Structural and Functional Characteristics of Mitral Paravalvular Leakage Identified by Multimodal Imaging and Their Implication on Clinical Presentation

Objective: Clinical presentation of patients with mitral paravalvular leakage (PVL) varies from asymptomatic to heart failure related with hemolytic anemia or pulmonary hypertension. We aimed to investigate the structural and functional characteristics of mitral PVL by multimodal imaging and their association with the severity of hemolysis and hemodynamic significance. Methods: A total of 74 patients with mitral PVL who underwent both cardiac computed tomography (CT) and echocardiography from March 2010 to December 2017 was investigated. Location and size of PVL, degree of left atrial (LA) calcification as measured by CT, and hemodynamic variables as measured by echocardiography were comprehensively analyzed. To investigate the degree of hemolysis and pulmonary hypertension, level of lactate dehydrogenase (LDH) and Doppler estimated systolic pulmonary artery pressure (SPAP) were used respectively. Results: Level of LDH was not related to PVL perimeter and was variable, especially in patients with a small PVL. However, it was positively correlated with mean mitral regurgitation velocity. Additionally, SPAP was significantly correlated with PVL perimeter and LA calcium score. In multivariable analysis, mean mitral regurgitation velocity was significantly correlated with levels of LDH (β = 0.345; p = 0.016), and PVL perimeter and LA calcium score were independently associated with SPAP (β = 0.249; p = 0.036 and β = 0.467; p < 0.001, respectively). Conclusions: Characteristics of mitral PVL and adjacent structures are associated with the severity of hemolysis and pulmonary hypertension. Evaluating the structural and functional characteristics of mitral PVL by complementary multimodal imaging would be important for understanding the clinical presentation and deciding optimal treatments for individual patients

Structural and Functional Characteristics of Mitral Paravalvular Leakage Identified by Multimodal Imaging and Their Implication on Clinical Presentation

Objective: Clinical presentation of patients with mitral paravalvular leakage (PVL) varies from asymptomatic to heart failure related with hemolytic anemia or pulmonary hypertension. We aimed to investigate the structural and functional characteristics of mitral PVL by multimodal imaging and their association with the severity of hemolysis and hemodynamic significance. Methods: A total of 74 patients with mitral PVL who underwent both cardiac computed tomography (CT) and echocardiography from March 2010 to December 2017 was investigated. Location and size of PVL, degree of left atrial (LA) calcification as measured by CT, and hemodynamic variables as measured by echocardiography were comprehensively analyzed. To investigate the degree of hemolysis and pulmonary hypertension, level of lactate dehydrogenase (LDH) and Doppler estimated systolic pulmonary artery pressure (SPAP) were used respectively. Results: Level of LDH was not related to PVL perimeter and was variable, especially in patients with a small PVL. However, it was positively correlated with mean mitral regurgitation velocity. Additionally, SPAP was significantly correlated with PVL perimeter and LA calcium score. In multivariable analysis, mean mitral regurgitation velocity was significantly correlated with levels of LDH (&beta; = 0.345; p = 0.016), and PVL perimeter and LA calcium score were independently associated with SPAP (&beta; = 0.249; p = 0.036 and &beta; = 0.467; p &lt; 0.001, respectively). Conclusions: Characteristics of mitral PVL and adjacent structures are associated with the severity of hemolysis and pulmonary hypertension. Evaluating the structural and functional characteristics of mitral PVL by complementary multimodal imaging would be important for understanding the clinical presentation and deciding optimal treatments for individual patients

Effectiveness of a Smartphone App–Based Intervention With Bluetooth-Connected Monitoring Devices and a Feedback System in Heart Failure (SMART-HF Trial): Randomized Controlled Trial

BackgroundCurrent heart failure (HF) guidelines recommend a multidisciplinary approach, discharge education, and self-management for HF. However, the recommendations are challenging to implement in real-world clinical settings. ObjectiveWe developed a mobile health (mHealth) platform for HF self-care to evaluate whether a smartphone app–based intervention with Bluetooth-connected monitoring devices and a feedback system can help improve HF symptoms. MethodsIn this prospective, randomized, multicenter study, we enrolled patients 20 years of age and older, hospitalized for acute HF, and who could use a smartphone from 7 tertiary hospitals in South Korea. In the intervention group (n=39), the apps were automatically paired with Bluetooth-connected monitoring devices. The patients could enter information on vital signs, HF symptoms, diet, medications, and exercise regimen into the app daily and receive feedback or alerts on their input. In the control group (n=38), patients could only enter their blood pressure, heart rate, and weight using conventional, non-Bluetooth devices and could not receive any feedback or alerts from the app. The primary end point was the change in dyspnea symptom scores from baseline to 4 weeks, assessed using a questionnaire. ResultsAt 4 weeks, the change in dyspnea symptom score from baseline was significantly greater in the intervention group than in the control group (mean –1.3, SD 2.1 vs mean –0.3, SD 2.3; P=.048). A significant reduction was found in body water composition from baseline to the final measurement in the intervention group (baseline level mean 7.4, SD 2.5 vs final level mean 6.6, SD 2.5; P=.003). App adherence, which was assessed based on log-in or the percentage of days when symptoms were first observed, was higher in the intervention group than in the control group. Composite end points, including death, rehospitalization, and urgent HF visits, were not significantly different between the 2 groups. ConclusionsThe mobile-based health platform with Bluetooth-connected monitoring devices and a feedback system demonstrated improvement in dyspnea symptoms in patients with HF. This study provides evidence and rationale for implementing mobile app–based self-care strategies and feedback for patients with HF. Trial RegistrationClinicalTrials.gov NCT05668000; https://clinicaltrials.gov/study/NCT0566800

Assessment of Sex Differences in 5-Year Clinical Outcomes Following Endovascular Revascularization for Peripheral Artery Disease.

Percutaneous transluminal angioplasty (PTA) is an effective treatment strategy for peripheral artery disease (PAD). Data are limiting regarding sex differences in patients with PAD who underwent PTA. We assessed the sex-related differences on 5-year clinical outcomes in patients with PAD who underwent PTA. We prospectively evaluated 765 patients with PAD (596 males and 169 females) who underwent PTA. We performed propensity score matching (PSM) analysis to adjust for any potential confounders. The primary endpoints were 5-year major adverse cardiac and cerebrovascular events (MACE) and major adverse lower-limb events (MALE) assessed by Kaplan-Meier curved analysis and log rank test. After PSM analysis, baseline clinical characteristics were similar in male and female patients. There was a trend toward a higher rate of major hematoma in female patients (6.1% vs. 0.9%, p = 0.066) and a lower rate of below the ankle amputation (24.7% vs. 16.5%, p = 0.097). During the 5-year clinical follow-up, male and female patients had similar rates of MACE (14.9% vs. 15.8%, log rank p = 0.838) and MALE (34.8% vs. 28.2%, log rank p = 0.264) as well as the individual endpoints. In subgroup analysis adjusted by PSM, female patients had a higher risk of bleeding complications in age ≥ 65 years, hypertension, diabetes mellitus, chronic kidney disease, and in the non-critical limb ischemia patients. Of patients with preserved renal function, female patients had a higher risk of MALE as compared to males. In conclusion, female patients with PAD who underwent PTA showed similar 5-year MACE and MALE compared with male patients