Therapeutic revolution in heart failure.

The introduction of basic treatment for heart failure dates to the late 1990s. Since that time, apart from a few new developments reserved for selected patients, there has been little progress. During these years, the epidemiology of the disease has evolved. The number of patients is constantly increasing and the prognosis is often darker than most oncological pathologies. With the arrival of the sacubitril/valsartan combination, Entresto®, a new therapeutic class has emerged. It has shown a significant reduction in mortality and hospitalizations for heart failure. The additional benefits to be expected from this molecule are still being evaluated. Significant positive remodeling seems to be a reality for many patients. This spectacular advance, however, is not the final solution. In addition, patients with preserved heart failure do not seem to benefit the same from this molecule. Other advances are being assessed. Sacubitril/valsartan is the first revolution, perhaps, in a long series

Global and regional myocardial function and outcomes after transcatheter aortic valve implantation for aortic stenosis and preserved ejection fraction

AimTo investigate the effects of transcatheter aortic valve implantation (TAVI) on early recovery of global and segmental myocardial function in patients with severe symptomatic aortic stenosis and preserved left ventricular ejection fraction (LVEF) and to determine if parameters of deformation correlate with outcomes.MethodsThe echocardiographic (strain analysis) and outcome (hospitalizations because of heart failure and mortality) data of 62 consecutive patients with preserved LVEF (64.54±7.97%) who underwent CoreValve prosthesis implantation were examined.ResultsEarly after TAVI (5±3.9 days), no significant changes in LVEF or diastolic function were found, while a significant drop of systolic pulmonary artery pressure (PAP) occurred (42.3±14.9 vs. 38.1±13.9mmHg, P=0.028). After TAVI global longitudinal strain (GLS) did not change significantly, whereas significant improvement in global mid-level left ventricular (LV) radial strain (GRS) was found (-16.71±2.42 vs. -17.32±3.25%; P=0.33; 16.57±6.6 vs. 19.48±5.97%, P=0.018, respectively). Early significant recovery of longitudinal strain was found in basal lateral and anteroseptal segments (P=0.038 and 0.048). Regional radial strain at the level of papillary muscles [P=0.038 mid-lateral, P<0.001 mid-anteroseptum (RSAS)] also improved. There was a significant LV mass index reduction in the late follow-up (152.42±53.21 vs. 136.24±56.67g/m2, P=0.04). Mean follow-up period was 3.5±1.9 years. Parameters associated with worse outcomes in univariable analysis were RSAS pre-TAVI, LV end-diastolic diameter after TAVI, relative wall thickness, and mitral E and E/A after TAVI.ConclusionGlobal and regional indices of myocardial function improved early after TAVI, suggesting the potential of myocardium to recover with a reduced risk for clinical deterioration

Echocardiographic reference ranges for normal left ventricular layer-specific strain: Results from the EACVI NORRE study

Aims To obtain the normal range for 2D echocardiographic (2DE) measurements of left ventricular (LV) layer-specific strain from a large group of healthy volunteers of both genders over a wide range of ages. Methods and results A total of 287 (109 men, mean age: 46 ± 14 years) healthy subjects were enrolled at 22 collaborating institutions of the EACVI Normal Reference Ranges for Echocardiography (NORRE) study. Layer-specific strain was analysed from the apical two-, three-, and four-chamber views using 2DE software. The lowest values of layer-specific strain calculated as ±1.96 standard deviations from the mean were -15.0% in men and -15.6% in women for epicardial strain, -16.8% and -17.7% for mid-myocardial strain, and -18.7% and -19.9% for endocardial strain, respectively. Basal-epicardial and mid-myocardial strain decreased with age in women (epicardial; P = 0.008, mid-myocardial; P = 0.003) and correlated with age (epicardial; r = -0.20, P = 0.007, mid-myocardial; r = -0.21, P = 0.006, endocardial; r = -0.23, P = 0.002), whereas apical-epicardial, mid-myocardial strain increased with the age in women (epicardial; P = 0.006, mid-myocardial; P = 0.03) and correlated with age (epicardial; r = 0.16, P = 0.04). End/Epi ratio at the apex was higher than at the middle and basal levels of LV in men (apex; 1.6 ± 0.2, middle; 1.2 ± 0.1, base 1.1 ± 0.1) and women (apex; 1.6 ± 0.1, middle; 1.1 ± 0.1, base 1.2 ± 0.1). Conclusion The NORRE study provides useful 2DE reference ranges for novel indices of layer-specific strain