Treatment of aortic stenosis with a self-expanding transcatheter valve: the International Multi-centre ADVANCE Study

Aim Transcatheter aortic valve implantation has become an alternative to surgery in higher risk patients with symptomatic aortic stenosis. The aim of the ADVANCE study was to evaluate outcomes following implantation of a self-expanding transcatheter aortic valve system in a fully monitored, multi-centre ‘real-world' patient population in highly experienced centres. Methods and results Patients with severe aortic stenosis at a higher surgical risk in whom implantation of the CoreValve System was decided by the Heart Team were included. Endpoints were a composite of major adverse cardiovascular and cerebrovascular events (MACCE; all-cause mortality, myocardial infarction, stroke, or reintervention) and mortality at 30 days and 1 year. Endpoint-related events were independently adjudicated based on Valve Academic Research Consortium definitions. A total of 1015 patients [mean logistic EuroSCORE 19.4 ± 12.3% [median (Q1,Q3), 16.0% (10.3, 25.3%)], age 81 ± 6 years] were enrolled. Implantation of the CoreValve System led to a significant improvement in haemodynamics and an increase in the effective aortic valve orifice area. At 30 days, the MACCE rate was 8.0% (95% CI: 6.3-9.7%), all-cause mortality was 4.5% (3.2-5.8%), cardiovascular mortality was 3.4% (2.3-4.6%), and the rate of stroke was 3.0% (2.0-4.1%). The life-threatening or disabling bleeding rate was 4.0% (2.8-6.3%). The 12-month rates of MACCE, all-cause mortality, cardiovascular mortality, and stroke were 21.2% (18.4-24.1%), 17.9% (15.2-20.5%), 11.7% (9.4-14.1%), and 4.5% (2.9-6.1%), respectively. The 12-month rates of all-cause mortality were 11.1, 16.5, and 23.6% among patients with a logistic EuroSCORE ≤10%, EuroSCORE 10-20%, and EuroSCORE >20% (P< 0.05), respectively. Conclusion The ADVANCE study demonstrates the safety and effectiveness of the CoreValve System with low mortality and stroke rates in higher risk real-world patients with severe aortic stenosi

The Relationship Between Electrocardiographic Findings and Cardiac Magnetic Resonance Results in Patients with Acute Myocarditis: A Retrospective Analysis

Background and Objectives: Electrocardiography (ECG), though non-specific, is widely applied as a valuable tool in the diagnostic work-up of acute myocarditis. Cardiac magnetic resonance (CMR) has become a key non-invasive tool. This study assessed the association of ECG findings (at baseline), echocardiographic parameters, circulating biomarkers, and CMR imaging features (myocardial edema and late gadolinium enhancement&mdash;LGE) in patients with acute myocarditis. Materials and Methods: This single-center, retrospective observational study included 86 patients admitted with acute myocarditis from January 2021 to December 2024. Data collected included demographics, clinical presentation, ECG, echocardiography, biomarkers (CRP, troponin I), and CMR imaging performed during hospitalization and at the six-month follow-up. Based on ECG findings, patients were stratified into three groups: no ST elevation or T-wave abnormalities (NSTG, n = 27), T-wave abnormalities (TWAG, n = 24), and ST elevation (STEG, n = 35). Results: We enrolled 86 patients (median age: 26 years; 87.2% male), and the most frequent CMR findings were either LGE (80.2%) and/or myocardial edema (75.6%). The prevalence of edema and LGE was higher in the STEG (both 91.2%) compared to TWAG (65.2%, 77.3%, respectively) and NSTG (57.7, 65.4%, respectively) (p &lt; 0.05). Peak troponin levels were also higher in the STEG than other groups (p = 0.005). In logistic regression analysis, TWAs were independently associated with both edema (OR = 3.15, 95% CI: 1.078&ndash;9.189, p = 0.036) and LGE (OR = 3.93, 95% CI: 1.256&ndash;12.276, p = 0.019). Biomarkers were associated with lower LVEF in univariate analysis, but not in multivariate models. Conclusions: ECG abnormalities, particularly STE and TWA, are common in acute myocarditis and significantly associated with CMR findings. Although CMR remains essential for definitive diagnosis and risk stratification in acute myocarditis, ECG may serve as a valuable initial screening tool in the context of a multimodal diagnostic approach