Publications by authors named "Marco de Carlo"
Atrial Secondary Tricuspid Regurgitation: Insights Into the EuroTR Registry.
JACC Cardiovasc Interv
December 2024
Article Synopsis
- Atrial secondary tricuspid regurgitation (A-STR) is a subtype of secondary tricuspid regurgitation (STR) that is often treated with transcatheter tricuspid valve edge-to-edge repair (T-TEER), showing distinct patient characteristics and treatment outcomes.
- A study involving 641 patients revealed that 31% had A-STR, which was linked to better heart function, a higher presence of atrial fibrillation, and more effective TR reduction post-procedure compared to nonatrial STR patients.
- A-STR patients experienced improved survival rates and lower symptomatic burdens after treatment; only 38% remained symptomatic (NYHA class ≥III) after 2 years, compared to 46
Article Synopsis
- Balloon-expandable valves (BEVs) and self-expanding valves (SEVs) are compared for their effects on patients with Sievers type 1 bicuspid aortic valve (BAV) stenosis undergoing transcatheter aortic valve replacement.
- The analysis, based on a registry of 955 patients, found no significant difference in midterm major adverse events or technical success between BEVs and SEVs after adjusting for baseline differences.
- However, BEVs had lower risks of new permanent pacemaker implantation and moderate or greater paravalvular regurgitation, but a higher risk of severe patient-prosthesis mismatch compared to SEVs.
Transcatheter Repair of the Tricuspid Valve: Not Just a Matter of Aesthetics.
JACC Cardiovasc Interv
December 2024
Article Synopsis
- The study examined the effects of pulmonary hypertension (PH) on patients receiving transcatheter tricuspid valve edge-to-edge repair (T-TEER), focusing on survival rates and heart failure hospitalization outcomes.
- Results showed that higher systolic pulmonary artery pressure (sPAP) was linked to increased risks of death or hospitalization within two years, with a notable threshold of sPAP > 46 mmHg identifying those at greater risk.
- However, both the severity of heart failure symptoms and tricuspid regurgitation improved after T-TEER, regardless of whether patients had pre- or postcapillary PH.
Article Synopsis
- A study collected data from 2,626 patients who underwent Transcatheter Aortic Valve Replacement (TAVR) in Italy from 2007 to 2017, focusing on those with normal or reduced Left Ventricular Ejection Fraction (LVEF).
- Reduced LVEF patients were further divided into ischemic and nonischemic groups, with the main goal being to track all-cause death and rehospitalizations over 8 years.
- Results showed that patients with reduced LVEF faced a higher risk of death and rehospitalizations, particularly those with an ischemic cause, highlighting the long-term challenges for these patients post-TAVR.
Background And Aims: Transcatheter aortic valve replacement (TAVR) determined a paradigm shift in the treatment of patients with severe symptomatic aortic stenosis but data on very long-term durability are lacking. We sought to evaluate the clinical and hemodynamic outcomes of the CoreValve porcine pericardial self-expanding bioprosthesis at 12-year follow-up.
Methods: 882 inoperable or high-risk patients were treated with the CoreValve bioprosthesis in 8 Italian high-volume centers between 2007 and 2011.
Article Synopsis
- Researchers studied how heart failure (HF) affects death rates in patients getting a special heart valve repair called M-TEER, focusing on a condition called secondary mitral regurgitation (SMR).
- They found that patients with advanced HF (serious heart problems) had a higher chance of dying in the next two years, but those who got much better SMR results had lower death risks.
- The results showed that improving SMR is important for all patients, whether their heart failure is advanced or not, as it can help them live longer.
Tricuspid regurgitation (TR) carries an unfavourable prognosis and often leads to progressive right ventricular (RV) failure. Secondary TR accounts for over 90% of cases and is caused by RV and/or tricuspid annulus dilation, in the setting of left heart disease or pulmonary hypertension. Surgical treatment for isolated TR entails a high operative risk and is seldom performed.
View Article and Find Full Text PDFArticle Synopsis
- * Cardiopulmonary exercise testing (CPET) helps assess metabolic and ventilatory issues causing exercise intolerance, while exercise-stress echocardiography (ESE) better evaluates cardiovascular function; combining these methods offers a comprehensive understanding of the condition.
- * This review aims to enhance clinicians' knowledge about exercise intolerance's underlying mechanisms and the practical use of CPET-ESE to improve diagnosis and treatment strategies for patients with undetermined causes of dyspnea and specific heart conditions.
Background: Right ventricular impairment is common among patients undergoing transcatheter edge-to-edge repair for secondary mitral regurgitation (SMR). Adherence to guideline-directed medical therapy (GDMT) for heart failure is poor in these patients.
Objectives: The aim of this study was to evaluate the impact of GDMT on long-term survival in this patient cohort.
Article Synopsis
- Transcatheter aortic valve replacement (TAVR) for patients with bicuspid aortic valve (BAV) stenosis can lead to complications like paravalvular regurgitation (PVR), which is the leakage of blood around the valve.
- A study involving 946 patients aimed to understand how often PVR occurs after TAVR, what factors predict it, and its impact on patient outcomes, finding that 44.7% experienced some level of PVR.
- Moderate or severe PVR was linked to higher risks of major adverse events (MAEs) like death or hospitalization, highlighting the importance of careful monitoring and management in these patients.
Background: Recent guidelines redefined exercise pulmonary hypertension as a mean pulmonary artery pressure/cardiac output (mPAP/CO) slope >3 mm Hg·L·min. A peak systolic pulmonary artery pressure >60 mm Hg during exercise has been associated with an increased risk of cardiovascular death, heart failure rehospitalization, and aortic valve replacement in aortic valve stenosis. The prognostic value of the mPAP/CO slope in aortic valve stenosis remains unknown.
View Article and Find Full Text PDFGiven the expanding indications toward younger patients at lower surgical risk, transcatheter aortic valve replacement (TAVR) simplification and streamlining are gaining increasing importance. Patients who underwent TAVR from the year 2015 to 2020 were prospectively enrolled. The patients were divided in time tertiles according to the date of intervention.
View Article and Find Full Text PDFBackground: Balloon post-dilation (BPD) is a widely adopted strategy to optimize acute results of TAVI, with a positive impact on both paravalvular leak and mean gradients. On the other hand, the inflation of the balloon inside prosthetic leaflets may damage them increasing the risk of structural valve deterioration (SVD). Furthermore, the impact of BPD on long-term clinical outcomes and valve hemodynamics is yet unknown.
View Article and Find Full Text PDF: We evaluated the bio-humoral and non-invasive haemodynamic correlates of renal congestion evaluated by Doppler renal venous flow (RVF) across the heart failure (HF) spectrum, from asymptomatic subjects with cardiovascular risk factors (Stage A) and structural heart disease (Stage B) to patients with clinically overt HF (Stage C). : Ultrasound evaluation, including echocardiography, lung ultrasound and RVF, along with blood and urine sampling, was performed in 304 patients. : Continuous RVF was observed in 230 patients (76%), while discontinuous RVF (dRVF) was observed in 74 (24%): 39 patients had pulsatile RVF, 18 had biphasic RVF and 17 had monophasic RVF.
View Article and Find Full Text PDFAcute coronary syndromes typically result from the formation of atherosclerotic lesions in a large epicardial vessel, which restrict blood flow either partially or completely. These lesions can be identified through angiography, an invasive imaging technique that enables visualization of the coronary arteries. However, a small percentage of patients, usually ranging from 5% to 10%, experience symptoms and/or signs of myocardial ischemia, either acute or chronic, without significant obstructive coronary lesions visible on angiography.
View Article and Find Full Text PDFAims: Degenerative aortic valve stenosis with preserved ejection fraction (ASpEF) and heart failure with preserved ejection fraction (HFpEF) display intriguing similarities. This study aimed to provide a non-invasive, comparative analysis of ASpEF versus HFpEF at rest and during exercise.
Methods And Results: We prospectively enrolled 148 patients with HFpEF and 150 patients with degenerative moderate-to-severe ASpEF, together with 66 age- and sex-matched healthy controls.
Symptoms of aortic stenosis (AS) are not proportional to its severity and patients with very severe AS (VSAS) remain asymptomatic for a long time. The appropriate time for intervention in patients with VSAS and the effects of transcatheter aortic valve implantation (TAVI) on left ventricular hypertrophy (LVH) remain debated. Our aim was to compare the procedural and 30-day outcomes of TAVI between patients with VSAS and patients with severe AS (SAS) and the changes in LVH.
View Article and Find Full Text PDFArticle Synopsis
- - The study focused on evaluating the performance of the ACURATE Neo2 transcatheter heart valve (THV) in patients with a horizontal aorta (HA), which is linked to worse outcomes after heart valve procedures.
- - Results showed that while both ACURATE Neo and Neo2 valves had similar success rates, the Neo2 valve significantly reduced the occurrence of moderate or severe paravalvular leak (PVL) compared to the Neo valve (5% vs. 15%).
- - The findings suggest that the Neo2 valve is a better option for patients with HA, offering improved PVL rates without compromising device success in the shorter term follow-up.
Background: The optimal access route in patients with severe peripheral artery disease (PAD) undergoing transcatheter aortic valve replacement (TAVR) remains undetermined.
Objectives: This study sought to compare clinical outcomes with transfemoral access (TFA), transthoracic access (TTA), and nonthoracic transalternative access (TAA) in TAVR patients with severe PAD.
Methods: Patients with PAD and hostile femoral access (TFA impossible, or possible only after percutaneous treatment) undergoing TAVR at 28 international centers were included in this registry.
Article Synopsis
- A study examined how changes in pulmonary congestion, measured by ultrasound B-lines, can help predict outcomes in patients with acute heart failure, regardless if they had reduced (HFrEF) or preserved (HFpEF) ejection fraction.
- It involved 208 patients, showing that the number of B-lines at discharge was a key predictor of cardiovascular death or hospital readmissions within six months, especially when there were more than 15 B-lines.
- The findings suggest that managing pulmonary congestion effectively during hospital stays can lead to better health outcomes for heart failure patients.