Mitral valve transcatheter edge-to-edge repair (M-TEER) has emerged as an alternative therapy for mitral regurgitation (MR), addressing the unmet clinical need for patients with high surgical risk. Previous large randomized controlled trials (RCTs), including EVERESTII, COAPT, and MITRA-FR, have established the safety and efficacy of M‑TEER for both etiologies of MR: primary (PMR) and secondary MR (SMR). The field of SMR treatment has been updated by the recent RCTs RESHAPE-HF2 and MATTERHORN, which have expanded the recommendations of M‑TEER in the current European guidelines. This article summarizes key evidence from pivotal trials, discusses patient selection, and presents ongoing studies in the field of M‑TEER.

Infective endocarditis is arare disease with increasing incidence and high mortality. Due to its nonspecific symptoms, complex diagnostics, the prolonged treatment and poor prognosis, it represents amajor clinical challenge. This review article outlines the contemporary management of infective endocarditis, including prevention, the role of the endocarditis team, diagnostic criteria, outpatient oral antibiotic treatment, the timing and indications of surgical treatment as well as the significance of infections of cardiovascular implantable electronic devices.

Infective endocarditis (IE) is asevere disease with high morbidity and mortality rates. Interdisciplinary endocarditis teams, consisting of specialists in cardiology, cardiac surgery, infectious diseases and microbiology, have been shown to improve patient care. Current guidelines of the European Society of Cardiology (ESC) and the American Heart Association (AHA) explicitly recommend the implementation. Observational studies showed significant reductions in hospital and 1‑year mortality, shorter hospital stays and fewer complications. Such multidisciplinary teams enable faster diagnosis through multimodal imaging, e.g. positron emission tomography (PET) computed tomography (CT), an early and targeted antibiotic therapy and optimized surgical care. A rapid referral to specialized centers with established teams clearly improves the prognosis. Registry data such as European Endocarditis (EURO-ENDO) and the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) also promote quality improvement and standardization. The widespread implementation of the endocarditis team concept is recommended.

The treatment of heart failure with preserved ejection fraction (HFpEF) involves symptomatic management of congestion with diuretics (classI recommendation) and treatment with sodium-glucose linked transporter 2 (SGLT2) inhibitors for improvement of the prognosis, which have aclassI recommendation across the entire spectrum of left ventricular ejection fraction (LVEF) in the current guidelines. The data supporting the recommendation of SGLT2 inhibitors in HFpEF come from the EMPEROR-Preserved and DELIVER studies. The FINEARTS-HF study showed positive effects on cardiovascular death/heart failure hospitalization of the treatment of HFpEF patients with finerenone, anonsteroidal mineralocorticoid receptor antagonist. The STEP-HFpEF (2023) and SUMMIT (2024) studies investigated the treatment with glucagon-like peptide 1 (GLP-1) analogs in patients with HFpEF and obesity and showed positive outcomes regarding quality of life and, in the latter study, positive effects on heart failure events. The treatment of severe mitral and tricuspid valve regurgitation impacts not only the symptom burden but also hospitalization and overall prognosis in HFpEF patients.

Up to one third of patients with an implantable cardioverter defibrillator (ICD) experience shock discharges in the last 24 h before death, which no longer have any therapeutic benefit. Even in patients who have aliving will (do not resuscitate, DNR, directive), the shock function of the ICD is activated in over 50% of those affected 24 h before death. Asignificant subgroup of ICD wearers must therefore experience painful, significantly stressful and unnecessary ICD shocks at the hour of their death. All available position papers on this topic call for patients to be informed about this issue in good time; however, in reality such aconversation almost never takes place. This paper outlines the legal basis that helps doctors to deactivate the ICD in the final stage of life and the specific conditions that must be met. This paper advocates repeatedly addressing the issue during the course of the illness and to involve relatives. The actual conversation about deactivation at the end of life should be proactively initiated by the responsible attending physician and should take the form of astructured, patient-centered dialogue in the spirit of good dialogue.

Previous leadless pacemaker systems were confined to the right ventricle, thus limiting the clinical applications. With the introduction of the first leadless atrial cardiac pacemaker, new perspectives in antibradycardia treatment were introduced. This device enables leadless atrial stimulation and electrical atrial sensing with the potential to reduce complications of cardiac pacemaker treatment. The atrial leadless atrial pacemaker is implanted transvenously with adelivery catheter via the femoral vein into the base of the right atrial appendage. In combination with aventricular leadless pacemaker, acomplete dual chamber pacemaker system can be created through galvanically coupled intracorporeal communication. This can be created as an upgrade from an already implanted ventricular or atrial leadless cardiac pacemaker or the system can be implanted directly (de novo). The possibility of an upgrade enables a flexible treatment adapted to the individual progression of the underlying disease. Current limitations for wider clinical use include economic considerations, limited battery capacity and insufficient data concerning retrievability after the battery is exhausted.

Palliative care is acrucial part of the holistic management of advanced heart failure; however, it remains unclear how palliative care is currently provided in the outpatient sector in Germany. We conducted asurvey among office-based cardiologists and general practitioners (GPs) in Germany on the current provision of palliative care for people with advanced heart failure. The survey was developed by amultiprofessional project group of the German Cardiac Society (DGK e. V.) and administered online by the National Association of Office-Based Cardiologists (BNK e.V.). Atotal of 235 individuals participated in the study. The majority of respondents reported frequently or always discussing goals of care with patients with advanced heart failure. The GPs reported significantly more often than cardiologists that they always or frequently address primary palliative care needs. None of the surveyed office-based cardiologists but 35.1% of GPs stated that they frequently or always prescribe specialized outpatient palliative care (SAPV) for patients with advanced heart failure. Over 90% of the cardiologists reported that they rarely or never continue to care for patients when they cannot come to the practice themselves. Only few office-based physicians in Germany regularly refer patients with advanced heart failure to specialized palliative care services. Primary palliative care and the involvement of SAPV are significantly more often managed by GPs than by office-based cardiologists.

Obesity is achronic, progressive, and relapsing disease that can contribute to morbidity, reduced life expectancy, and adverse health outcomes. The prevalence of obesity increased worldwide in the past 60years, mainly because of changes in our environment and society. With the technical revolution of the last century, new modes of transportation and working conditions, automatization, and computerization, human energy demands have decreased. In parallel, the availability of energy-dense food, refined carbohydrates, and fat has markedly increased. These developments in society clash with biological factors that predispose humans to the development of obesity. At the individual level, obesity is the result of along-term imbalance between too much energy consumed and too little energy expended. Therefore, lifestyle and behavior interventions aimed at reducing calorie intake and increasing energy expenditure target the root causes of obesity. However, both at the individual and population level, obesity prevention and treatment strategies that are based only on behavior modification are frequently not successful in the long term. The limited effectiveness of behavior interventions on weight loss are explained by complex and persistent hormonal, metabolic, and neurochemical adaptations that prevent weight loss and promote weight regain. However, behavior interventions lead to important health benefits beyond weight loss and are therefore an integral part of obesity management. This review discusses how abetter understanding of the pathophysiology of obesity can influence weight loss strategies through behavioral modification. The complex factors contributing to the development of obesity require amultimodal long-term approach that is based on behavior interventions but may also include pharmacological or surgical approaches. The treatment paradigm has recently shifted from simple weight loss strategies towards treating obesity as amultisystem disease.