Transcatheter edge-to-edge repair (TEER) currently represents a valuable therapeutic option for patients with severe mitral regurgitation (MR) considered at high surgical risk. Besides symptoms and left ventricular (LV) echocardiographic improvements upon TEER, it has been postulated that left atrial (LA) function plays a prognostic role. The aims of our study were to evaluate LA changes after TEER, measured by two-dimensional speckle-tracking echocardiography analysis (2D-STE), their association with atrial fibrillation (AF) occurrence, and relative arrhythmic burden. We considered in a single-center study 109 patients affected by symptomatic severe MR undergoing TEER from February 2015 to April 2022. By 2D-STE, LA reservoir (R_s), conduct (D_s), and contractile (C_s) strains were assessed along with four-chamber emptying fraction (LAEF-4CH) before, 1, 6, and 12 months following TEER. Statistical analysis for comparison among baseline, and follow-ups after TEER was carried out by ANOVA, MANOVA, and linear regression. Successful TEER significantly improved LV dimensions and LA performances, as indicated by all strain components, and LAEF-4CH after 1 year. Strikingly, a significant reduction in arrhythmic burden was observed, since only one case of subclinical AF detected by a previously implanted cardiac electronic device was found in the cohort of sinus rhythm patients (n = 48) undergone TEER; in addition, ventricular rate was reduced in the AF cohort (n = 61) compared to baseline, together with few episodes of nonsustained ventricular tachycardias (5/61, 8.2%) after MR improvement. Overall, TEER was associated with improved cardiac performance, LA function amelioration, and reduced arrhythmic burden.

Background: Infectious agents may be involved in the pathogenesis of vascular disease and related complications. The aim of this review is to analyze the most relevant information on the common infections related to vascular disease, discussing the main pathophysiological mechanisms. Methods: In the current review, the most important evidences on the issue of infections and vascular disease were searched on Medline, Scopus, and ScienceDirect database. Results: Among infectious agents, herpesviruses, parvovirus B19, hepatitis viruses, human immunodeficiency virus, severe acute respiratory syndrome coronavirus 2, treponema pallidum, mycobacterium tuberculosis, pseudomonas aeruginosa, staphylococcus aureus, and candida albicans seem to particularly related to vascular disease. Conclusion: Infectious agents may affect vessel’s homeostasis and functionality, both on the arterial and venous side, by means of several pathophysiological mechanisms such as dysregulation in vasomotor function, thromboembolic complications, initiation and progression of atherosclerosis, alteration of perivascular adipose tissue, recruiting inflammatory cells and molecules.

Objective interventional edge-to-edge repair by MitraClip ™ is widely demonstrated to be able to reduce the degree of MR in patients with high surgical risk. The left atrial (LA) dysfunction in patients with severe MR is associated with poor prognosis and its changes after MV repair is reported in several studies. While, little is known about the full evaluation of the LA function by Two-dimensional speckle echocardiography tracking (2D STE) Materials and methods from March 2015 to December 2021, clinical and echocardiographic data of 67 patients with MR who underwent Mitraclip™ implantation in our division were evaluated for LA function. Strain Reservoir (S_R), Conduit Strain (S_Cd), Contractile Strain (S_Ct), LA emptying Fraction (LAEF_4CH), LAESV (Left atrial end-systolic volume), LAEDV (Left atrial end-diastolic volume) at baseline, at 1 month, at 6 months and 1 year of follow up were assessed. The variation of continuous variables was evaluated using a student T test for paired data. The categorical variables between baseline, at 1 month, at 6 months and 1 year of follow up were evaluated using the ANOVA test. The Multiple Bonferroni test comparison was conducted as a post hoc analysis P values <0.05 were considered significant. Results the etiology of the MR was primary in 29,2% and secondary in 70,8% of the included patients. The MR degree was 3+ in 16,9% of patients and 4+ in 81,5%. When compared to baseline at 6 months and 1 year a statistically significant improvement was observed for LAEF_4CH (p 0.006 and <0.001) and at 1 year for S_R (p 0.013) and S_Cd (p 0.033). When compared at 1 month the S-R improvement was observed at 6 months and 1 year (shown in Table 1). Finally, no significant changes were observed in S_Ct at different time point analyzed. Conclusions the MR improvement after MitraClip™ procedure allows hemodynamic changes with LA remodeling which can be detected by 2D STE through an improvement in LA function. These data emphasize the hypothesis that these echocardiographic parameters represent an advanced method to evaluate the response to device implantation.

Background Despite many therapeutic resources and technological innovations, coronary artery diseases (CAD) yet represent the first cause of death in industrialized countries. In order to improve outcomes in CAD and other chronic diseases, it has been proposed to implement personalized and continuous home-monitoring through digital applications. Currently, dyslipidemias are considered the ideal target condition for the development of such telemedicine approaches. Objectives The main goal is to evaluate the efficacy of a mobile app on the clinical cardiovascular outcomes, by analyzing the adherence to lipid-lowering therapy of dyslipidemic patients, compared to out clinics patients followed under standard work-ups. Materials and methods From March 2022 to September 2022, 15 patients were enrolled who were able to benefit from remote monitoring and 8 patients undergoing outpatient monitoring. The two groups were divided into four categories: 8 ischemic patients to whom the mobile app was recommended admitted with a diagnosis of CAD and undergoing PCI (percutaneous coronary intervention), 4 ischemic patients undergoing outpatient follow-up, 7 not ischemic admitted for other procedure for which remote monitoring was proposed, 4 non-ischemic patients with outpatient procedure. the lipid profile was assessed by mobile application and outpatient visit, respectively. Results In the evaluation between the group of patients who underwent the diagnostic application procedure and the outpatient group, greater adherence to the use of telemedicine was found in patients aged 40-69 years or who could benefit from the help of family members. Lack of information and experience in using the systems and devices was a significant obstacle in 5 percent of patients all over 78 years of age and in the absence of a family member. Given the many logistical and waiting time problems for hospital visits, 57 percent of patients who underwent a medical examination via the app benefited most from using the remote app. Mean LDL values of 97 mg/dL at one month after discharge were found in 66% of patients particularly the subgroup of ischemic patients who, given the strong correlation between atherosclerotic disease and ischemic heart disease, require closer follow-up, with mean LDL values of 95mg/dL found. Conclusions Telemedicine has the potential to improve clinical outcomes in patients with dyslipidemia, although efficacy is influenced by parameters such as age and family support; in the future, telemedicine platforms could be an aid to evaluate new therapeutic opportunities for innovative treatments, such as bempedoic acid. Telemedicine helped patients in understanding the importance of reducing LDL cholesterol.

Background The comprehensive management of patients affected by heart failure with reduced ejection fraction (HFrEF) should pursue the goals of improving quality of life and reducing hospitalizations. Disease amelioration and cardiovascular mortality reduction are currently obtained by following guidelines-directed medical therapy (GDMT) that includes beta blockers, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), angiotensin receptor-neprilysin inhibitors (ARNIs), diuretics and mineralocorticoid receptor antagonists (MRAs); recently, sodium-glucose cotransporter-2 inhibitors (SGLT2Is) have been added on top of previous drugs, but real-world data are yet missing. Whether clinical management of patients affected by HFrEF bearing either implantable cardioverter/defibrillators (ICD) or cardiac resynchronization therapy devices (CRT-D) with a digital application (App) might further reduce hospitalization for HF independently of GDMT yet needs to be addressed. Materials and methods From February 2021 to June 2022 a total of 28 patients with HFrEF in GDMT previously undergone ICD/CRT-D implants were remotely monitored at our institution. Patients were instructed to download a dedicated application (MYTRIAGEHF) on their smartphones/tablets. Clinical data were retrieved monthly, through the App, according to data sent from answering to the following questions: i) shortness of breath; ii) feet, legs or ankles swelling; iii) feeling tired; iv) fatigue, lack of energy; v) weight gain in the last 3 days; vi) inconstant intake of diuretic therapy. Medical therapy was optimized accordingly. Results Satisfaction and regular use of the app was reported by 18/28 patients; most data came from ICD-implanted subjects (n=12, 75% dual chamber; 25% single chamber), while remaining were CRT-D. Eleven percent of App-users received SGLT2 inhibitors on top of medical therapy. Remarkably, only one patient of the non-App group was treated with SGLT2 inhibitors on top of medical therapy. Remaining non-App users as well as patients not in therapy with SGLT2 inhibitors are lost at follow-up; they presented with ischemic etiology in most cases and significantly reduced ejection fraction compared to App-group. Conclusion Our cohort demonstrated that implementing therapy with SGLT2 inhibitors and/or digital applications that follow patients remotely are valuable tools for the optimization of HFrEF clinical condition. Although cause and effect cannot be decisive from this study, the utilization of remote monitoring for therapy adjustments requires further investigation. The use of digital technologies to ensure a more personalized decision-making process will lead better care assistance.