Cardiac resynchronization therapy and its effects in patients with type 2 DIAbetes mellitus OPTimized in automatic vs. echo guided approach. Data from the DIA-OPTA investigators

Objectives: To evaluate the effects of cardiac resynchronization therapy (CRTd) in patients with type 2 diabetes mellitus (T2DM) optimized via automatic vs. echocardiography-guided approach. Background: The suboptimal atrio-ventricular (AV) and inter-ventricular (VV) delays optimization reduces CRTd response. Therefore, we hypothesized that automatic CRTd optimization might improve clinical outcomes in T2DM patients. Methods: We designed a prospective, multicenter study to recruit, from October 2016 to June 2019, 191 consecutive failing heart patients with T2DM, and candidate to receive a CRTd. Study outcomes were CRTd responders rate, hospitalizations for heart failure (HF) worsening, cardiac deaths and all cause of deaths in T2DM patients treated with CRTd and randomly optimized via automatic (n 93) vs. echocardiography-guided (n 98) approach at 12 months of follow-up. Results: We had a significant difference in the rate of CRTd responders (68 (73.1%) vs. 58 (59.2%), p 0.038), and hospitalizations for HF worsening (12 (16.1%) vs. 22 (22.4%), p 0.030) in automatic vs. echocardiography-guided group of patients. At multivariate Cox regression analysis, the automatic guided approach (3.636 [1.271–10.399], CI 95%, p 0.016) and baseline highest values of atrium pressure (automatic SonR values, 2.863 [1.537–6.231], CI 95%, p 0.006) predicted rate of CRTd responders. In automatic group, we had significant difference in SonR values comparing the rate of CRTd responders vs. non responders (1.24 ± 0.72 g vs. 0.58 ± 0.46 g (follow-up), p 0.001), the rate of hospitalizations for HF worsening events (0.48 ± 0.29 g vs. 1.18 ± 0.43 g, p 0.001), and the rate of cardiac deaths (1.13 ± 0.72 g vs. 0.65 ± 0.69 g, p 0.047). Conclusions: Automatic optimization increased CRTd responders rate, and reduced hospitalizations for HF worsening. Intriguingly, automatic CRTd and highest baseline values of SonR could be predictive of CRTd responders. Notably, there was a significant difference in SonR values for CRTd responders vs. non responders, and about hospitalizations for HF worsening and cardiac deaths. Clinical trial ClinicalTrials.gov Identifier NCT04547244. © 2020, The Author(s)

Case Report: Moderate-to-severe paravalvular leak regurgitation after recurrent prosthetic valve endocarditis in a patient with a double-chambered right ventricle associated with a restricted membranous ventricular septal defect

BackgroundManaging aortic paravalvular leak (PVL) regurgitation following multiple surgical aortic valve replacements (SAVRs) due to recurrent infective endocarditis (IE) presents significant clinical challenges.Case summaryA 46-year-old woman with a history of severe aortic regurgitation and an asymptomatic membranous ventricular septal defect underwent SAVR with a bioprosthetic aortic valve (Perimount 23 mm) in 2005. Concomitantly, a double-chambered right ventricle was diagnosed. Ten years later, due to recurrent IE, another bioprosthetic valve replaced the previous valve (Magna Ease #25). In 2018, she developed sepsis from Bordetella hinzii endocarditis, leading to a third SAVR in 2019, this time with a mechanical aortic valve (On-X® #23). In 2024, two-dimensional transesophageal echocardiography (TEE) revealed moderate-to-severe PVL regurgitation near the right coronary cusp. After a multidisciplinary evaluation, transcatheter PVL closure was planned. Under general anesthesia and TEE/angio-fluoroscopic guidance, the PVL was successfully crossed via the right femoral artery, and a 10 mm × 4 mm Occlutech paravalvular leak device was deployed. Post-procedural imaging confirmed effective PVL closure with a trace-mild residual leak.DiscussionThis case highlights the feasibility of transcatheter PVL closure as a less invasive alternative for patients with multiple prior SAVRs and high surgical risk. Advanced imaging techniques were crucial in procedural success, ensuring precise device placement. A multidisciplinary heart team approach is essential for optimizing outcomes in complex valve pathology. Long-term follow-up is necessary to monitor the durability of the closure and potential complications

442 Thrombocytopenia following transcatheter aortic valve implantation in portico and Evolute recipients

Abstract Aims Thrombocytopenia (TP) following transcatheter aortic valve implantation (TAVI) is a common phenomenon and is associated with mortality and complications. The underlying mechanisms are still unclear. Few data exist on differential risk of thrombocytopenia between different types of transcatheter valves. Methods and results This retrospective study aimed to evaluate the different behaviour of platelet count in Portico or Evolut recipients. Patients underwent TAVI between Feb 2017 to Aug 2021 at Gemelli Molise Hospital were enrolled and were divided in two groups: Portico (n = 90) and Evolut recipients (n = 64). Blood samples and platelets count were collected at admission (T1), implantation day (T2), second post TAVI day (T3), third post TAVI day (T4) and at discharge (T5). Drop platelets count (DPC) was calculated in this way: 100% × (baseline platelet count–nadir platelet count)/(baseline platelet count). CT and echo data were collected. The overall analysis consisted of a total of 154 patients who underwent TAVI. Among these patients, 90 patients (58%) were implanted with Portico valve, and 64 patients (42%) with an Evolut valve. We observed no differences among baseline characteristic between two groups. Interestingly, patients implanted with Portico valve, showed a high degree of thrombocytopenia at time T3, T4 and T5 (respectively, 122 ± 42 vs. 143 ± 43, P 0.004; 111 ± 39 vs. 137 ± 43, P 0.000; 136 ± 56 vs. 173 ± 69, P 0.001). DPC was greater in Portico valve (44 ± 16 vs. 31 ± 15, P = 0.000). No differences were found among inflammation variables (neutrophil lymphocyte ratio, CRP), implantation depth, degree of calcification evaluated with CT (FACTS score) and PVL. Balloon post dilatation (BPD) was performed in 33% of Portico recipients vs. 18% of Evolut recipients (P 0.044). No correlations were found between DPC and BPD in Portico patients (r = 0.035, P = 0.744) and Evolut recipients (r = 0.074, P = 0.569). Conclusions Our study suggests a more thrombocytopenia in Portico recipients, irrespective inflammation, valve calcification, perivalvular leak, implantation factors. Larger studies are needed to confirm these data. </jats:sec

Neutrophil to lymphocyte ratio predicts permanent pacemaker implantation in TAVR patients

In this prospective multicenter analysis, we aimed to investigate the predictive role of neutrophil/lymphocyte ratio (NLR) in permanent pacemaker implantation (PPI) in patients undergoing transcatheter aortic valve replacement (TAVR)

Cardiac resynchronization therapy and its effects in patients with type 2 DIAbetes mellitus OPTimized in automatic vs. echo guided approach. Data from the DIA-OPTA investigators

Abstract Objectives To evaluate the effects of cardiac resynchronization therapy (CRTd) in patients with type 2 diabetes mellitus (T2DM) optimized via automatic vs. echocardiography-guided approach. Background The suboptimal atrio-ventricular (AV) and inter-ventricular (VV) delays optimization reduces CRTd response. Therefore, we hypothesized that automatic CRTd optimization might improve clinical outcomes in T2DM patients. Methods We designed a prospective, multicenter study to recruit, from October 2016 to June 2019, 191 consecutive failing heart patients with T2DM, and candidate to receive a CRTd. Study outcomes were CRTd responders rate, hospitalizations for heart failure (HF) worsening, cardiac deaths and all cause of deaths in T2DM patients treated with CRTd and randomly optimized via automatic (n 93) vs. echocardiography-guided (n 98) approach at 12 months of follow-up. Results We had a significant difference in the rate of CRTd responders (68 (73.1%) vs. 58 (59.2%), p 0.038), and hospitalizations for HF worsening (12 (16.1%) vs. 22 (22.4%), p 0.030) in automatic vs. echocardiography-guided group of patients. At multivariate Cox regression analysis, the automatic guided approach (3.636 [1.271–10.399], CI 95%, p 0.016) and baseline highest values of atrium pressure (automatic SonR values, 2.863 [1.537–6.231], CI 95%, p 0.006) predicted rate of CRTd responders. In automatic group, we had significant difference in SonR values comparing the rate of CRTd responders vs. non responders (1.24 ± 0.72 g vs. 0.58 ± 0.46 g (follow-up), p 0.001), the rate of hospitalizations for HF worsening events (0.48 ± 0.29 g vs. 1.18 ± 0.43 g, p 0.001), and the rate of cardiac deaths ( 1.13 ± 0.72 g vs. 0.65 ± 0.69 g, p 0.047). Conclusions Automatic optimization increased CRTd responders rate, and reduced hospitalizations for HF worsening. Intriguingly, automatic CRTd and highest baseline values of SonR could be predictive of CRTd responders. Notably, there was a significant difference in SonR values for CRTd responders vs. non responders, and about hospitalizations for HF worsening and cardiac deaths. Clinical trial ClinicalTrials.gov Identifier NCT04547244. </jats:sec

A frightening complication after TAVI with Portico Valve: A case report of a “frozen” leaflet stuck in the opened position.

A stuck leaflet is a rare complication of transcatheter aortic valve implantation (TAVI). It occurs when one of the leaflets in the implanted valve doesn’t open and close properly. This complication can lead to serious health problems, even death

Cardiac Resynchronization Therapy and its Effects in Patients with type 2 DIAbetes Mellitus OPTimized in Automatic vs. Echo Guided Approach. Data from the DIA-OPTA Investigators

Abstract Objectives: To evaluate the effects of cardiac resynchronization therapy (CRTd) in patients with type 2 diabetes mellitus (T2DM) optimized via automatic vs. echocardiographic guided approach. Background: Suboptimal optimization of atrio-ventricular (AV) and inter-ventricular (VV) timings reduces CRTd response. Thus, we hypothesize that automatic CRTd optimization could ameliorate clinical outcomes in T2DM patients.Methods: We designed a prospective, multicenter study to recruit, from October 2016 to June 2019, 191 patients with T2DM and heart failure (HF) candidate to receive a CRTd. Study outcomes were CRTd responders rate, hospitalizations for HF worsening, cardiac deaths and all cause of deaths in T2DM patients treated with a CRTd and randomly optimized via automatic (n 93) vs. echocardiographic (n 98) guided approach at 12 months of follow-up.Results: We had a significant difference in CRTd responders rate (68 (73.1%) vs. 58 (59.2%), p 0.038), and hospitalization for HF worsening (12 (16.1%) vs. 22 (22.4%), p 0.030) in automatic vs. echo-guided group of patients. At multivariate Cox regression analysis, automatic guided approach (3.636 [1.271-10.399], CI 95%, p 0.016) and baseline highest values of atrium pressure (automatic SonR values, 2.863 [1.537-6.231], CI 95%, p 0.006) predicted CRTd responders rate. In automatic group, we had significant difference in SonR values comparing CRTd responders vs. non responders (1.24 ± 0.72 g vs. 0.58 ± 0.46 g (follow-up), p 0.001), hospital admission for HF worsening events (0.48 ± 0.29 g vs. 1.18 ± 0.43 g, p 0.001), and cardiac deaths ( 1.13 ± 0.72 g vs. 0.65 ± 0.69 g, p 0.047).Conclusions: automatic optimization increased CRTd responders rate, and reduced hospitalizations for HF worsening. Intriguingly, automatic CRTd and highest baseline values of SonR could predict the outcome of CRTd responders. Notably, there is a significant difference in SonR values for CRTd responders vs. non responders, hospitalizations for HF worsening and cardiac deaths. Clinical trial: ClinicalTrials.gov Identifier NCT04547244;</jats:p