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Background Concomitant right ventricular (RV) failure and tricuspid regurgitation (TR) are common comorbidities in patients undergoing mitral valve transcatheter edge‐to‐edge repair (M‐TEER) and are associated with worse prognosis. Improvement of TR after M‐TEER occurs frequently, however determinants of this course are poorly understood. This study aimed to analyze serum biomarkers that are differentially regulated in patients with TR and to identify biomarkers predictive of the course of TR after M‐TEER. Methods and Results Biomarker expression was analyzed in 242 prospectively included patients undergoing M‐TEER. Patients with moderate‐to‐severe TR had significant comorbidities (median EuroSCORE II 5.2 in patients with severe TR, 4.9 in moderate TR, 3.2 in no/mild TR; p = 0.002) and a large number of biomarkers was upregulated including IGFBP‐2 (1.4‐fold in severe TR compared to no/mild TR, p = 0.005). Echocardiographic follow‐up 3 months after M‐TEER was carried out in 99 patients. RV reverse remodeling (RVRR) as defined by improvement of concomitant TR by at least one grade and/or RV diameter downsizing of at least 10% compared to baseline was seen in 50 patients (50.5%). IGFBP‐2 (Odds Ratio 2.078) and presence of chronic pulmonary disease (Odds Ratio 15.341) proved independent predictors of non‐development of RVRR within 3 months after M‐TEER. Conclusions In patients undergoing M‐TEER with concomitant moderate or severe TR, numerous cardiometabolic biomarkers including IGFBP‐2 are upregulated. Higher levels of IGFBP‐2 at baseline are independently associated with persistent TR and/or RV dilation after M‐TEER.

Objective The aim of this study was to investigate the influence of systolic blood pressure (SBP) values on admission on the outcome of mitral transcatheter edge‐to‐edge repair (M‐TEER). Methodology We included all patients who underwent interventional MV repair in our institution between January 2010 and October 2020. All data are obtained from the MiTra ULM registry. Based on SBP values measured on admission, all patients were divided into four groups: < 120, 120−129, 130−139, and ≥ 140 mmHg. Results Eight hundred and fifty‐eight patients were included in this study. There were no major differences in demographic and clinical characteristics between the four observed groups. The patients with SBP on admission ≥ 140 mmHg had the lowest prevalence of functional MR and the highest LVEF. Higher SBP at admission (HR 0.74, 95% CI: 0.63−0.87) and preprocedural LVEF values (HR 0.99, 95% CI: 0.97−0.99) were predictors of lower 1‐year mortality but did not impact 1‐year hospitalization rate or MACE in the whole study population. When patients were separated into two groups according to the mechanisms of MR (functional and structural), the results showed that higher SBP on admission and better preprocedural LVEF were associated with significantly lower 1‐year CV mortality in both groups of patients, with functional and structural MR. Higher SBP at admission was also associated with lower 1‐year CV mortality (HR 0.73, 95% CI: 0.55−0.96) in patients with preserved ejection fraction (LVEF > 50%), but not with 1‐year rehospitalization and MACE. Conclusion Higher SBP on admission (> 140 mmHg) is an independent predictor of a better 1‐year outcome in patients treated with M‐TEER. The effect of higher SBP on outcome after M‐TEER should be further investigated. Kaplan−Meyer curves illustrate 1‐year survival after M‐TEER in patients with different blood pressure groups. The survival significantly declined with reduction of baseline SBP, but it was statistically significant between patients with the highest and lowest SBP (SBP≤ 140 vs. SBP < 120 mmHg), as well as between patients with lowest SBP and those with 130 < SBP < 139 mmHg.

The molecular mechanisms that regulate cardiomyocyte proliferation during embryonic heart growth are not completely deciphered yet. In a forward genetic N-ethyl-N-nitrosourea (ENU) mutagenesis screen, we identified the recessive embryonic-lethal zebrafish mutant line weiches herz (whz). Homozygous mutant whz embryos display impaired heart growth due to diminished embryonic cardiomyocyte proliferation resulting in cardiac hypoplasia and weak cardiac contraction. By positional cloning, we found in whz mutant zebrafish a missense mutation within the T-box 20 (Tbx20) transcription factor gene leading to destabilization of Tbx20 protein. Morpholino-mediated knock-down of Tbx20 in wild-type zebrafish embryos phenocopies whz, indicating that the whz phenotype is due to loss of Tbx20 function, thereby leading to significantly reduced cardiomyocyte numbers by impaired proliferation of heart muscle cells. Ectopic overexpression of wild-type Tbx20 in whz mutant embryos restored cardiomyocyte proliferation and heart growth. Interestingly, ectopic overexpression of Tbx20 in wild-type zebrafish embryos resulted, similar to the situation in the embryonic mouse heart, in significantly reduced proliferation rates of ventricular cardiomyocytes, suggesting that Tbx20 activity needs to be tightly fine-tuned to guarantee regular cardiomyocyte proliferation and embryonic heart growth in vivo.

Background Predictors for the need of permanent pacemaker implantation (PPMI) in the context of transcatheter aortic valve implantation (TAVI) are not well defined yet. We evaluated the impact of conduction disturbances, calcium volume of the device landing zone, oversizing and implantation depth on PPMI after TAVI with the balloon-expandable Edwards Sapien 3 (ES3). Methods and results 335 consecutive patients undergoing transfemoral TAVI with the ES3 for the treatment of symptomatic severe aortic stenosis were included (clinicaltrials NCT02162069). Rate of PPMI after TAVI was 18.4%, excluding patients with permanent pacemakers prior to TAVI or valve-in-valve implantations. Patients requiring PPMI more often had first degree atrioventricular block (AVB) at baseline (48.7 vs. 16.5%, p  < 0.01), preprocedural complete right bundle branch block (RBBB; 25.0 vs. 3.9%, p  < 0.01) and higher calcium volume of the aortic valve (258.5 ± 317.3 vs. 163.6 ± 178.8 mm³, p  < 0.01). There was a trend towards higher rate of PPMI in patients with new-onset left bundle branch block after TAVI (32.7 vs. 20.7%, p  = 0.06). Multivariate logistic regression analysis showed that baseline first degree AVB (odds ratio 3.9, 95% confidence interval 1.73–9.10, p  < 0.01) and preprocedural complete RBBB (odds ratio 4.5, 95% confidence interval 1.50–13.21, p  < 0.01) were independent predictors of PPMI. Of note, neither oversizing nor implantation depth were independent predictors for need of PPMI with the ES3. Conclusions In patients treated with the ES3 for symptomatic severe aortic stenosis first degree AVB and complete RBBB at baseline were independently associated with higher rates of postprocedural PPMI, whereas implantation depth and oversizing did not have an impact on PPMI.

Background ST-elevation myocardial infarction (STEMI) demands near-time reperfusion to reduce the risk of long-term heart failure. This study evaluates the proportion of impaired left ventricular ejection fraction (LVEF) following STEMI in the context of current healthcare settings at a tertiary care center equipped with the most advanced and up-to-date standards of care. Methods Patients experiencing STEMI as their first manifestation of coronary artery disease were analyzed, as these individuals had no prior experience with heart-related chest pain. LVEF was assessed by levocardiography at admission and semiautomatically using TOMTEC in patients with eligible full-cycle echocardiography of 2- and 4-chamber view available at discharge and 1-year follow-up (FU). Pain-to-balloon time was divided into quartiles (Q) [0-111, 112–159, 160–246 and 247–784 min]. Multiple logistic regression analysis identified independent predictors of reduced LVEF < 50% at 1-year FU. Results A total of 1,379 consecutive STEMI patients were reviewed from 2010 to 2017, with 130 meeting the inclusion criteria. Mean age was 63 ± 12 years, 75% were male, 14% had diabetes, 72% had arterial hypertension, and 56% had history of smoking. LVEF was reduced in 94% of patients at admission, 69% at discharge, and remained reduced in 45% at the 1-year follow-up. Anterior wall myocardial infarction (OR 3.2 [95%-CI 1.2–6.9], p  = 0.018) and increasing pain-to-balloon time across quartiles (Q2: OR 15.7 [95%-CI 1.8–140.4], p  = 0.014; Q4: OR 33.7 [3.4–278.7] p  = 0.002) were independently associated with reduced LVEF at 1 year. Conclusion Despite optimal medical management and advanced healthcare structures, nearly half of patients with STEMI as their first presentation of coronary artery disease continue to exhibit reduced LVEF at 12-months. Anterior wall myocardial infarction and pain-to-balloon time exceeding 2 h remain independent predictors of left ventricular dysfunction. Further improvements in healthcare systems and public education are essential to reduce treatment delays and improve long-term outcomes.

BackgroundThe development of transcatheter tricuspid edge-to-edge repair for tricuspid regurgitation is a therapeutic milestone but a specific periprocedural risk assessment tool is lacking. TRI-SCORE has recently been introduced as a dedicated risk score for tricuspid valve surgery.AimsThis study analyzes the predictive performance of TRI-SCORE following transcatheter edge-to-edge tricuspid valve repair.Methods180 patients who underwent transcatheter tricuspid valve repair at Ulm University Hospital were consecutively included and stratified into three TRI-SCORE risk groups. The predictive performance of TRI-SCORE was assessed throughout a follow-up period of 30 days and up to 1 year.ResultsAll patients had severe tricuspid regurgitation. Median EuroSCORE II was 6.4% (IQR 3.8–10.1%), median STS-Score 8.1% (IQR 4.6–13.4%) and median TRI-SCORE 6.0 (IQR 4.0–7.0). 64 patients (35.6%) were in the low TRI-SCORE group, 91 (50.6%) in the intermediate and 25 (13.9%) in the high-risk groups. The procedural success rate was 97.8%. 30-day mortality was 0% in the low-risk group, 1.3% in the intermediate-risk and 17.4% in the high-risk groups (p < 0.001). During a median follow-up of 168 days mortality was 0%, 3.8% and 52.2%, respectively (p < 0.001). The predictive performance of TRI-SCORE was excellent (AUC for 30-day mortality: 90.3%, for one-year mortality: 93.1%) and superior to EuroSCORE II (AUC 56.6% and 64.4%, respectively) and STS-Score (AUC 61.0% and 59.0%, respectively).ConclusionTRI-SCORE is a valuable tool for prediction of mortality after transcatheter edge-to-edge tricuspid valve repair and its performance is superior to EuroSCORE II and STS-Score.

Background We present a case with a close temporal association of the first diagnosis of multiple sclerosis and stress cardiomyopathy. Case presentation A 19-year-old man experienced severe dyspnoea. The cardiac biomarkers troponin T and NT-proBNP were elevated, and transthoracic echocardiography showed basal hypokinesia. The man was diagnosed with stress cardiomyopathy after main differential diagnoses such as acute coronary syndrome, myocarditis, and pheochromocytoma were excluded. Furthermore, the patient reported vertigo and paraesthesia. Brain and spinal MRI revealed T2-hyperintense lesions with a prominent acute lesion in the pontomedullary area. Cerebrospinal fluid findings revealed a lymphocytic pleocytosis and intrathecal IgG synthesis. Serum neurofilaments were elevated. The patient was diagnosed with MS, and treatment with intravenous Methylprednisolone was initiated. The brainstem lesion due to multiple sclerosis was assumed to be the cause of stress cardiomyopathy. The patient fully recovered. Conclusion Stress cardiomyopathy may be linked with the first manifestation of multiple sclerosis in the presented case since pontomedullary lesions could affect the sympathetic nervous system. This case highlights the importance of neurological history and examination in young patients with unexplained acute cardiac complaints.

Permanent pacemaker implantation (PPMI) after transcatheter aortic valve implantation is of high clinical relevance, but PPMI rates differ widely between valve types. Although the Lotus valve can be repositioned, reported rates for PPMI are high. The predictors of PPMI after Lotus valve implantation have not been defined yet. We analyzed the impact of preexisting conduction disturbances, depth of implantation, oversizing, and amount of calcification on PPMI in 216 patients with severe symptomatic aortic stenosis underdoing Lotus valve implantation. PPMI was required in 39.8% of patients. Patients with need for PPMI compared with patients without need for PPMI had more often the following criteria: male gender (P=.035); preprocedural right bundle-branch block (RBBB) (16.3% vs 0, P<.001); atrioventricular (AV) block first degree (26.7% vs 10.1%, P=.004); higher calcium volume of the left coronary cusp (63.1±87.5 mm3 vs 42.8±49.3 mm3, P=.05); and deeper valve implantation at right coronary (P=.011), noncoronary (P=.026), and left coronary (P=.012) position. Oversizing in relation to annulus and left ventricular outflow tract did not have an impact on need for PPMI. By multiple regression analysis, preprocedural AV block first degree (P=.005), RBBB (P<.001), and depth of implantation (P=.006) were independent risk factors for need of PPMI. In patients with severe aortic stenosis receiving transfemoral Lotus valve, preexisting AV block first degree, RBBB, and implantation depth are independent predictors of PPMI, highlighting the importance of careful valve positioning.

Abstract Aims Prevalence of mitral regurgitation (MR) and comorbidity burden rise with age. Mitral valve transcatheter edge-to-edge repair (M-TEER) is increasingly performed in elderly patients, but only limited data are available for this specific subgroup. In this study, outcomes of octogenarians and nonagenarians undergoing M-TEER were analysed using a large real-world dataset. Methods This retrospective study included consecutive patients undergoing M-TEER at the Ulm University Heart Center between January 2010 and December 2021. The cohort was divided into an elderly group and a younger group based on the cohorts' median age. Group differences regarding 1 and 3 year mortality and heart failure hospitalization rates were assessed using Kaplan–Meier survival analysis and Cox proportional hazard models. Results A total of 1118 patients [median age 79 (inter-quartile range 74–83) years; 42% female] were included and divided into 513 elderly (≥80 years) and 605 younger (<80 years) patients. Primary MR was more frequent in the elderly group (56% vs. 27%, P < 0.001). Pre-procedural and post-procedural MR grades were comparable between groups (pre-procedural MR grade 4: 69% in the elderly group vs. 71% in the younger group, P = 0.67; post-procedural MR grade 1: 60% in the elderly group vs. 58% in the younger group, P = 0.77) as well as in-hospital mortality rates (0.2% vs. 0.3%, P = 0.66). Three-year heart failure hospitalization rates did not differ significantly between both groups (30.7% in the older age cohort vs. 36.0% in the younger cohort, P = 0.191). While 1 year all-cause mortality rates were comparable (18% vs. 16.4%, P = 0.577), 3 year all-cause mortality was significantly higher in the elderly [43.1% vs. 33.0%; hazard ratio (HR) 1.29 (95% confidence interval 1.02–1.65), P = 0.035]. Pre-procedural N-terminal pro-brain natriuretic peptide (NT-proBNP) ≥3402 pg/mL [HR 2.29 (95% CI 1.34–3.90), P = 0.002], pre-interventional MR grade [HR 1.79 (95% CI 1.01–3.17), P = 0.045] and European System for Cardiac Operative Risk Evaluation (EuroSCORE) II [HR 1.06 (95% CI 1.03–1.08), P < 0.001] were identified as independent predictors of 3 year mortality in the elderly. Conclusions M-TEER displays a safe and effective treatment option for elderly patients with symptomatic MR, offering symptom relief and comparable 1 year outcomes to younger patients. Elderly patients with elevated EuroSCORE II and advanced heart failure might benefit from additional care to further reduce 3 year mortality. Mitral valve transcatheter edge-to-edge repair in elderly patients is safe and offers comparable mitral valve regurgitation reduction and symptom relief to younger patients. At 3 years, increased all-cause mortality is observed in elderly patients with advanced heart failure and elevated EuroSCORE II.