Corona (Poland)

Background: Tricuspid regurgitation (TR) is a common valvular heart disease that often causes disabling symptoms. Caval valve implantation with the TricValve system is one of the transcatheter treatment options proposed for TR symptom reduction. With this prospective registry, we aim to summarize our early experience with TricValve system implantation. Methods: Registry participants, selected out of patients who were referred for TR treatment but who were not eligible for the transcatheter tricuspid edge-to-edge valve repair (T-TEER), were qualified for the caval valve implantation following a HeartTeam discussion. Results: Four patients (four women; median age 71 years; 67.5–77 years) in whom a one-year follow-up was completed were included in the study. The patients were highly symptomatic in the NYHA class III despite intensive diuretic treatment; all of them were considered a high-mortality risk during conventional cardiac surgery. The TricValve system was successfully implanted in all patients. At 6-month follow-up, we observed a reduction in symptoms in three out of four patients. Up to 12 months, only one patient survived, with a reduction in symptoms of NYHA class II; two patients died because of heart failure; one died due to a progression in neoplastic disease. Conclusions: In highly symptomatic TR patients who were not eligible for the T-TEER and who had a prohibitive risk of cardiac surgery, TricValve implantation led to a reduction in symptoms in a 6-month perspective. Long-term survival was limited mainly by heart failure progression and severe concomitant disorders. Further studies are needed to fully elucidate the role of caval valve implantation in the treatment of TR patients.

Cardiac magnetic resonance (CMR) is the gold standard for assessing left ventricular ejection fraction (LVEF). Artificial intelligence (AI)-based echocardiographic analysis is increasingly utilized in clinical practice. This study aimed to compare the results of LVEF echocardiography (ECHO) assessed by experts and automated AI, with CMR as the reference standard. We retrospectively analyzed 118 patients who underwent both CMR and ECHO within 7 days. LVEF measured on CMR was compared with the results obtained from an AI‑ based software, which automatically analyzed all stored digital imaging and communications in medicine loops (multiloop AI analysis) on ECHO. Additionally, AI results were repeated using only 1 best‑ quality loop for 2-chamber view and 1 for 4‑ chamber view (single loop AI analysis) on ECHO. These results were further compared with standard ECHO analysis performed by 2 independent experts. Agreement was investigated using the Pearson correlation and Bland-Altman analysis as well as the Cohen κ and concordance for categorization of LVEF into subgroups (≤30%, 31%-40%, 41%-50%, 51%-70%, and >70%). Both experts demonstrated strong inter‑ reader agreement (R = 0.88; κ = 0.77), and their assessment correlated well with CMR‑ assessed LVEF (expert 1, R = 0.86; κ = 0.74; expert 2, R = 0.85; κ = 0.68). The results of the multiloop AI analysis correlated strongly with those of CMR (R = 0.87; κ = 0.68) and the experts (R = 0.88-0.9; κ = 0.77). The single‑ loop AI analysis demonstrated numerically higher concordance with CMR‑ assessed LVEF (R = 0.89; κ = 0.75) than the multiloop AI analysis and expert analysis. AI‑ based analysis showed similar LVEF assessment results as human expert analysis in comparison with CMR. AI‑ based ECHO analysis is a promising approach, but its results should be interpreted with caution.

This study aimed to determine whether the mediastinal lymph node/tumour ratio (NTR) of the standardised uptake value (SUV) predicts N2 involvement more accurately than node SUV in patients with non-small cell lung cancer (NSCLC). We retrospectively analysed consecutive patients with lung cancer at clinical stages I-IVA. All patients underwent positron emission tomography-computed tomography (PET-CT), followed by mediastinal staging using endobronchial ultrasound and endoscopic ultrasound imaging, and curative-intent lung resection with systematic lymph node dissection. Pathological examination of the surgical specimen was performed for confirmation. The data from 774 patients were analysed. There was a significant correlation between the risk of false-negative PET results for N2 disease and both the SUV of the mediastinal nodes (p = 0.012) and NTR (p = 0.030). The NTR outperformed node SUV in predictive ability; the Akaike information criterion was 307.268 for NTR compared to 308.498 for node SUV. Three factors were significantly associated with the positive predictive value of PET: patient age (p = 0.021), female sex (p = 0.012), and adenocarcinoma histology (p = 0.036). There were no significant correlations between PET sensitivity, specificity, and negative predictive value (NPV), and age, sex, body mass index (BMI), tumour grade, lobar location, or histological type. The NTR may be a useful tool for excluding N2 disease in NSCLC. PET sensitivity and NPV for detecting N2 disease are not influenced by age, sex, BMI, tumour grade, lobar location, or histological type.

Preliminary research indicates that higher iron levels are associated with worse outcomes in patients with coronary artery disease. The study aimed to investigate the relationship between iron levels and the type and composition of coronary plaques. In patients with ≥1 coronary stenosis ≥50% on computed tomography angiography, iron levels, presence of high-risk plaque features, such as low-attenuation plaque (LAP), napkin-ring sign, positive remodeling, and spotty calcium, as well as type and plaque composition (calcified/fibrous/fibro-fatty/necrotic core) were evaluated. Fibro-fatty and necrotic core components were analyzed together as vulnerable component. The study included 300 patients (191 men, 62.2 [23.0] years). Two thousand one hundred and eighty-four plaques were found (1201 calcified, 584 non-calcified, and 397 mixed). High-risk plaque was observed in 208 patients (107 LAP, 54 napkin-ring signs, 354 positive remodeling, and 281 spotty calcium). Patients with LAP had higher iron levels (P <0.0001). In univariable regression, LAP predictors were high iron levels (odds ratio [OR], 1.02; 95% CI, 1.00-1.03; P <0.0001), male sex (OR, 2.50, 95% CI, 1.40-4.46; P = 0.002), and hemoglobin (OR, 1.23; 95% CI, 1.01-1.49; P = 0.04). In multivariable regression, only iron and male sex were LAP predictors (OR, 1.02; 95% CI, 1.01-1.03; P = 0.0002, and OR, 2.41; 95% CI, 1.24-4.70; P = 0.009, respectively). The iron threshold for LAP prediction was >98 μg/dl (AUC 0.665; P <0.001), which corresponds with an OR of 3.2 (95% CI, 1.80-5.80; P = 0.0001) for LAP prediction. Higher iron correlated with more fibro-fatty (P = 0.01) and necrotic core (P = 0.02) components, with no relation to calcified and fibrous components. Higher iron was positively correlated with the percentage of vulnerable plaque component (P = 0.004). Higher iron levels were associated with LAP presence and more vulnerable component of coronary atherosclerotic plaques.

OBJECTIVETo evaluate the cardiovascular effects of semaglutide by baseline glycated hemoglobin (HbA1c) and change in HbA1c in a prespecified analysis of Semaglutide Effects on Cardiovascular Outcomes in People With Overweight or Obesity (SELECT).RESEARCH DESIGN AND METHODSIn SELECT, people with overweight or obesity and atherosclerotic cardiovascular disease without diabetes were randomized to weekly semaglutide 2.4 mg or placebo. The primary end point of first major adverse cardiovascular event (MACE) (cardiovascular mortality, nonfatal myocardial infarction, or stroke) was reduced by 20% with semaglutide versus placebo. Analysis of outcomes included first MACE, its individual components, expanded MACE (cardiovascular mortality, nonfatal myocardial infarction, or stroke; coronary revascularization; or hospitalization for unstable angina), a heart failure composite (heart failure hospitalization or urgent medical visit or cardiovascular mortality), coronary revascularization, and all-cause mortality by baseline HbA1c subgroup and categories of HbA1c change (<−0.3, −0.3 to 0.3, and >0.3 percentage points) from baseline to 20 weeks using the intention-to-treat principle with Cox proportional hazards.RESULTSAmong 17,604 participants (mean age 61.6 years, 72.3% male), baseline HbA1c was <5.7% for 33.5%, 5.7% to <6.0% for 34.6%, and 6.0% to <6.5% for 31.9%. Cardiovascular risk reduction with semaglutide versus placebo was not shown to be different across baseline HbA1c groups and was consistent with that of the overall study for all end points, except all-cause mortality. Cardiovascular outcomes were also consistent across subgroups of HbA1c change.CONCLUSIONSIn people with overweight or obesity and established atherosclerotic cardiovascular disease but not diabetes, semaglutide reduced cardiovascular events irrespective of baseline HbA1c or change in HbA1c. Thus, semaglutide is expected to confer cardiovascular benefits in people with established atherosclerotic cardiovascular disease who are normoglycemic at baseline and/or in those without HbA1c improvements.Video 1.This image is from a video available online at https://bcove.video/3WedKuq. American Diabetes Association 84th Scientific Sessions: SELECT Trial—New Looks at Glycemia, Inflammation, and Heart Failure.6357437865112dc240764video1

This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.

One of the crucial aspects of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) is the valve prosthesis selection. To assess the consistency of the aortic valve sizing in SAVR and TAVR by comparing the sizes of aortic prostheses selected based on the intraprocedural annulus measurements and simulation of the TAVR planning. The study comprised of 167 patients with aortic stenosis treated with SAVR. Simulation of the prosthesis sizing blinded to the SAVR results was performed based on the assessment of cardiac computed tomography (CCT) images. Based on the CCT images, the average value of the aortic annulus diameter was 25.4 ±3.0 mm. Aortic valve calcifications were mild in 29 cases, moderate in 78 cases, and severe in 53 cases. The sizes of the valves recommended by the simulations were larger than valves surgically implanted in 98.6% of patients for self-expanding and in 91.7% of patients for balloon-expandable prostheses. The average difference for self-expanding prostheses was 6.4 mm and 4.5 mm for balloon expandable valves. Additionally, a negative correlation was observed for the difference in prosthesis size and size of the valve used by surgeons. There is a systematic difference between sizes of aortic prostheses used in SAVR and TAVR. Further studies are needed to evaluate if the difference in prosthesis size selection contributes to the frequency of prosthesis-patient mismatch phenomenon and burden of high postoperative mean transaortic gradient.

Left atrial enlargement (LAE) predicts atrial fibrillation (AF) recurrence after cryoballoon-based pulmonary vein isolation (CB). Increased left ventricular wall thickness (LVWT) is pathophysiologically associated with LAE and atrial arrhythmias. To assess effect of increased LVWT on long-term outcomes of CB depending on coexistence of LAE. LAE was defined using either echocardiography ( > 48 cm³/m²) or multislice computer tomography (MSCT, ≥63 cm³/m²). Increased LVWT was echocardiographic septal/posterior wall thickness > 10 mm in males and > 9 mm in females. All patients achieved 2-year follow-up. Of 250 patients (median [interquartile range, IQR] age of 61 [49.0-67.3] years; 30% female) with AF (40% non-paroxysmal), 66.5% had hypertension, and 27.2% underwent redo procedure. MSCT was done in 76%. During follow-up of 24.5 (IQR, 6.0-31.00) months the clinical success rate was 72%, despite 46% of patients having arrhythmia recurrence. Arrhythmia recurrence risk was increased by LAE and increased LVWT (hazard ratio [HR], 1.801; P = 0.002 and HR, 1.495; P = 0.036; respectively). The highest arrhythmia recurrence (61.9% at 2 years) was among patients with LAE and increased LVWT (33.6% of patients); intermediate (41.8%) among patients with isolated LAE; and lowest among patients with isolated increased LVWT or patients without LAE or increased LVWT (36.8% and 35.2% respectively, P = 0.004). After adjustment for body mass index (BMI), paroxysmal AF, CHA₂DS₂-VASc score, clinically-significant valvular heart disease, and cardiomyopathy, patients with LAE and concomitant increased LVWT diagnosis had a 1.8-times increased risk of arrhythmia recurrence (HR, 1.784; 95% confidence interval [CI], 1.017-3.130; P = 0.043). Joint occurrence of LAE and increased LVWT is associated with the highest rate of arrhythmia recurrence after CB for AF.