Obesity in heart failure with preserved ejection fraction: Insights from the REDUCE LAP-HF II trial.

Aims: Obesity is causally related to the development of heart failure with preserved ejection fraction (HFpEF) but complicates the diagnosis and treatment of this disorder. We aimed to determine the relationship between severity of obesity and clinical, echocardiographic and haemodynamic parameters in a large cohort of patients with documented HFpEF.

Methods And Results: The REDUCE LAP-HF II trial randomized 626 patients with ejection fraction ≥40% and exercise pulmonary capillary wedge pressure (PCWP) ≥25 mmHg to atrial shunt or sham procedure.

Impact of Left Ventricular Assist Devices on Days Alive and Out of Hospital in Hemodynamically Stable Patients with End-Stage Heart Failure: A Propensity Score Matched Study.

The two main surgical options to treat end-stage heart failure are heart transplantation (HTx) or left ventricular assist device (LVAD) implantation. In hemodynamically stable patients, the decision for HTx listing with or without LVADs is challenging. We analyzed the impact of both options on days alive and out of hospital (DAOH) and survival.

Cardiovascular magnetic resonance T2* mapping for the assessment of cardiovascular events in hypertrophic cardiomyopathy.

Background: Hypertrophic cardiomyopathy (HCM) is associated with an increased risk of adverse cardiac events. Beyond classic risk factors, relative myocardial ischaemia and succeeding myocardial alterations, which can be detected using either contrast agents or parametric mapping in cardiovascular magnetic resonance (CMR) imaging, have shown an impact on outcome in HCM. CMR may help to risk stratify using parametric T2* mapping.

Retrospective phase-based gating for cardiac proton spectroscopy with fixed scan time.

Background: Respiratory motion is a major limiting factor for spectral quality and duration of in vivo proton MR spectroscopy of the heart. Prospective navigator gating is frequently applied to minimize the effects of respiratory motion, but scan durations are subject-dependent and hence difficult to predict.

Purpose: To implement cardiac proton MRS with fixed scan time by employing retrospective phase-based gating and to compare the proposed method to conventional navigator-gated MRS.

Coronary Angiography With Pressure Wire and Fractional Flow Reserve.

Background: Approximately 800 000 coronary angiography procedures are per- formed in Germany each year, mainly in order to identify coronary artery stenoses. As a rule, revascularization is indicated only when coronary artery stenoses cause relevant ischemia, but this cannot be determined unequivocally by angiography alone. Pressure wire measurement and the measurement of fractional flow reserve (FFR) enable direct evaluation of the hemodynamic relevance of coronary artery stenoses during diagnostic coronary angiography.

Secondary right heart failure due to haemodynamically relevant iatrogenic atrial septal defect: does the sequence of structural interventions sometimes matter? A case report.

Background: Edge-to-edge mitral valve repair is a common procedure for treating severe symptomatic mitral valve regurgitation in patients not eligible for surgery.

Case Summary: After necessary transseptal puncture during the MitraClip procedure, an iatrogenic atrial septal defect (iASD) routinely remains and closes spontaneously in most cases. We present a case in which this shunt persisted due to increased left heart pressure, causing repeated rehospitalization, and ultimately requiring interventional closure: after successful transcatheter edge-to-edge repair of severe, symptomatic mitral regurgitation, the iASD persisted presumably due to underestimated paradoxical low-flow, low-gradient aortic valve stenosis.

Myocardial triglycerides in cardiac amyloidosis assessed by proton cardiovascular magnetic resonance spectroscopy.

Background: Cardiac involvement of amyloidosis leads to left-ventricular (LV) wall thickening with progressive heart failure requiring rehospitalization. Cardiovascular magnetic resonance (CMR) is a valuable tool to non-invasively assess myocardial thickening as well as structural changes. Proton CMR spectroscopy (H-CMRS) additionally allows assessing metabolites including triglycerides (TG) and total creatine (CR).

Cardiac- versus diaphragm-based respiratory navigation for proton spectroscopy of the heart.

Objectives: To study inter-individual differences of the relation between diaphragm and heart motion, the objective of the present study was to implement respiratory navigation on the heart and compare it against the established method of navigator gating on the diaphragm for single-voxel cardiac H-MRS.

Materials And Methods: H-MRS was performed on a 1.5T system in 19 healthy volunteers of mixed age (range 24-75 years).

Performing and Interpreting Fractional Flow Reserve Measurements in Clinical Practice: An Expert Consensus Document.

Fractional flow reserve (FFR) measurements can determine the haemodynamic relevance of coronary artery stenoses. Current guidelines recommend their use in lesions in the absence of non-invasive proof of ischaemia. The prognostic impact of FFR has been evaluated in randomised trials, and it has been shown that revascularisation can be safely deferred if FFR is >0.