Severe Impairment of Left Ventricular Regional Strain in STEMI Patients Is Associated with Post-Infarct Remodeling.

Background: Measures of global left ventricular (LV) systolic function have limitations for the prediction of post-infarct LV remodeling (LVR). Therefore, we tested the association between a new measure of regional LV systolic function—the percentage of severely altered strain (%SAS)- and LVR after acute ST-elevation myocardial infarction (STEMI). As a secondary objective, we also evaluated the association between %SAS and clinical events during follow-up.

[Changes in cardiac implantable electronic device follow-up induced by the COVID-19 pandemic in 2020: report of a single-centre experience].

Background: The COVID-19 pandemic caused by SARS-CoV-2 has greatly modified outpatient follow-ups. The aim of this retrospective study was to evaluate the organizational modalities and clinical effects of rearrangements of pacemaker (PM) and implantable cardioverter-defibrillator (ICD) outpatient visits performed in our centers at Ravenna and Lugo Hospitals, Italy, during the pandemic outbreak in 2020.

Methods: All scheduled in-person device follow-up visits in March-December 2020 have been considered.

Indirect ultrasound evaluation of left ventricular outflow tract diameter implications for heart failure and aortic stenosis severity assessment.

Background: Whereas dependency of left ventricular outflow tract diameter (LVOTD) from body surface area (BSA) has been established and a BSA-based LVOTD formula has been derived, the relationship between LVOTD and aortic root and LV dimensions has never been explored. This may have implications for evaluation of LV output in heart failure (HF) and aortic stenosis (AS) severity.

Methods: A cohort of 540 HF patients who underwent transthoracic echocardiography was divided in a derivation and validation subgroup.

New measures of right ventricle-pulmonary artery coupling in heart failure: An all-cause mortality echocardiographic study.

Aims: Right ventricle-pulmonary artery coupling (RVPAC) has emerged from pathophysiology to clinical interest for prognostic implication in heart failure and is commonly measured as the ratio between tricuspid annular plane systolic excursion and systolic pulmonary artery pressure (TAPSE/SPAP). However, feasibility of SPAP is limited (down to 60% in trials, and maybe lower in clinical practice). We ought to assess the prognostic value of the TAPSE times pulmonary acceleration time (TAPSE x pACT) product and TAPSE to peak tricuspid regurgitation velocity (TAPSE/TRV) ratio as new alternative measures of RVPAC.

Current Role of Echocardiography in Cardiac Resynchronization Therapy: from Cardiac Mechanics to Flow Dynamics Analysis.

Purpose Of Review: The aim of this review is to summarily explain what LV synchrony, coordination, myocardial work, and flow dynamics are, trying to clarify their advantages and limitations in the treatment of heart failure patients undergoing or with implanted cardiac resynchronization therapy (CRT).

Recent Findings: CRT is an established treatment for patients with heart failure and left ventricular systolic dysfunction. In the current guidelines, CRT implant indications rely only on electrical dyssynchrony, but in the last years, many aspects of cardiac mechanics (including contractile synchrony, coordination, propagation, and myocardial work) and flow dynamics have been studied using echocardiographic techniques to better characterize patients undergoing or with implanted CRT.

Right Atrial Pressure Is Associated with Outcomes in Patients with Heart Failure and Indeterminate Left Ventricular Filling Pressure.

Background: In a significant proportion of patients with left-sided heart failure (HF), left ventricular filling pressure (LVFP) may not be estimated using echocardiography, so filling pressure status may remain indeterminate. In these patients, mean right atrial pressure (mRAP) has been suggested as a surrogate of LVFP. The aim of this study was to determine whether high mRAP has prognostic value in patients with HF with indeterminate pressure (IP) and whether mRAP-based reclassification of patients with IP has an impact on outcomes.

Left ventricular output indices in hospitalized heart failure: when "simpler" may not mean "better".

Assessment of left ventricular (LV) output in hospitalized patients with heart failure (HF) is important to determine prognosis. Although echocardiographic LV ejection fraction (EF) is generally used to this purpose, its prognostic value is limited. In this investigation LV-EF was compared with other echocardiographic per-beat measures of LV output, including non-indexed stroke volume (SV), SV index (SVI), stroke distance (SD), ejection time (ET), and flow rate (FR), to determine the best predictor of all-cause mortality in patients hospitalized with HF.

Paradoxical low-flow phenotype in hospitalized heart failure with preserved ejection fraction.

Background: Low flow (LF) in heart failure with preserved ejection fraction (HFpEF) is a paradox but is associated with worse prognosis. Determinants of LF in HFpEF have not been clarified but their assessment could corroborate recognition and definition of such a paradoxical condition.

Methods: A cohort of 193 patients hospitalized with HFpEF was retrospectively studied and divided in a group with LF (N = 45), defined by a left ventricular (LV) stroke volume index (SVI) < 30 ml/m, and a group with normal flow (N = 148).

Novel Echocardiographic Approach to Hemodynamic Phenotypes Predicts Outcome of Patients Hospitalized With Heart Failure.

Background: Although in clinical practice heart failure (HF) patients are classified using left ventricular ejection fraction (LVEF), this categorization is insufficient for prognosis, especially when LVEF is preserved or there is a concomitant right ventricular (RV) dysfunction. We hypothesized that a combined noninvasive evaluation of LV forward flow, filling pressure, and RV function would be better than LVEF in predicting all-cause mortality of hospitalized patients with HF.

Methods: Transthoracic echocardiographic examinations of 603 patients hospitalized with HF were analyzed.

Echocardiographic Evaluation of Left Ventricular Output in Patients with Heart Failure: A Per-Beat or Per-Minute Approach?

Background: Left ventricular (LV) output is a predictor of adverse outcome in patients with heart failure. It can be evaluated using a per-beat approach, measuring stroke volume index (SVI), or a per-minute approach, calculating cardiac index (CI). However, the prognostic value of these two approaches has never been compared.

Intracardiac flow analysis in cardiac resynchronization therapy: A new challenge?

In the past years, assessment of cardiac function has become possible through the analysis of intracardiac flow dynamics, performed noninvasively using phase-contrast cardiac magnetic resonance and contrast and noncontrast ultrasound techniques. From 2013 to 2019, 9 echocardiographic investigations have considered 215 patients with cardiac resynchronization therapy (CRT) as a model for assessing flow dynamics within the left ventricle. Preliminary results have been reported about the acute hemodynamic effects of CRT and programming of the CRT device, showing the potential of an approach based on analysis of intracardiac flows.

Efficacy and safety of catheter ablation of atrioventricular nodal re-entrant tachycardia by means of flexible-tip irrigated catheters.

Purpose: Irrigated-tip ablation catheters increase safety and efficacy of ablation procedures, but their use in atrioventricular nodal re-entrant tachycardia (AVNRT) ablation has not been systematically evaluated. The aim of this study is to evaluate the safety and efficacy of radiofrequency (RF) catheter ablation of AVNRT by means of the novel flexible-tip open-irrigated catheter FlexAbility™ and a 3D electroanatomic mapping (EAM) system.

Methods: This is a single-center and single-operator study on 80 patients referred for AVNRT catheter ablation.

Prognosis after pacemaker implantation in extreme elderly.

Aims: Significant comorbidities may limit the potential benefit of pacemaker (PM) implantation in extreme elderly. A short-term mortality risk prediction score, able to identify high-risk patients, may be a useful tool in this population.

Methods And Results: We retrospectively analyzed 538 patients aged >80 years at the time of implant who underwent PM implantation.

[Treatment of secondary ischemic mitral regurgitation: controversial issues].

The presence of secondary mitral regurgitation is an unfavorable prognostic factor in patients with chronic ischemic heart disease. This type of regurgitation can be treated with medical therapy, cardiac resynchronization therapy, surgically or percutaneously but each strategy has controversial aspects. The purpose of this review is to discuss the most debated issues relative to the various modalities available to treat ischemic secondary mitral regurgitation, highlighting also future perspectives.

Intracardiac Flow Analysis: Techniques and Potential Clinical Applications.

Analysis of intracardiac flows has gained increasing interest in the last years. This analysis has become possible due to the development of technologies for noninvasive cardiovascular imaging, which allow visualization and quantitation of intracardiac flow dynamics. Several studies have shown that abnormalities in cardiac function are related to changes in intracardiac vortical flows.

[Echocardiography in ST-elevation myocardial infarction].

Echocardiography is an imaging technique of paramount importance for the management of patients with ST-elevation myocardial infarction. In particular, this technique may be useful for diagnosis and is essential for prognosis and to guide drug therapy. The role in the recognition of mechanical complications and in the identification and management of other complications such as pericarditis and left ventricular thrombosis is also crucial.

[How severe is mitral regurgitation? Possibilities and problems of echocardiographic evaluation in clinical practice].

Echocardiography is the most commonly used technique for evaluating patients with mitral regurgitation (MR) and estimating MR severity. However, in clinical practice, echocardiographic assessment of MR severity remains challenging in many cases, particularly in patients with forms of intermediate or borderline severity. The main causes are the improper application of the echocardiographic methods for assessment of MR severity and the lack of a validated standardized approach for quantification of various types of MR, including organic and functional MR.