and right ventricular structure and function were consistent with reverse myocardial remodelling. These results would support the potential of this shunt device as a treatment for HF. [ABSTRACT FROM AUTHOR]

: Copyright of European Journal of Heart Failure is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Orban, Mathias, Rottbauer, Wolfgang, Williams, Mathew, Mahoney, Paul, von Bardeleben, Ralph Stephan, Price, Matthew J., Grasso, Carmelo, Lurz, Philipp, Zamorano, Jose L., Asch, Federico M., Maisano, Francesco, Kar, Saibal, Hausleiter, Jörg

المصدر: European Journal of Heart Failure

مصطلحات موضوعية: Medizinische Klinik und Poliklinik I (Kardiologie), ddc:610

الوصف: Aims Mitral valve transcatheter edge-to-edge repair is a guideline-recommended treatment option for patients with secondary mitral regurgitation (SMR). The purpose of this analysis was to report contemporary real-world outcomes in SMR patients treated with third-generation MitraClip systems. Methods and results EXPAND is a prospective, multicentre, international, single-arm study with 1041 patients treated for mitral regurgitation (MR) with MitraClip NTR/XTR, with 30-day and 1-year follow-up. All echocardiograms were analysed by an independent echocardiographic core lab. Study outcomes included procedural outcomes, durability of MR reduction, and major adverse events including all-cause mortality and heart failure hospitalizations (HFH). A subgroup of 413 symptomatic patients (age 74.7 ± 10.1 years, 58% male) with severe SMR were included. MR reduction to MR ≤ 1+ and MR ≤ 2+ was achieved in 93.0% and 98.5% of patients, respectively, which was sustained at 1-year follow-up. All-cause mortality was 17.7% at 1-year- follow-up, and the combined endpoint of all-cause mortality or first HFH occurred in 34% of patients. This combined endpoint was significantly less frequently observed in MR ≤ 1+ patients (Kaplan–Maier estimates: 29.7% vs. 69.6% for MR ≤ 1+ vs. MR ≥ 2 +; p < 0.0001). New York Heart Association (NYHA) functional class improved significantly from baseline (NYHA ≤ II: 17%) to 1-year follow-up (NYHA ≤ II: 78%) (p < 0.0001). While MR reduction was comparable between NTR-only vs. XTR-only treated patients, less XTR clips were required for achieving MR reduction. Conclusions Under real-world conditions, optimal sustained MR reduction to MR ≤ 1+ was achieved in a high percentage of patients with third-generation MitraClip, which translated into symptomatic improvement and low event rates. These results appear to be comparable with recent randomized clinical trials.

وصف الملف: application/pdf

العلاقة: Orban, Mathias ORCID logoorcid:0000-0001-7846-8808; Rottbauer, Wolfgang; Williams, Mathew; Mahoney, Paul; von Bardeleben, Ralph Stephan; Price, Matthew J.; Grasso, Carmelo; Lurz, Philipp; Zamorano, Jose L.; Asch, Federico M.; Maisano, Francesco; Kar, Saibal und Hausleiter, Jörg (2023): Transcatheter edge‐to‐edge repair for secondary mitral regurgitation with third‐generation devices in heart failure patients – results from the Global EXPAND Post‐Market study. In: European Journal of Heart Failure, Bd. 25, Nr. 3: S. 411-421 [PDF, 750kB]; https://epub.ub.uni-muenchen.de/108813/1/European_J_of_Heart_Fail_-_2023_-_Orban_-_Transcatheter_edge%E2%80%90to%E2%80%90edge_repair_for_secondary_mitral_regurgitation_with.pdfTest; http://nbn-resolving.de/urn:nbn:de:bvb:19-epub-108813-0Test; https://epub.ub.uni-muenchen.de/108813Test/

الإتاحة: https://doi.org/10.1002/ejhf.2770Test
https://epub.ub.uni-muenchen.de/108813/1/European_J_of_Heart_Fail_-_2023_-_Orban_-_Transcatheter_edge%E2%80%90to%E2%80%90edge_repair_for_secondary_mitral_regurgitation_with.pdfTest
https://epub.ub.uni-muenchen.de/108813Test/
http://nbn-resolving.de/urn:nbn:de:bvb:19-epub-108813-0Test

المؤلفون: Biner, Simon, Siegel, Robert J., Feldman, Ted, Rafique, Asim M., Trento, Alfredo, Whitlow, Patrick, Rogers, Jason, Moon, Marc, Lindman, Brian, Zajarias, Alan, Glower, Donald, Kar, Saibal

المصدر: European Journal of Heart Failure; Aug2012, Vol. 14 Issue 8, p939-945, 7p, 6 Charts

مصطلحات موضوعية: HEMODYNAMICS, CARDIAC patients, DIASTOLE (Cardiac cycle), HEART ventricles, CAPILLARIES, BLOOD pressure, MITRAL valve insufficiency

مستخلص: Aims To evaluate the haemodynamic effect of acute procedural success (APS) after MitraClip therapy in patients with haemodynamic decompensation. Methods and results Of 107 patients, 79 achieved APS after MitraClip implantation. The increase in cardiac index (CI) was primarily detected in patients with a low baseline CI (2.0 ± 0.5 to 2.5 ± 5 L/min/m2, P < 0.001). There was a decrease in left ventricular end-diastolic pressure (LVEDP) (20 ± 5 to 13 ± 5 mmHg, P = 0.002) and mean pulmonary capillary wedge pressure (PCWPm) (20 ± 4 to 16 ± 5 mmHg, P = 0.001) in patients with values >15 mmHg at baseline, and a decrease in mean pulmonary artery systolic (PAPm) (36 ± 4 to 29 ± 7 mmHg P = 0.003) in those with values >30 mmHg before the MitraClip procedure. Patients with decompensation compared with patients with compensation experienced significant reduction in LVEDP (–8.3 ± 11.9 mmHg vs. –0.2 ± 4.5 mmHg, P = 0.009), a reduction in PCWPm (–3.5 ± 5.6 mmHg vs. 1.9 ± 4.7 mmHg, P < 0.001), and a reduction in PAPm (–8 ± 9 mmHg vs. 3 ± 6 mmHg, P < 0.001). Conclusion The favourable haemodynamic effects of MitraClip therapy on CI were primarily detected in patients with low CI before the procedure, and improvements in left-sided filling pressure and PAP were primarily seen in those with elevated values at baseline. [ABSTRACT FROM AUTHOR]

: Copyright of European Journal of Heart Failure is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Kessler, Mirjam¹ (AUTHOR) mirjam.kessler@uniklinik-ulm.de, Rottbauer, Wolfgang¹ (AUTHOR), Bardeleben, Ralph Stephan² (AUTHOR), Grasso, Carmelo³ (AUTHOR), Lurz, Philipp² (AUTHOR), Mahoney, Paul⁴ (AUTHOR), Price, Matthew⁵ (AUTHOR), Williams, Mathew⁶ (AUTHOR), Denti, Paolo⁷ (AUTHOR), Estevez‐Loureiro, Rodrigo⁸ (AUTHOR), Kar, Saibal⁹ (AUTHOR), Maisano, Francesco⁷ (AUTHOR)

المصدر: European Journal of Heart Failure. May2024, p1. 9p. 6 Illustrations, 1 Chart.

مستخلص: Aim Methods and results Conclusions This analysis aimed to compare the clinical outcomes associated with heart failure (HF) readmissions and to identify associations with HF hospitalizations (HFH) in patients treated with the MitraClip™ NTR/XTR System in the EXPAND study.The global, real‐world EXPAND study enrolled 1041 patients with primary or secondary mitral regurgitation (MR) treated with the MitraClip NTR/XTR System. Echocardiograms were analysed by an independent echocardiographic core laboratory. The study population was stratified into HFH and No‐HFH groups based on the occurrence of HFH 1 year post‐index procedure. Clinical outcomes including MR severity, New York Heart Association (NYHA) functional class, Kansas City Cardiomyopathy Questionnaire (KCCQ) score, and all‐cause mortality were compared (HFH: n = 181; No‐HFH: n = 860). Both groups achieved consistent 1‐year MR reduction to ≤1+ (HFH vs. No‐HFH: 87.3% vs. 89.5%, p = 0.6) and significant 1‐year improvement in KCCQ scores (+16.5 vs. +22.3, p = 0.09) and NYHA functional class. However, more patients in the No‐HFH group had 1‐year NYHA class ≤II (HFH vs. No‐HFH: 67.9% vs. 81.9%, p < 0.01). All‐cause mortality at 1 year was 36.8% in the HFH group versus 10.4% in the No‐HFH group (p < 0.001). The HFH rate decreased by 63% at 1 year post‐M‐TEER versus 1 year pre‐treatment (relative risk 0.4, p < 0.001). Independent HFH associations were MR ≥2+ at discharge, HFH 1 year prior to treatment, baseline NYHA class ≥III, baseline tricuspid regurgitation ≥2+, and baseline left ventricular ejection fraction ≤40%.This study reports the impact of HFH on clinical outcomes post‐treatment in the EXPAND study. Results demonstrate that the occurrence of HFH was associated with worse 1‐year survival, and treatment with the MitraClip system substantially reduced HFH and improved patient symptoms and quality of life. [ABSTRACT FROM AUTHOR]